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Home My WebLink About02-0977Register of Wills of Cutberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of also known as VIRGIL H. SARIANO NO. c~.l`0~.--1`11 Deceased Social Security No. 201-18-6698 rer,ua,nii•i, was ~siera t0 re•n of p• or door, •DWVf e•1 lor. (COMPLETE "A" OR "f3" BELOW:) (~L A. Probate and Grant of Letters and aver that Petitionerlsi is/are the executrix named in the Last Witl of the `~ Decedent, dated November 13 , 1987 and codicil(s) dated ,_ Sate r•1•vtnt dtcurtnt•ncn, •.0~. rxwnd•tion, tl•a~ of a><•wtar, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executicn of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration lat..., a. e.n.c.t.•.: p.ne«,te uu; au,.nt. se•enu•: aw.r,te rr.mdutel Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse I;4 -~n..l nnrl hc;rr Decedent at death owned property with estimated values as follows: 60, 000.00 (If domiciled in PA1 All personal property .............................. S Ilf not domiciled in PA1 Personal property in Pennsylvania ...................... S (If not domiciled in PAI Personal property in County .......................... S ............................. Value of real estate in Pennsylvania ......... ' ' ' ' ' ' ' ' ' S Total ............. S Real Estate situated as follows: _ Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signat/ur~ey /~'~ Typed or panted name and residence ~ ~ "O~r ~IC~O L..~.tJSu E.G t.J /°r"4• ~c ~ i % J Wig.+r~ %>l ~ c cif ~ 7~'i/ Cumberland Count Penns Ivania, with hisiher last family or principal Decedent was domiciled at death in y- y residence at 130 Reeser Road, Camp Hi PA ;list auaat, numeer arE munrdV•ILLrI Decedent, then 91 years of age, died October 24, , 2002 at 130 Reeser Rd. , Camp Hill, PA Ileuuml Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representatively) of the Decedent, Petitioner(s) will well and truly administer the estate accordin~o law. Sworn to and affirmed anti subscribed before me this 31st day of 02 ~O 0 - OCTOBER Estate of ut~rttt ur rtt~i~ i try /r'y s ~~ o VIRGIL H. SARIANO also known as Deceased No. Social Security No: 201-18-6698 .Date of Death: October 24,_ 2002 AND NOW, OC~6BER 31 , 2002 . in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ®Testamentary ^ of Administration are hereby granted to consuelo M. Rosito Ic.ta., d.Gn.r..t.; Penamw in e; aurs„e aosenua, awanee mnoma~c~ in the above estate and that the instrument(s), if any, dated November 13, 1987 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters.... .. $ 1 1 5 5 0 0 ~ ~~ ~,~~ Register of Wilts Short Certificate(s).......... g 1 5.00 Renunciation .................. S Affidavit ( ) ................. S Extra Pages ( )..........., g 6.00 Codicil .......................... $ Jordan D. Cunningham, Esquire Cunningham & Chernicoff, P.C. JCP Fee ........................ S 5.00 Attorney: Inventory & Tax Forms... S I.D. No: 23144 2 20 North Secon treet Other ............................ S Address: P. 0. Box 60457 Harrisburg, PA 17106-0457 TOTAL ................ S 1 41 _ nn Telephone: ~ 717) 238-6570 DATE FILEiL~• 10-3 1 -2002 c a 'e - - ,t ~ y t+i '..'i~,l'- ~;11C rYI~.' ;;7'l, _«~JI)!1 j1E,i~ :,l.~cil ,ti COfr2CC~~' CO~iei~. $i'Oi 7 r._ +'., ldC t ~';,.'~.- ~-. ,~ ] f .. ... ., r .- .. ,,,I } L.,1`51~~1, ~ {?C I I it,~l _ ~tlLl°_ Wi~l ~lC ~C',;N~,iPC~~/' t0 C~le ~13Ci' ~/t~,Rll6fl"'i~: I~ 1~3 111~'~~I ~C% ~~pllGB~e ISIS G~I~~ ~"3wr y~~ivtl~:t.s.~ £',' ,. .' , i~ :o f .~ r t.-, ~ C 71.) _~ ~ o ~,_.-.~ ~ .> • r „r~~ ;r- _ _ - r ,~ <:~ _~ ~; ~. ~* ,: ~ ~:~.': ~: ~l 7 ~ ~; 4 ~,~ 1 8643014 ~~~~ ~~ _ ~~ ZGv2 TM~~~ G~ _-- _-- - ~>%-- ~;`-~:':3?~? IS l~t',~ Ay ;;ear ~,;WS: ev L: e7 COMMONWEALTH OF PENNSYLVANfA • DEPARTMENT OF HEALTH • 41TAL RECORDS CERTIFICATE OF DEATH SrAIE %iLE NI;MBER NAME OF DECEDENT ;Frst. Middle, uvl SEx $I.CIAL $ECU RIT'r NUMBER DATE GF LEATH htr:nd'.. Car. ~ean H. Sariano il ,. Virg 2.Male ~. 201 _- 18 - 6698 ..October 24, 2002 AGE M t Bv~nda UNDER t YEAR _ _ UNDER 1 DAY DATE OF BIRTH BIRTHPLACE ~. rd PLACE OF JE ATH ' r..r:~ ly -- ut'l U w~.n '~•rlal __ r, as Months r DAYS Hours ~ Mviutea '.MOnlh. DaV I a >tal9 or rrreny ,Iryl HOSPITAL. -- ~ _ __ OTHER - Vrs 91 1-28-11 Harrisburg, PA InpalieM^ ~R~oolpal t~~ ~„^ Narainy --.y olner Hume ^ ResAtencallS rSpeoryl tJ 8 ~ 9. 7. __ ae. COUNTY Of DEATH CIT'/, BORO, TWP OF DEATH FACILRV NAME (II rw~ msrn,ul;n ;~ e wee! and numceri ECEDENT OF HISPANIC ORIGIN? WAS D RACE -American Inaan, Black, Wnne. etc. ~~ I specify Cuben Nary Yn ^ 11 Yea 15Geuryl Cunberland • Hampden `Trap 130 Reeser Road . , Mealtan,PuurloRlcan,WC Whig ab. . ~ _ 9. 18. ' DECEDENT'S USUAL OCCUPATION HIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS -Married W~dowetl J Haver Married I SURVIVING SPOUSE II rile ivn inaden nenlnl (G ve land el work done dwmq nosl e U S. ARMED FORGES? . . ete IS ~ onl ni hest cede cum Oworced ISUec~ryl rt C S . ~ ! d) 1 vrwtiing ere: do na use rear i PLCB Yes ^ No ® ege o Elementary/ econdary 12th12) o4ors., Married Marian A. sariano sor 1,. Superv „b ,: ,. 1~ ,e DECEDENT'S MAILING ADORESS(SVeel. C~ryROwn. Slate. Zip Codel DECEDENT'S H en decedent nvedm M'P ~VAlll (7 Did 17c~Ves ~eTlTl 7 S 130 Reeser Road . . y . tate ACTUAL l e. RESIDENCE decedent PA 17011 Camp Hill `s~~nyrucl~ona ayama n umer side townsMp? No, decedent IivW l ~ , le. wnnin xmalrmaa ei- _-__cnynnro nb. coanty Cllm F'rland.__-- na. FATHER'S NAME IFesl. Middle. Lasq MOTHER'S NAME iF.i sl. Middle. nta~den Suinamel Frank Sariano An aline Salerno ,g. INFORMANT'S NAME IT'rPe'pri^tl INFORMANT'S MAILING ADDRESS ISaeel. CityRown, Stela. Zlp Cotlel Sariano Marian A Camp Hill, PA 17011 130 Reeser Road . 2a , 10b- METHOD OF DISPOSITION GATE OF DISPOSITION PLACE OF DISPOSITION Nama of Cemetery, Crematory LOCATION ~ CirylTOwn, State, Zq Cod Banal ® Cremation ^ Removal Iron Slab ^ ^ (MOnln. Day. Year) 10-28-02 or Omer PIaCe Rolling Green Memorial Par Camp Hill, PA 17011 Dnnatien^ annr,Specily 2te. 2ID. 210, 21d. ~ SIGNATURE OF FU A CE EN E OR PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY 012755-L PA 17011 CH 1903 Mkt St Myers-Harney FH . 22e _ _ 22b. , , , 2,~. Complete items only when cam To tM boat o1 my knowledge. dale occurred al the nine. dale and place slated. LICENSE NUMBER GATE SIGNED pnyvcian n vadaole al Ume dl lath to h d = ISgnalure ant Ttlle) p ~ - ~ / ~ / 3 L) ~ L IMOrNn~,O1ay, vend ~ ~ ` . canary cause eat r- .. . I / `- N 27e. IM~a'^'~~ 2]b. . ki .~~ ' / ~ C . 23c. w hams 2428 mull d completed by TIME OF OEA DATE PR NOUNCED DEAD lMOinn. Day. Pearl WAS CASE REFERRED TO MEDICAL E%AMINER/CORONER? +~ ^ ~ } Yea l.J No~ person wfn prorqurtces da1R v ~~"'~ L~ ~ ~ 2a. ~~ 2e. V ~ ~(~ 1T M. 25. tX,.c+a- ~- inrynes or complicalans wnich caused lee Oeatn Oo not amer lee mode o1 dying, such as cardiac or r¢spramry arrest, sno<k or naan tailwe. i Approximate PART II: Other signdKaM mndilwns coMributinq to dale. Dut PART I: Emer the diseases 27 , . List Only one cause on aacn line. ~ mtenal Oefween cwt resuamq in tM uridelly n~ use given m PMT 1. onset and darn l / ~ ` / {//J IMMEDIATE CAUSE ?Final l / /~ / ~ -~~/ _ disease or conaaon ~ r/.-~Gkt~ L~12:~~•'"•a'• lesWOngmdeathl-- a. --r - DUETO ASAC SEGUE CE ~ a /~ ~j ~~f/~ ~~ ~ i ~ ~ Sequenliaay nsi condnwns D ~-~ '~~ "'~` ' - . I ~ d any, leaning to immediala DUE 70 (OR AS a CONSEO ICE OF) I cause. Enter UNDERLYING •- _ CAUSE ID~seasewa,a,ry c. ---j---- i~ Nat nnaleo events DUE TOIOR AS A CONSEQUENCE OFT: I ewninq in tleaml LAST 0 WAS AN AUTOPSY , WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY UME OF INJURY INJURY AT WORK7 DESCRIBE MOW INJURY OCCURRED. ~ PERFORMED? AVAILABLE PRIOR TO (Monet. Oay, Veai) ~, COMPLETION OF CAUSE i ^ ~ H OF DEATH? omic de Natural Yea ^ Na f t Invesligalan ^ Accident ^ Pendin V ^ N a ^ NO ^ V g ~ Swcide ^ Could not be determined l..J TM. _ SOD. M. Jllc. _ .]Od. pIACE OF INJURY ~ AI twine. farm, iileel. factory, odiCe LOCATION (Shear C,ty/T wn, $fa161 o~ ef !!!!!! e Duilang, etc. f$pacdv) ' 2aa tab. 29. 20e. Jef. CERTIFIER ICneca oniv ~+iel SIGNATURE AND TITLE OF CERTIF 'CERTIFYING PHYSICIAN lPnysu:an ceiulpnq cause W death when arwUer pnvsKan rtes urcnwix:ed Beam anJ ccmnlneled Item 2J1 - l %', "v ..... .. .... ...... To me best of my %rwwledge, dam occurred due to the cauaelal and manner as stated .................. . ]lb. - -_ LICENSE NUMBER DATE SIGNEOIM .m Ua .reed r _ 'PRONOUNCING AND CERTIFYING PMYSIGIAN IPr r a an r r - -.~ ~J Jean and Len ty ny to ~ ao.e ul Jea r.l j ~ ] it ~ S/ C /L'7 1 '~'~ O~- r.,l i',1vvL Tld. _ To the best ei my knowledge, Death occurred at the lime, da n, and place and due to the causela) and manner as elated. ......... -__ --_ -._.._ . - NAME AND ADDRESS OF PERSON W HO COMPLETED CAUSE OF DEATH (Item L7l Typyor Pnnl`~~ ~ t~,A~L~ p~ '~'~ "• 'MEDICAL EXAMINER/CORONER On me basis of examination and/or investigation, In my opinion, deem occurred at me time, date, and place, and due to me cause(s) and `--' y~ J /,lx ,Far, r~~ m ner as afar d .. ... .. ... .......... ..... ..... ......... .... .... ............... REGISTR9R' SIGNATURE AND euIMBE DATE FILED Innonm Day. Vearl ~„ - -, t/ W I L L I, VIRGIL H. SARIANO of Camp Hill, Pennsylvania declare this to be my last will and revoke any will previously made by me. ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM TWO: I give, devise and bequeath my entire estate to my three children, Consuelo M. Rosito, Virgil Richard Sariano and James M. Sariano, share and share alike per stripes. ITEM THREE: I appoint CONSUELO M. ROSITO, Executrix of this my last will. Should she fail to qualify or cease to act as Executrix, I appoint JAMES M. SARIANO to act as Executor with the same rights, powers and duties. ITEM FOUR: All estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM FIVE: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SIX: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. ~/ 2/.~~ ~`' C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. ITEM SEVEN: My wife, MARIAN SARIANO, is not mentioned in the above disposition. I note that my wife is sufficiently provided for by virtue of property that we own jointly which she will inherit upon my death. IN WITNESS WHEREOF, I have hereunto set my hand this ~> day of ~~~ 1987. SIGNED~~ The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testator was on the day and date thereof signed, published and declared by the Testator therein named as and for his last will, in the presence of us, who at his request, in his presence and in the presence of each other have subscri ed our names. ~~ ~ ~ _--- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We "/U~`~ tint' ~ V~`(~ and Cl,~;t~~.C, /'foc~s~d~witnesses whose names are sign to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his last will; that he signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence . Sworn and subscribed to before me this / ~f~ day of /VO -~6rnb~1~ 1987 . Notary Public lCAR~N ~. BYERS, Riotary p~b3iC ~ ~3ar4h Hanc~~aer St. Cariiste, G~~m~r~rl~s~c~ C'r`y,, PA 17013 lady T~rrn ~~c,~ir~~ ,~~{~r~ut~ i8, 1~~1 COMMONWEALTH OF PENNSYLVANIA . SS COUNTY OF CUMBERLAND I, VIRGIL H. SARIANO, whose name is signed to the attached instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed. ~/ ~ /~' . VIRGI H. SARIANO ~~~ Sworn and affirmed to and acknowledged before me this ~ day o f /j/111/~ belt-' 19 8 7 . 1 Notary Pub c KAREN i". R~~~ a, N~?tary Public ~ Nortb ~tar~~r~~e,• St. Gariis~e, Curr+~e~ias~~i CtY•, PA 17013 ~iy Term Expires March 1>3~, 139E Name of Decedent: Date of Death Will No CERTIFICATION OF NOTICE UNDER RULE 5.6(a) VIRGIL H. SARIANO October 24, 2002 File Number 2002-00977 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration 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 November 27, 2002 Name Address Consuelo M. Rosito 16 Victoria Way, Cam= H;11~ pA 17(111 James Sariano 901 Robert Street, Mechanicsburg, PA 17055 Virgil R. Sariano 738 Liberty Street, E1 Cerrito, CA 94530 Marian Sariano 130 Resser Road, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except February 4, 2003 Date: None i~~~ Signature Jordan D. Cunn' ara, Esquire Name ~- y or econ ree Harrisburg, PA 17110 Address Telephone (717 238-6570 Capacity: Personal Representative XX Counsel for personal representative Beverly Enterprises, Inc. DBA West Shore Health & Rehabilitation Center PO Box 180970 Fort Smith, AR 72918 ITEMIZED RESIDENT STATEMENT RESIDENT NAME Virgil Sariano RESIDENT NUMBER 44693-00285-99577 STATEMENT TYPE: ^INTERIM DISCHARGE ®ITEMIZED DATE PREPARED 08/29/02 DATE/PERIOD COVERED DESCRIPTION UNITS CHARGES PAYMENTS 12/19-12131101 Medicare First 20 days 13 $0.00 01/01-01/07/02 Medicare First 20 days 7 $0.00 01/08-01/31/02 Medicare & Co-Insurance 24 $0.00 02/01-02122/02 Medicare & Co-Insurance 22 $0.00 Co-Insurance is pending if Co-Insurance denies or determines a patient portion this amount will become the liability of the responsible party. 02/23-02128/02 Room Charge (Private Pay) 6 $957.86 05635/) IV Solution 1 $112.32 03/01-03110/02 Room Charge (Private Pay) 10 $1,441.94 28137/) Eucerin Lotion 1 $12.30 20023/) Gauze Sponge 2x2 1 $1.00 20055/) Telfa Nonstick Pad 1 $1.00 20093/) Syringe 1 $1.00 22207/) Saline Solution 1 $1.00 22597/) Aerosol Mask 1 $1.82 22643/) Airlife H/H Neb 1 $1.66 22901/) Replicare Thin 1 $3.84 22991/) Curex 4x4, 8 Ply 3 $0.42 23976/) Sterile Water 1 $2.44 24409/) Transeal Film Dressing 2 $1.24 03/11/02 Discharged BALANCE FORWARD CHARGES C REDITS AMOUNT DUE $0.00 $2,539.84 $0.00 $2,539.84 Virgil Sariano c/o Marian Sariano 130 Reeser Road Camp Hill, PA 17011 CLAIM AGAINST DECEDENT'S ESTATE CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF: VIRGIL SARIANO FILE NUMBER 21-02-977 The undersigned hereby presents for filing against the above estate this statement of claim and alleges: BEVERLY ENTERPRISES/DBA WEST SHORES HEALTH AND REHAB CENTER PO Box 180970 Fort Smith, AR. 72918-0970 The basis of claim is: SEE ATTACHED The amount of the claim is $2,539.84 that is now due and owing. 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. Signed on February 4,2003 ~~"`"~ aimant SANDRA BURNETT I SWEAR THIS STATEMENT IS CORRECT Subscribed and sworn to before me ~~ ~ ~~~~ Notary Public My Commission Expires ~~ ~ ~ - ~~ , ~ Alma F. Parish County OF Sebas,ian Notary Public - Arkans,:.v My Commission Exp. O8/1 `/3012 ~r B~V~RLY E N T E R P R I S E S February 4, 2003 Cumberland County Register of Wills 1 Courthouse Square Carlisle, FA. 1 7%13 Dear Mr. or Madam: Enclosed please find itemized statement, a claim form and a check in the amount of $5.00 to be used to file a claim against the estate of Virgil Sariano, case # 21-02-977. Mr. Sariano incurred this debt while a resident in our facility, West Shores Health and Rehab Center. If you should need additional information or have questions regarding this please feel free to contact me at 479-201-2322 Monday thru Friday from 8:00 to 5:00 PM Central Time. Sincerely, ` r ,~-c.l ~$etty C~lawlford Corporate Collections encl cc: Jordan Cunningham Client's File P.O. Box 180970 Fort Smith, AR 72918-0970 (501) 201-2000. 1-(877) 8BEVERLY CHARLES E. SHIELDS, I ATTORNEY-AT-LAW 6 CLOUSER ROAD r Corner of Trindle and Clouser Roads MECHAMCSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) April 10, 2003 Honorable George Hoffer, P. J. Cumberland County Courthouse Carlisle, PA 17013 Re: Estate of Virgil Sariano Dear Judge Hoffer: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find attached a Petition to extend the time to elect against a will. I have reviewed the local rules and discussed the matter with solicitor Ralph Wright. Assuming that none of the beneficiaries object, I will submit copies of proof of service by certified mail after the appropriate amount of time has elapsed. I will then request that you sign the Order attached. Thank you. Very truly yours, ~~ Charles E. Shields, III CES:mmh IN RE: ESTATE OF VIRGIL H. SARIANO, IN THE COURT OF COMMON PLEAS OF LATE OF HAMPDEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA No. 21 - 02 - 977 ORPHANS' COURT DIVISION PETITION TO ElTEND THE TIME TO TAKE AN ELECTIVE SHARE IN ACCORDANCE WITH 20 PA. C. S. A. SECTION 2210(b). TO THE HONORABLE JUDGES OF THE SAID COURT: The Petition of MARIAN SARIANO respectfully states that: A. Jurisdiction venue, power, and authority lies in this court per PEF Code Section 711 (1), 712 (3), 2203 and 2210. 1. Virgil H. Sariano died on October 24, 2002, having resided at 130 Resser Road, Camp Hill, Pennsylvania 17011, and having left a will dated November 13, 1987, which was admitted to probate by the Register of Wills of Cumberland County, Pennsylvania on October 31, 2002. A copy of the will is attached hereto as Exhibit A. 2. Letters Testamentary thereon were granted to Consuelo Rosito, as executrix on October 31, 2002. 3. Petitioner, Marian Sariano, an adult individual, is the surviving widow of decedent. She resides at 130 Resser Road, Camp Hill, Pennsylvania 17011, which was her residence on the date of decedent's death. She was married to decedent on December 3, 1969, at Trinity Lutheran Church, Camp Hill, Pennsylvania. 4. Under Item Two of his will, the decedent provided that his residuary estate got o his three children, by a prior marriage: Consuelo M. Rosito, Virgil Richard Sariano and James M. Sariano, share and share alike per stirpes. 5. The names, addresses and relationships of those interested in decedent's estate, and the extent of their respective interests in the estate are as follows: James Sariano 901 Robert Street Mechanicsburg, Pennsylvania 17055 (one-third of residue) Virgil R. Sariano 738 Liberty Street El Cerrito, California 94530 (one-third of residue) Consuelo M. Rosito 16 Victoria Way Camp Hill, Pennsylvania 17011 (one-third of residue) 6. Under the provisions of 20 Pennsylvania C.S.A. Section 2210(b), the time within which petitioner must elect to take an elective share will expire on April 30, 2003, unless an extension is granted. 7. No inventory has been filed and counsel for executrix has advised petitioner that he has been unable to obtain complete values for all items that would be part of the calculation as to whether or not petitioner would be well advised to elect against decedent's will.. Counsel for executrix is not sure exactly how soon all of the necessary items may be available. 8. It is therefore probable that petitioner and her counsel will be unable to adequately analyze and reflect upon the advisability of petitioners taking or not taking an elective share within the standard period in which an election must be made. 9. Petitioner has served notice of the filing of this petition and a copy of this petition to all of the above listed interested parties by certified mail with return receipt requested. After the expiration often (10) days from the receipt of the notice by the last of the three (3) interested parties, in the event no objections have been filed, petitioner will provide copies to the Register of Wills and docket copies of the said receipts. Wherefore, petitioner respectfully requests that this Court grant an extension to July 31, 2003 of the time within which she may elect to take an elective share of the property of the decedent, believing that upon current representations this should provide sufficient time. _--- ~~t ccivl ~. can U MARIAN SARIANO, Petitioner Respectfully submitted by Charles E. Shields, III 6 Clouser Road Mechanicsburg, PA 17055 717/766-0209 Supreme Court ID No. 38513 W I L L I, VIRGIL H. SARIANO of Camp Hill, Pennsylvania declare this to be my last will and revoke any will previously made by me. ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM TWO: I give, devise and bequeath my entire estate to my three children, Consuelo M. Rosito, Virgil Richard Sariano and James M. Sariano, share and share alike per stripes. ITEM THREE: Z appoint CONSUELO M. ROSITO, Executrix of this my last will. Should she fail to qualify or cease to act as Executrix, I appoint JAMES M. SARIANO to act as Executor with the same rights, powers and duties. ITEM FOUR: All estate, inheritance, successio:, and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM FIVE: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SIX: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. ~~~" IN RE: ESTATE OF VIRGIL H. SARIANO, IN THE COURT OF COMMON PLEAS OF LATE OF HAMPDEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA No. 21 - 02 - 977 ORPHANS' COURT DIVISION VERIFICATION I, Marian Sariano, Petitioner in the attached Petition, hereby verify that the facts recited are true and correct to the best of my knowledge, information and belief. I make this verification subject to penalty for unsworn falsification to authorities. WITNESS: ~%~ ~ ~ ~~ ~.~ MARIAN SARIANO CERTIl~ KATE OF SERVICE I, Charles E. Shields III, Esquire, hereby certify that I served a true and correct copy of the attached Petition To Extend The Time To Take An Elective Share In Accordance with 20 PA. C. S. A. Section 2210 (b). upon the below named individuals by depositing the attached document in the U. S. Mail, postage prepaid, return receipt requested, at Mechanicsburg, Pennsylvania, 17055 on the date set forth below. James Sariano 901 Robert Street Mechanicsburg, Pennsylvania 17055 Virgil R. Sariano 738 Liberty Street EI Cerrito, California 94530 Consuelo M. Rosito 16 Victoria Way Camp Hill, Pennsylvania 17011 Mr. Jordan D. Cunningham, Esq. P.O. Box 60457 Harrisburg PA 17106-0457 Date: /''~%''w` ~y f~ 2003 ~~ Charles E. Shields, III, Esquire 6 Clouser Road Mechanicsburg, PA 17055 717-766-0209 IN RE: ESTATE OF VIRGIL H. SARIANO, IN THE COURT OF COMMON PLEAS OF LATE OF HAMPDEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA No. 21 - 02 - 977 ORPHANS' COURT DIVISION O ER v" 1 Now, this day of , A. D. 2003, upon consideration of the annexed petition; and since no objec ' have been filed within the time allotted therefore, it is hereby decreed that the time within which Marian Sariano may decide to take or not to take an elective share of the property of Virgil H. Sariano, deceased, is extended to July 31, 2003. N ._ ~ "; Od N ~" 3 :: :~' O y;? "_ _ _;. ~. .. ,` ~+ CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHAMCSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) April 30, 2003 Honorable George Hoffer, P. J. Cumberland County Courthouse Carlisle, PA 17013 Re: Estate of Virgil Sariano Dear Judge Hoffer: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find attached my letter of April 10, 2003 regarding the attached petition to extend the time to elect against a will. As per my original letter, after discussion with Ralph Wright, I have now received the return of all receipts for mailing to the named parties in interest. The last of them signed for the letter and enclosures including the Petition, on April 18, 2003. More than 10 days has now elapsed and no objections to an extension have been made. I therefore respectfully request that you sign the order at this time. Proofs of the service and the dates are attached hereto. Thank you. Very truly yours, i i; , ;~ >, - , a Charles E. Shields, III CES:mmh r° _ ~ '. '~:.~ ,, , ~.~ Q °'~~ ,1 ~, _ ~ Mr. Jordan D. Cunningham, Esq., P.O. Box 60457 R7 Harrisburg, PA 17106-0457 ~ Postage ~ G) ,r~.~aN~t.,'S~"• p Certified Fee '7l o mark ~ Return Receipt Fee ,~~Here i p (Endorsement Required) ~. 7 ~ I ~ r.P,qq )~ p Restricted Delivery Fee ~ ==~Jlj,~ ,, p (Endorsement Required; ~ i !,Q i p Total Postage & Fees ~ $ "7, p ~' Name (Please Pnnt Cleady~ (to be completed by mailer) m ~~ss ~~gg ~ 8heef,-ApGC~oa;ro-i150'Boxl~lds;~li---- - -- ----- --- -- --- -- ----- -- - I o c;ry,~§raieMechantc burl -PA 17055- -- ------- --- ------------------- ---a ~ ~ S> .~~ I • • ^ Complete. items 1,'' ~ I • . • • • item 4 if Restricted Del very is desiredplete ^ Print your name and address A e eived by (P ~ lease Print /earl y) B• ate of Delive on the reverse so that we can return the card to ry /C ~ / ` ? ~~ you. ^ Attach this card to the back of the mailpie or o th C. Signat , n e front if space permits ~ . 1. Article Addressed to: ML JOrdan ]~ ~ uuu D. I delivery addr Agent ^ Addressee s ifferent from item 1 ? . . ilgham Esq. P.O. Box 60457 If YES, enter d!1 very address below: ^ No Harnsburg, PA 17106-0457 3• Skrvice Type Certified Mail ^ Express Mail Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (E~~ Fee) 2. Article Number (Copy from service /abe/) 7099 3400 0004 5004 3145-Sariano ~ Yes PS Form 3811, July 1999 'r:7 ' ,' } N ~_ rYl C=CC. ~ ;MA i~ L~ O ., '.~ Domestic Return Receipt 102595-99-M-7789 r- m ' f'U James Sarian- rtT 901 Robert Street, Mechanicsburg, PA 17055 ~ Postage $ ~ L~ ~ Certified Fee ;: ~ 3 ~} Return Receipt Fee ~^ (~ ~ (Endorsement Required) ~, -7 ,`~, ~ O ,~ O Restricted Delivery Fee p (Endorsement Required) ~ ~ Total Postage & Fees $ x~. (.(xj O ~ Name (Please Print Clearly) (to be completed by mailer) m --- -----~~ar-~~~-~k~lds--1~1------- ---- Q- Street, Apt. o.; or Box o ' ~ . _________ 6_ Clouser Road_,_________ ~ City State, ZlP+4 ----~--------~ r~ T.T....L___.__i ... .____ t ^ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ^ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: James Sariano 901 Robert Street Mechanicsburg, PA 17055 A. Received by (Please Print Clearly) B. D t of D ive~ a C. Sign ure X ~~ ~~ ^ Agent ^ Addressee D. ~ delivery address different from item 1? ^ Yes If YES, enter delivery address below: ^ No 3. S ice Type I~PJ Certified Mail ^ Express Mail ^ Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) ^ Yes 2. Article Number (Copy from service label) 7099 3400 0004 5004 3237-Sariano PS Form 90811, July 1999 Domestic Return Receipt 102595-99-M-1789 •- !+ r, .,..~ ~~' t.~ >~ 4;, CL _ 2 tr ~ ~ ~ '~ 0 ru m ~ Postage ~ t.ri Certified Fee ~. Return Receipt Fee (Endorsement Required] O O Restricted Delivery Fee O (Endorsement Requredl ~ O Total Postage & Fees ~ Name (Please Print Clean m - hh g Stre t Ap~ (I~~ ~ ~ , j e P ~~ ~' _ _ 6 Clou ser F 0 _ _ City State, ZIP~4 r~ I Ld.-..L_._' _ ~ ^ Complete items 1, 2, and 3. Also complete "item 4 if Restricted fielivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ^ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Virgil R. Sariano 738 Liberty Street El Cerrito, California 94530 A. Received by (Please Print Clearly) ~ B. Date of Delivery C. Signatur~ ~~~~ ~ l X r /// Agent Addressee D. Is delivery address different from item 1? Yes If YES, enter delivery address below: ~ No 3. Se ce Type Certified Mail ^ Express Mail ^ Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) ^ Yes 2. Article Number (Copy from service label) 70993400 (~Q4 32p6-Sariano Form ~, July 1999 K,.~~ r''1 C~ ::? +1 ,~ ~ M .,,..~ ~ (~ ~ a.i '..: l.:i Domestic R~tturn Receipt 702595-99-M-1789 r- m O O LI7 O O D m ~' O r- .~ .. . .-. onsue o . Rostto 16 Victoria Way, Camp Hill, PA 17011 Postage I S ~pGj t~~L~~L \" .. Certlfled Fee i /, ~. ~ ~ `( P ~ -~ U~ nark Return Receipt Fee ~ ~, (Endorsement Required) ~ ~ I ere ~~ Restricted Delivery Fee (Endorsement Required) ~ ";fir LIIVV ~3 ~ Total Postage 8 Fees ~ $ ~ ~ ~ ~ '~ i ~-~~%"f Name (Please Pnnt Clearly) (to be completed by mailer) ------------C(~~~leg- -~k~elds,,-1~1--------- -- ~ -- -- ~ ~ox o. Street, Apt. No.: or Pt i, 6 Clouser Road ~ City. State. ZIP-4 Mechanicsburg, PA 17055 I :~ ^ Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. ^ Print your name and address on the reverse so that we can return the card to you. ' ^ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Consuelo M. Rosito 16 Victoria Way Camp Hill, PA 17011 A. Received by (Please Print Clearly), 6. `Date of [ -_, _ _,_ _._ :_~ ~.._. C. ip re '. ' `~~-'~ 7 -- / ~ ~. ^ Agent ~1~,~ G_~_~A ~ ,'~9-Addr€ Is delivery address different from item 1 . Yes If YES, enter delivery address below: ^ No r; 3. Service Type ^ Certified Mail ^ Express Mail ^ Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. 4. Restricted Delivery? (Extra Fee) ^ Yes 2. Article Number (Copy from service label) 7099 3400 0004 5004 31 76-Sariano 5 Form 31511, July 1999 ~ ,,. , ~ ..,, ~. - ~ a M Cz ~:a 4C iz ,.i Domestic Return Receipt 702595-99-M-1789 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 REV-1162 EX111-96) NO. CD 002834 CUNNINGHAM JORDAN D ESQUIRE 2320 N SECOND STREET HARRISBURG, PA 17110 ACN ASSESSMENT AMOUNT CONTROL NUMBER told ESTATE INFORMATION: ssrv: tot-is-ssss FILE NUMBER: 2102-0977 DECEDENT NAME: SARIANO VIRGIL H DATE OF PAYMENT: 07/23/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/24/2002 101 ~ $4,194.44 TOTAL AMOUNT PAID: REMARKS: CONSUELO M ROSITO C/O JORDAN D CUNNINGHAM ESQUIRE SEAL CHECK# 0092 INITIALS: AC RECEIVED BY: DONNA M. OTTO 54,194.44 DEPUTY REGISTER OF WILLS REGISTER OF WILLS Register of Wills of cur>BExL~rn County, Pennsylvania INVENTORY R'~J-S Estate of VIRGIL H. SARIANO also known as No. 21-02-00977 Date of Death 10/24/02 Deceased Social Security No. 201-18-6698 Personal Representative{s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each 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/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 490 lating to unsworn f Isific ion to authorities. (') Name of ers epresentauve: ~(\ V C~.% Jordan D. Cunningham, Esquire ~ Consuelo Rosito Attorney: I.D. No.: 23144 16 Victoria Way Camp Hill, PA 17011 Address: 2320 North Second Street Dated_ ~~z-S ~a~ Harrisburg, PA 17110. - -~-r--- Telephone: 717-238-65 70 Description Value 1. 182 shares - SunLife Financial of Canada, Inc. 3,423.42 2. 297 shares - PNC Bank Corp. 11,885.94 3. U.S. Savings bond 9,304.00 4. U.S. Savings bond:9,304.00 5. U.S. Savings bond 9,304.00 6. Pennsylvania State Bank -Account ~k10117547 2,973.13 7. Pennsylvania State Bank -Account ~~22004899 52,490.34 8, ivtellon Bank - C.D. ~~6140-8764335 9,663:86 Total: 108 , 348.69 (Attach Additional Sheets if necessaryj 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 Inveirtory. IN RE: ESTATE OF VIRGIL H. SARIANO, IN THE COURT OF COMMON PLEAS OF LATE OF HAMPDEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA c No. 21 - 02 - 977 ORPHANS' COURT DIVISION ELECTION TO TAKE UNDER WILL AND CONVEYANCES TO THE EXECUTOR OF THE LAST WILL OF VIRGIL H. SARIANO I am satisfied with the provisions made for me by my deceased husband, Virgil H. Sariano, during his life time and with the provisions in his last will dated November 13, 1987, and otherwise. Therefore, intending to be legally bound hereby, I elect to take under that will, and I hereby relinquish and waive my right to tak an elective share. 4/~,~ Witness MARIAN SARIANO DATED: a 3 ZD03 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND ion the c~~ day of , 2003, MARIAN SARIANO, personally appeared before me in a form of law acknowledging the foregoing election to be her act and deed and desired the same to be recorded as such. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public My Commission expires: NpTAR1Al_ SEAL Nl Notary PubiiC Chafes E. Shiekfs~nd County Mor~Oe Twp. Tres June 24, 2004 My Commission Exp ij-~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX ~FP (01-03) DATE 09-09-2003 ESTATE OF SARIANO VIRGIL H DATE OF DEATH 10-24-2002 FILE NUMBER 21 02-0977 - COUNTY CUMBERLAND JORDAN D CUNNINGHAM ~ ACN 101 CUNNINGHAM ETAL Amount Remitted 2320 N 2ND ST HBG PA 17110 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~ _____________________ -------------------------- ---------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SARIANO VIRGIL H FILE N0. 21 02-0977 ACN 101 DATE 09-09-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) ,00 43,221.36 ,00 NOTE: To insure proper credit to your account, submit the upper portion (4) ,00 of this fora with your (5) 65,127.33 tax payment. (6) .00 (7) .00 ($) 108,348.69 APPROVED DEDUCTIONS AND EXEMPTIONS: 12,599.12 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 84 539 2 10 Debts/Mortgage Liabilities/Liens (Schedule I) (10) . , 96 ) 5 138 . (11) . . 11. Total Deductions (12) 93,209.73 12 Net Value of Tax Return .00 . 13 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedu le J) (14) 9 3,209.7 3 . 14. Net Value of Estate Subject to Tax NOTE: If an assessment was issued previously, lines 14, 15 f ALL returns andior 16, 17, 18 assessed to date. and 19 will eflect figures that include the total o r ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount ofi Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due NUMBER /PEN PAID (-) .00 AMOUNT PAID 00 _ .oo 045= 4,194.44 12 = .00 15 = .00 (19)= 4,194.44 TOTAL TAX CREDIT 4,194.44 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 (15) . 00 X (16) 93,209.73 X (17) . 00 X (18) • 00 X * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. pFREFUND.DSEEIREVERSECSIDEAOFATHISEFORM FOR)INSTRUCTIONS,DUE ~.l_U.j_) *' I REV.1500 ,-~FFICI,\L us: ''::'Jl ~ l I COMMONWEAl. TH OF PENNSYlVANIA INHERITANCE TAX RETURN FILE NUMBER DEPARTMENT OF REVENUE RESIDENT DECEDENT 21 02 00977 DEPT. 280601 HARRISBURG. PA 17128-0601 ....0' 'NTY ............e YEAR NUMBER DECEOENrs NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER !z Sariano, Virgil H 201-18-6698 w DATE OF DEATH (MM-DD-YEAR) ! DATE OF BIRTH (MM-OO-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 0 I w 10/24/2002 I 0l/281l911 U REGISTER OF WILLS w 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL) SOCiAl SECURITY NUMBER Sariano, Marian A.. 181 ,. Original Return 02. Supplemental Retum ] 3. Remainder Return (date 01 death prior to 12-13-a2) w ~ 0 0 4a. Future Interest Compromise (date of death o 5. Federal Estate Tax Retum Required ~:$'" 4. Limited Estate <.>"~ after 12-12-82) w"U :00 181 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach 1 8. Total Number of Safe Deposit Boxes <.>"~ .... of Will 00 ofTru - ~ ) o 9. Litigation Proceeds Received py st) o 10. Spousal Poverty Credit (date of death between o 11.Election to tax under Sec. 9113(A) (Attach Sch 0) I 12-31-91 and 1-1.95\ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~AME COMPLETE MAILING ADDRESS .~ Jordan D. Cunningham "': Ww IRM NAME (If applicable) &io - 2320 North Second Street OZ Cunningham & Chemicoff, P.c. <.>~ Harrisburg, P A l71l 0 ELEPHONE NUMBER 717/238-6570 1. Real Estate (Schedule A) (1) NOM CJ ,'-.'~IL '( \.....;, 2. Stocks and Bonds (Schedule B) (2) 43,221.36 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None N 4. Mortgages & Notes Receivable (Schedule D) (4) None l,~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 65,127.33 ~~::; (Schedule E) l,.J 6. Jointly OWned Property (Schedule F) (6) None "1 Z o Separate Billing Requested :..". 0 3 7. Inter~Vivos Transfers & Miscellaneous Non-Probate Property (7) None E (Schedule G or L) .. 8. Total Gross Assets (total Lines 1-7) (8) 108,348.69 '" U w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 12,599.12 " 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10) 2,539.84 ! 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (11) 15,138.96 93,209.73 (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (13) (14) 93,209.73 15.Amount of Line 14 taxable at the s~ousal tax rate. x .00 (15) or transfers under Sec. 9116(a)(1. ) Z 93,209.73 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x g .. 17.Amount of Une 14 taxable at sibling rate x .12 (17) .. 0 <.> S 18. Amount of Une 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 4,194.44 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 4,194.44 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV.1500 EX (Rev. 6-(0) Decedent's Complete Address: STREET ADDRESS 130 Reeser Road CITY Camp Hill I STATE PA IZIP 17011 Tax Payments and Credits: 1. Tax Due (Pagel line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,194.44 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty If applicable D. Interest E. Penalty (3) 0.00 (4) (5) 4,194.44 (SA) (58) 4,194.44 TotallnleresUPenally (D + E) 4. 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. A. Enter the interest on the tax due. 8. Enter the total of line 5 + SA. This is the BALANCE DUE. ~~~ l:..~'I<.:....~:::.....;,.';'.. , .~ ,~' '_ .""'~'!~,,'" ,r"" .": ,~> , . "~...'" ~~, :(__~':.:"~ ." -,~ Make Check Payable to: REGISTER OF WILLS, AGENT 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.... ........,..................................................... b. retain the right 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 care?... ................................. ................. 2. If death occurred after Oecember 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................. ......m....................... ................ . 3. Did decedent own an Uin trust for" or payable upon death bank account or security at his or her death?........ 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation?.............................................................. . .................... ................. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS '~ i o o o ~ ~ ~ IF THE ANSWER 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 dedare thai I have examined this return. including accom~anylng schedules and statements, and to tM: OOstof my knowledge. and belief, it is true, COI"I"eO. and t.amplete. DeclaraUon or pre parer otl'1er than tI'1e personal representative is based on all infOfTllation of which preparer has any knowleCQe. SlGNATURE OF PERSON SPONSIBLE FOR FILING RETURN ADDRESS DATE Consuela Rosit M>ORESS 16 Victoria Way Cam Hill,PA 17011 ~s&<~ ) - rY3 -tU DATE O/...;J a /71<.:> 7 u 'Os DATE 2320 North Second Street Harrisburg, P A 1711 0 il:t'}j!I.~151i"~:MHifi1 --~mr "i:~~l>'Va- For dates of death on or after July 1, 1994 and before January 1., 1.995, the tax rate imposed on t\1e 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. 59116 (a) (1.1) (il)}. The statute does ont exemot 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 beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net .....alue 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. 59116 (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 P .S. ~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. . SCHEDULE B STOCKS & BONDS CQ/.1MONWEAL TH OF PENNSYLVANIA INHERITANCE fAX RETURN RES1OE:Ni OECcDarr ESTATE OF . Sariano, Virgil H I FILE NUMBER 21 - 02 - 00977 All property jointly-..owned with right of survivorship must be disclosed on Schedule F. , ITEM 'I DESCRIPTION NUMBER I I 182 shares - Sun Life Financial of Canada, Inc. @ 29.40 on 10/24/02 (Canadian $ = I .639816 USD. on 10/24/02 or 18.81 USD per share) i (See attached Smith Barney statement for value SLFT on 10/24/03 and conversion " chart for value of Canadian dollar to United States dollaIT on 10/24/02) UNIT VALUE I I VALUE AT DATE + OF DEATH i 3,423.42 I 2 297 shares - PNC Bank Corp.@40.00 per share on 10/24/02 (See attafched Smith Barney statement for value ofPNC on 10/24/02.) 11,885.94 3 United States savings hand - $10,000.00 issued 8/12/92 bearing bond #X2185386EE (See attached valuation of bonds) 9,304.00 4 United States savings bond - $10,000.00 issued 8/12/92 bearing and #X2185387EE (See attached valuation of bonds) 9,304.00 5 United States savings bond - $10,000.00 issued 8/12/93 bearing bond #X2185388EE I 9,304.00 TOTAL (Also enter on line 2, Recapitulation) 43,221.36 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMl.4OHWEAL TH OF PENNSYLVANIA INHERITANCE Tf.J( RETURN RESIOeN'f DeCeDENT ESTATE OF S' V"\ H anana, lrgl I FILE NUMBER 2\ - 02 - 00977 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 2,973.13 Pennsylvania State Bank - Account #10117547 2 Pennsylvania State Bank - Account #22004899 52,490.34 3 Mellon Bank (Citizens Bank by merger) CD #6140-8764335 9,663.86 TOTAL (Also enter on Line 5, Recapitulation) 65,127.33 *' SCI-EDlI..EH FUN3W..EXPENSES& Al:WNSTRATlVE UJtj I~ COMMONWEALTH OF PENNSYlI/N<4LA INHERITANCE TAX RETURN RESIDENT DECEOENT ESTATE OF Sariano, Virgil H I FILE NUMBER 21 - 02 - 00977 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: 1 Myers Harner Funeral Home 4,333.00 2 Trinity Evangelical Lutheran Church 245.12 B. ADMINISTRATIVE COSTS: 0.00 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State - Zip Year(s) Commission paid 2. Attorney's Fees Cunningham & Chernicoff, P.C. 4,350.00 3. Family Exemption: (If decedent's address \s not the same as claimant's, attach explanation) 3,500.00 I Claimant Marian Sariano Street Address 130 Reeser Road I I Camp Hill 17011 , City State PA Zip , I 4. Relationship of Claimant to Decedent WIfe Probate Fees Register of Wills 171.00 5. Accountant's Fees 6. Tax Return Pre parer's Fees 7. Other Administrative Costs I TOTAL (Also enter on line 9, Recapitulation) 12.599.12 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMOH'NEAL TH OF PENNSYlVANIA INHEAITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF . " Sanano, Virgil H I FILE NUMBER 21 - 02 - 00977 Include unreimbursed medical expenses. ITEM NUMBER 1 Beverly Enterprises (Nursing Home) DESCRIPTION AMOUNT 2,539.84 TOTAL (Also enter on Line 10, Recapitulation) 2,539.84 REV'.1513 EX... (9-00) *' SCHEDULE J BENEFICIARIES COMMONYIEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I FILE NUMBER 21 - 02 - 00977 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE OF ESTATE ESTATE OF Sariano, Virgil H I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Consuela Rosita 16 Victoria Way CampHill,PA 17011 Daughter 113 2 Virgil R. Sari ana 738 Liberty Street E1 Cerrito, CA 94530 Son 1/3 3 James Sariano 90 I Robert Street Mechanicsburg, P A 17055 Son I 1113 I I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee~ II. 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE W ILL I, VIRGIL H. SARIANO of Camp Hill, Pennsylvania declare this to be my last will and revoke any will previously made by me. ITEM ONE: I direct that all my debts and funeral expenses, including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM TWO: I give, devise and bequeath my entire estate to my three children, Consuelo M. Rosito, virgil Richard Sariano and James M. Sariano, share and share alike per stripes. ITEM THREE: I appoint CONSUELO M. ROSITO, Executrix of this my last will. Should she fail to qualify or cease to act as Executrix, I appoint JAMES M. SARIANO to act as Executor with the same rights, powers and duties. ITEM FOUR: All estate, inheritance, succession and other taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. ITEM FIVE: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM SIX: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. Vrff~ .--...~_..-- .. . ~ -.~".~' .,,,~.~. " M . C. To repair, alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition real or personal property, and to give options for leases. E. To make distribution in kind. F. To compromise claims. ITEM SEVEN: My wife, MARIAN SARIANO, is not mentioned in the above disposition. I note that my wife is sufficiently provided for by virtue of property that we own jointly which she will inherit upon my death. IN WITNESS WHEREOF, I have hereunto set my j'l./vV , 1987. hand this ! J r1ay of SIGNED~) 4_~A-<'''~ The preceding instrument, consisting of this and two other typewritten pages each identified by the signature of the Testator was on the day and date thereof signed, published and declared by the Testator therein named as and for his last will, in the presence of us, who at his request, in his presence and in the presence of each other have subscri ed our names. COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND weC)6vG~ to G rrl~ andCl..i'\rl..( tfc,"'J"f<:,,,,witnesses whose names are ~~gne~ to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as his last will; that he signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. - --'- --~ --,'\...<:,"---;').-..0'" L-"Ji< / l; I " I , '-;- ,;:j ;"'" -,- SMITH BARNEY_ cltlgroupJ April 11, 2003 Jordan Cunningham Cunningham and Chernicoff 340 Equus Drive Camp Hill, PA 17011 Dear Jordan, Here are the price's you requested, Date of Death Svmbol 1 C!24/2Cl02 PNC SLFT 10/24/2002 I hope this is helpfuL S!:lce;e!y. \,/L '<<,"~' " &;~'J) _~ .-/~.r-O.Y'f-/ ~.~- -~- -- Suzan Shadle Sales J\ssistant for Steven iN, La P-xte Second Vice Fresidem in','esrrnents I,' -...J ? 'i:; Open Close 41 26.69 40,02 (US $) 29.40 (Canadian $) THE ABOV'C SUMMARY/PRlCES'QUOTESIST ATISTICS HA YE BEEN OIrrAJNED FROM SOURCES WE BEl.JEVE TO BE REUABLE. BIJT WE CA "'NOT GUARANTEE ITS ACCURACY OR COMPLETENESS, PAST PERFORMANCE IS NO GUARANTEE Of n:TU1<E RESULTS_ Cit;group Globll M:uk.ett Inc.. 1 J North 3rt! Street. 1nJ rJoor H~li)b\l,tr,. PA 17101 Tel 717 7RO 1700 F~ 117 133 2U90 l-oJl-fl'':l,; SOO 1.371700 APR-11-2003 14:07 7172332090 98% ~% P,02 P,01 CIBC Mellon Trust Company February 13, 2003 Attention: Jordan D. Cunningham Cunningham & Chernicoff Attorneys at Law P.O. Box 60457 Harrisburg, PA 17106-0457 U.S.A. Dear Mr. Cunningham: RE: SUN LIFE FINANCIAL SERVICES OF CANADA INe. EST ATE OF VIRGIL H. SARIANO ACCOUNT NUMBER: 12515716 NUMBER OF SHARES: 182 We refer to the subject estate and return to you legal documents for the following reasons: . Letters of Testamentary must be dated within 60 days of presentation for transfer. . Certificate number C-0160283 must be presented for transfer. For your convenience, please return this item to our ChaseMellon Shareholder Services, our U.S. co-transfer point,. The address is: ChaseMellon Shareholder Services, Transfer Department, P.O. Box 3310, South Hackensack, New Jersey 07606. Courier or Personal Delivery is at ChaseMellon Shareholder Services, 120 Broadway, 13th Floor, New York, New York 10271. If you have any questions regarding our transfer requirements, please do not hesitate to communicate with us at 1-800-526-080 I. Yours very truly, crnc MELLON TRUST COMPANY o t,"-" f1 ~ 1 Denise Ft~i~ Senior Administrator Legal & Estates Ene!. va/ps1.l3 (6) 199 Bay Street Commerce Court West Securities level Toronto, ON M5l IG9 Mailing Address P.O. Box 7010 Adela\de Street Postal StiH10fl Toronto, ON M5C 2W9 Tel 800.387.0825 Fax 416.643.3135 In quiries@dbcmellon.com www.cibcmellon.com ::SC "'ellon Trull CJmc~rv i~ ~ licensed user of !he nBC .no 'leilan ".'~~m",.< COMMON CUSIP 693475 10 5 COMMON HilS CE.RTIFICATE: \5 TRANSFEMBlE. IN NEW yaRK. H" INCORPOAATEO UNDEfl fHE lAWS OFTHE COMMOf'tWEAL1H Of' PENNSYLVANIA CPT2311192 SU:HfVIH;( IPHUI'TAINl1fr'lrJIIIONS PNC111AN1l(" PNC Bank Corp. FULLY PAID AND NON.ASSESSABLE SHARES OF THE PAR VALUE OF $5.00 EACH OF THE COMMON STOCK OF ~::/!;t~~1;jpt/itAf?~?E' 'i:!tf,~ IFcK'hV'" ''f1:'.,~"",,<,..;Id -,t~'" d- ,~~",;""fJJ:A#Ii_.!I?"""""" 1/,1-,rdd (,{,,;;dr;md; dru/ ,/;,1" &7"__M/';'H ffH/ IA" ;;"",,,,ri:- ,1~YHU/'/ MI __/r8 ffi,<;y ffr/;,I--~~id __#;'0'.1. !>>u/d ~~ MAY 27 1993 CHAIRMAN IIN[1 CHIFT DEcUTnlE OFrlCER CQUN1"ERSIGNEO (1,1'10 REGISTI'J\f.\l CHEMICAL BANK lRAtlSFER /l.C,~NT MID REGIST J/dkm J ~ BV ASSISTANT U)Rf"ORilTE SECRETI\R~ AUTHORIZ ,. '...!' ~ . _" .~"'1<"-. I. '- .:~' ~ ....."" " ' , ' ," -~.,~:~ -\~Z9T4 ----- :';:~::kB ' ,. 'i-~'(r" -. "~"<i'~~ ""j.i~i~r~.~Jj?!t":'h... . '>VLRGI L.H. SARI ANaT~",~-.~, ...:":',;,"u;,,-.: "~~~a:'~~[;ir;~{: ' '--- ~ ~.<. 1 aB.:6__ ....,(.;.'''i'1'.i?p.~...._''j,i "'-":~.01_ii?-1. ~17ila-. l.j' _..', .~ 'ij't.,I'", .f~::tl;,! ;;:'1:: j';~'j.,_.~~~_.--,,~!~~'ti,~r:p'-',~Jll; L~'tJ: :+ii;b'~oo qoo~U;';;'~'~- It 3~;;~7ra 5 labu" .' -""",'f'n '. ~ \,I :.. I :t_-y "" ~ '" :J.......__-- ~ . . ,E __ , '. . . l""'-"',_ '-co,''" .~,,. ..... ';;;_ m~~mm~~ ..n_........'.' .........."" "Il:Ill~__~l~ ;,,~~t"'r.-';' : z;Ql.:;Tij"669B-" . '" !~~t,ii~A~~f~*>til1 '" . '- . - - '.', ",~' .,' ~~; "0J,ili~~~t, InrJI, ;r:&~bmqOb~";';;'~~ .~ct;;~a~'38a.u'~ 1, riltiJ:UilEf] cr~ 0'-\. 0 {) q ~Ol,\. 00 C\ ~O\A ,00 i (\ \ert::>-{ L( sac! ' DO * ~ \ January 23,2003 Cunningham & Chemicoff, P.C. Attorneys At Law P.O Box 60457 Harrisburg, PAl 71 06 Attention: Jordon D Curmingham Re: The Estate of Virgil H Sariano Dear Mr. Cunningham. This letter amends my letter from December 23, 2002. The balance at date of death for account# 22004899 was $52,490.34. The amount for account# 10117547 remains the same ($2,973.13). I apologize if this has caused any problems. Sincerely, ~Wn~ Heather Williams Senior Banking Specalist 1148 Market Street P.O. Box 487 Camp Hill, PA 17001-0487 717.731.7171 fax 717.731.7176 pastatebank.com ~ ,. December 23, 2002 Cunningham & Chernicoff, P.C. Attorneys At Law P.O Box 60457 Harrisburg, PA 17106 Attention: Jordon D Cunningham Re: Estate of Virgil H Sariano Dear Mr Cunningham, As per your letter dated December 12, 2002, the following is the information you requested. The balance at the date of death for account# 22004899 was $49,738.62. The balance for account# 10117547 was $2,973.13. If! may be of any assistance, please feel free to contact me at (717) 731-7272. Sincerely., ~v, W ~.rwJ Heather Williams Senior Banking Specialist ,". .. i5,'1 C,:' " : .,- -- - --- --- ~ ~ ~ rJ) z ~ ~ c u ~ i>;;:.'"'\" ..:l ~ ... (t ~~\Q~ ~ritl\..:l ;. ~ ;!\~ ... "0 III ... . Q . ... ~OI> .... 1<'" (t '" n ~ ~ ~ ~\ ~. ~~i ~ 'f\ ~.~\ .\ -\ \..\ \....., P '"I :\ ~ -\ \ ", ~.. -" 0...." ..,.n;!! ':Oo~ ~ -<\ ~ i ~~ ~-"=\ t ~ ~ ':i 6i III ~ QC\ = !l III ~ ';ll:"Ql ~ i ~\\ ~ ~ ~ tn~\ <<' ~ o "'~.. (t o ~ii ! ~ \, \ \ ... a p.. =io e.\ 9 ~ - ~. '\"'" '5 .- /;" .." ~"O ~ ........ 9 ~ ~ ... lP ~ r I>< If' . ., 11' \,IJ 'g . '(; ~ 7f ig ~~ , -,~r. ~ ---- ~ ~...-.,~-~ , --.r-' -~ . ---:;,..-. [Trinity 'Evangelical Eutheran Church TWO THOUSAND CHESTNUT STREET CAMP HILL, PENNSYLVANIA 17011 717-737-8635 FAX 717-730-9297 SENIOR PASTOR J. STEWART HARDY, PH.D. ASSISTANT PASTOR NANCY R. EASTON, M.DIV. ASSOCIATE PASTOR JOHN H. BROCK, M.DIV. DIRECTOR OF MUSIC H. TIMOTHY KOCH DIRECTOR OF LEARNING MINISTRIES JAYNE E. COOVER, EO.D. YOUTH MINISTRY COORDINATOR PETER A. FOX, B.A. November 22, 2002 Ms. Connie Rosito 16 Victoria Way Camp Hill, PA 17011 INVOICE Charges for Virgil Sariano funeral meal: Total cost of meal $245.12 $245.12 Total amount due Thank you, ~~\..'LW V-.. ~ Carleen K. Brokus Interim Financial A CONSUELO M. ROSITO L1C# 10558366 PH.717-728-1347 lSYICTORIA WAY CAMP HIU., PA. 1 'f - t> c:)L lit'" $~" ~ollars rr 11~f!.It~ " . :....__..,.~ . F~?4#,.,..",,',~ r.-r....,~ i:di ~:UJ2cf5 51: 'il' ,,0 no SOClI"OE,OE, -- ......-.... beverly Enterprises, Inc. DBA West Shore Health & Rehabilitation Center PO Box 180970 Fort Smith, AR 72918 ITEMIZED RESIDENT STATEMENT RESIDENT NAME RESIDENT NUMBER Virgil Sarlano 44693-00285-99577 DATE PREPARED STATEMENT TYPE: DINTERIM DISCHARGE [iJITEMIZED 08/29/02 : DATE/PERIOD COVERED DESCRIPTION UNITS CHARGES PAYMENTS 12/19-12/31/01 Medicare First 20 days 13 $0.00 01/01-01/07/02 Medicare First 20 days 7 - $0.00 01/08-01/31/02 Medicare & Co-Insurance 24 $0.00 02/01-02/22/02 Medicare & Co-Insurance 22 $0.00 Co-Insurance is pending if Co-Insurance denies or determines a patient portion this amount will become the liability of the responsible party. 02/23-02/28/02 Room Charge (Private Pay) 6 $957.86 05635/J IV Solution 1 $112.32 03/01-03/10/02 Room Charge (Private Pay) 10 $1 ,441.94 28137/J Eucerin Lotion 1 $12.30 20023/J Gauze Sponge 2x2 1 $1.00 20055/J Telta Nonstick Pad 1 $1.00 200931J Syringe 1 $1.00 22207/J Saline Solution 1 $1.00 22597/J Aerosol Mask 1 $1.82 22643/J Airlite H/H Neb 1 $1.66 22901/J Replicare Thin 1 $3.84 229911J Curex 4x4, 8 Ply 3 $0.42 23976/J Sterile Water 1 $2.44 24409/J Transeal Film Dressing 2 $1.24 03/11/02 Discharged - BALANCE FORWARD CHARGES CREDITS AMOUNT DUE $0.00 $2,539.84 $0.00 $2,539.84 Virgil Sanano c/o Marian Sarlano 130 Reeser Road Camp Hill, PA 17011 1 JRD/June 30, 1992/17858 In Re: Estate of Virgil H Sariano Late of Hampden Township Estate No.: 21-02-0977 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-02-0977 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Consuelo Rosito Counsel for Personal Representative: Jordan Cunningham Date of Decedent's Death: 10/24/2002 Date of Delinquency Notice: 08/11/04 The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on April 30, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 11/08/04 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for at in Courtroom No. 3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. George~ Ho PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION " Name of Decedent: VIRGIL Date of Death:, 10/24/2002 Estate No.: 21-02-0977 STATUS REPORT UNDER RULE 6.12 H. SARIANO 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: State whether administration of the estate is complete: Yes x No Date: 1.1/16/2,004 (MAH:rmt/AM3) If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No x B. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes x No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with th~~ and may be attached to this report. Jordan D. Cunningham, Esquire Name(Pleasetypeorprint) P.O. Box 60457 Harrisburg, PA 17106-0457 Address 717-238-6570 Telephone No. R.W. - 50 Capacity: X Personal Representative Counsel for Personal Representative ESTATE SETTLEMENT AGREEMENT THIS AGREEMENT, is made theC~'Tk¥~ day of September 20~ by and between Consuelo Rosito, Executrix of the Estate of Virgil Sariano, deceh..~d (horein referred to as Executrix), and Consuelo Rosito, Virgil R. Sariano and James Sariano as specific beneficiaries of the said Estate, hereinafter collectively referred to as the "Beneficiaries". In accordance with her desire that the administration of the Estate of Virgil Sariano be expedited, the parties hereto, in consideration of the mutual covenants herein expressed, and intending to be legally bound hereby, agreed that: 1. The Estate of Virgil Sariano who died October 24, 2002, is now in the process of administration, Letters Testamentary having been duly granted to the Executrix, by the Register of Wills of Cumberland County, Pennsylvania on October 31, 2002. 2. Under the provisions of the decedent's Will, decedent gave all of the residue of his Estate as follows: thirty-three and one-third percent (33 1/3%) to Consuelo Rosito, thirty-three and one-third percent (33 1/3%) to Virgil R. Sariano and thirty-three and one-third percent (33 1/3%) to James Sariano, the Beneficiaries. 3. During the administration of the Executrix has made advance distributions to the Beneficiaries as follows: PRINCIPAL: Virgil R. Sariano, 10/30/03 James Sariano, 11/10/03 Consuelo Rosito, 11/10/03 $10,000.00 10,000.00 10,000.00 The Beneficiaries hereby acknowledge the prior receipt thereof. 4. The Executrix intends to distribute additional sums to the Beneficiaries as follows, upon the execution of this Estate Settlement Agreement. PRINCIPAL: Virgil Sariano James Sariano Consuelo Rosito INTEREST: Virgil Sariano James Sariano Consuelo Rosito 21,918.05 21,918.05 21,918.04 1,096.21 1,096.21 1,096.21 5. In lieu of a formal Accounting, the Executrix has prepared a proposed First and Final Accounting and Schedule of Distribution, which is incorporated herein by reference and marked Exhibit "1." The parties waive the filing of an Accounting and audit and accept the Accounting provided in Exhibit "1" in lieu thereof. 6. Without intending to limit the rights or remedies of the Executrix, the parties further agree to indemnify the Executrix and save the Executrix harmless against all liability, loss, and expense (including, but not limited to, costs and counsel fees) which the Executrix may incur, whether due to the Executrix's negligence or otherwise, as a result of making the above described distributions without a Court audit. 7. The parties, and each of them, hereby forever fully release, compromise, settle and discharge any and all claims, demands, actions or causes of action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which any of them may have against any other party hereto or against the Estate of Virgil Sariano, deceased, or the Executrix thereof, by reason of any matter, cause or thing growing out of, or relating to any property or assets of the said Estate, or growing out of or relating to any act of the Executrix in her administration of said Estate, even if attributable to negligence, and agree that any period for the limitation of actions for the collection of any erroneous distribution or distributions shall commence only at such time as the Executrix shall have obtained actual knowledge of such erroneous distribution or distributions and that in no event shall the period for collection or any erroneous distribution or distributions be less than two (2) years after the actual discovery thereof by the Executrix. 8. The parties agree to execute such additional releases as the Executrix may submit to them in order to confirm their discharge from any further liability to the parties in connection with the said Estate. 9. The foregoing provisions which apply to the Executrix shall apply also to any Executrix who may be appointed in connection with any ancillary administration which may be required in order to complete distributions in the Commonwealth of Pennsylvania. 10. This Agreement may be executed in multiple counterparts and, when so executed, shall be binding upon all the parties, and their respective heirs, next-of-kin, personal representatives, and assigns. 4 IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. WITNESS: ESTATE OF VIRGIL SARIANO By.~--~7~ '~. CONSUELO ROSITO, EXIgCUTRIX BENEFICIARIES: VIRGIL R. SARIANO ~/~I~ES SARIANO / 5 IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA FIRST AND FINAL ACCOUNT OF CONSUELO ROSITO, EXECUTRIX FOR VIRGIL H. SARIANO, DECEASED FILE NO. 21-02-00977 Date of Death: October 24, 2002 Account Stated to: September 10, 2004 Jordan D. Cunningham, Esquire I.D. #23144 CUNNINGHAM & CHERNICOFF, P.C. 2320 North Second Street P. O. Box 60457 Harrisburg, PA 17106-0457 Telephone: (717) 238-6570 Principal: SUMMARY OF ACCOUNT Receipts: (1) Cash TOTAL NET VALUE Less Disbursements: (1) Debts of Decedent (2) Administration Expenses (3) State Inheritance Taxes (4) Fees & Commissions (5) Reserve Advance Distributions to Beneficiaries Principal on Hand: (1) Cash Income: Receipts Less Disbursements: Advance Distributions to Beneficiaries Income on Hand Total Net Value of Principal & Income 1,800.00 6,974.86 4,194.44 5,080.00 300.00 30,000.00 $114,103.44 $114,103.44 $65,754.14 3,288.63 0 0 3,288.63 69,042.77 RECEIPTS OF PRINCIPAL CASH: Pennsylvania State Bank (checking) $ 2,973.13 Pennsylvania State Bank (savings) 52,490.34 Mellon Bank (C.D.) 9,663.86 TOTAL BONDS: 1. U.S. Savings Bond 2. U.S. Savings Bond 3. U.S. Savings Bond TOTAL STOCKS: $9,304.00 9,304.00 9,304.00 182 Shares Sun Life Financial of Canada 297 Shares PNC Financial Corp. TOTAL $ 3,423.42 11,885.98 ADJUSTMENT TO STOCKS: 182 Shares of Sun Life sold on 6/24/04 for $5,136.04 resulting in an increase of $1,712.58 297 Shares of PNC sold on 5/27/04 for $15,928.11 resulting in an increase of $4,042.13 TOTAL PRINCIPAL RECEIPT OF INCOME: 3. 4. 5. 1/30/04 Pennsylvania State Bank, Interest $267.16 1/14/04 U.S. Savings Bond interest 1,692.00 3/29/04, Sun Life Dividend 148.50 7/8/04, Sun Life, Dividend 15.91 9/9/04, Mellon Bank, Interest 1,165.06 TOTAL INCOME TOTAL INVENTORY 3,288.63 $65,127.33 27,912.00 15,309.40 1,712.58 4,042.13 $114,103.44 $117,392.07 DISBURSEMENT OF PRINCIPAl, DEBTS: Beverly Enterprises (Nursing Home expense) $2,539.84 ADJUSTMENT TO DEBT: Executrix negotiated a reduction of the Beverly Enterprises debt from $2,539.84 to $1,800.00 resulting in a reduction of TOTAL 739.84 ADMINISTRATION EXPENSES: 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Register of Wills 141.00 Myers Harmon Funeral Home 4,333.00 Trinity Lutheran 245.12 Register of Wills 15.00 Register of Wills 10.00 Register of Wills 15.00 Register of Wills 24.00 Marion Sariano (family exemption) 3,500.00 Northern Indemnity, Inc. (bond for lost certificate) 94.00 Smith Barney commission and transaction fee on sale of Sun Life stock 131.37 Smith Barney commission and transaction fee on sale of PNC stock 266.37 TOTAL 8,774.86 ADJUSTMENT TO ADMINISTRATIVE EXPENSE: Executrix negotiated a reduction of $1,800.00 of the Family Exemption owed to Marian Sariano from $3,500.00 as a result of Ms. Sariano's failure to pay nursing home expenses during decedent's lifetime. <1,800.00> TOTAL 1,800.00 6,974.86 Et STATE INHERITANCE TAX: 1. Register of Wills FEES AND COMMISSIONS: 1. Cunningham & Chemicoff, P.C. 2. Cunningham & Chemicoff, P.C. RESERVE FOR ADMINISTRATION TOTAL DISTRIBUTION 5 4,874.00 206.00 300.00 4,194.44 18,349.30 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Virgil R. Sariano, 10/30/03 James Sariano, 11/10/03 Consuelo Rosito, 11/03/03 TOTAL DISTRIBUTION $10,000.00 10,000.00 10,000.00 30,000.00 PROPOSED DISTRIBUTION OF THE BALANCE OF PRINCIPAL TO BENEFICIARIES Virgil R. Sariano James Sariano Consuelo Rosito TOTAL PROPOSED DISTRIBUTION 21,918.05 21,918.05 21,918.04 65,754.14 PROPOSED DISTRIBUTION OF INCOME Virgil R. Sariano James Sariano Consuelo Sariano TOTAL PROPOSED DISTRIBUTION 1,096.21 1,096.21 1,096.21 3,288.63 6 Consuelo Rosito, Executrix, of the Estate of Virgil Sariano, deceased, hereby declares under oath that she has fully and faithfully discharged the duties of her offilce; 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 accordance with Section 3392 of the Probate, Estates and Fiduciary Code, that, to her knowledge, there are no other claims now outstanding against the Estate; and that all taxes presently due from the Estate have been paid. It is hereby certified that written notice of the filing of the Account and the call thereof for audit or confirmation has been given to every unpaid claimant who has given written notice of his claim to the accountant and to every other person known to the accountant to have or claim an interest in the Estate as creditor, beneficiary, heir or next of kin; that such notice stated the date, time and place of audit, and that any objections to the Account must be filed, in writing, not later than the audit session of the Court. Such notice was given to the following persons at the addresses listed: Consuelo M. Rosito 16 Victoria Way Camp Hill, PA 17011 787-6526 James Sariano 901 Robert Street Mechanicsburg, PA 17055 Virgil R. Sariano 738 Liberty Street El Cerrito, CA 94530 Estate of Virgil Sariano COMMONWEALTH OF PENNSYLVANIA : : ss; COUNTY OF ~ CllI~.R~.A~ql): SWORN and Subscribed to Before me this 3[?___~_~ day of ~4~:ro bec NOTARY PUBLIC My Commission Expires: 10/3t 7