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Home My WebLink About04-1033 PETITION FOR PROBATE and GRANT OF LETTERS Esta,eoS also known as To: Register of Wills for the Deceased. County of Cumberland in the Social Security No, 162-26-3§55 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrix named in the last wilt of the above decedent, dated Novonb~r 20, ,1990 and codicil(si c'ated ~'rl~arcl H. Roth dit=d Priorn~ alternate executors, Ri~-W. Cleckner and Dennis O. Shatto have renounced. Petitioner is, therefore, the most senior survivir~_ partner in the law firm of Cl~]~nor and Poar~n (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cural:~rland County, Pennsylvania, with h er last family or principal residence at 1013 Tt~ka,n~d T.ane, F.a.qt- Ponn~hom (Sst streeL, number. Twp. or Boro.) Decedent, i hen years of age, died Septel~aer 26 , ~ 2000 at her home. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent 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: 1/2 int~rost in r~l nrnr~r~v ~il-~.~-o in Wa%ale Township, Mifflin County, Pbnn~ylv~nia WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters test. ament;ary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. - - Ann g. Rhoa~ 119 Locust Strut P. O. Box 11847 flal~Fi~hlll°~: PA 171(~R--1~7 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF _ C,~_~3'~IBE"F(t-/~_ ss The petitioner(s) above-named swear(s) or 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 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 ~.~c'----- ~before me this ~__ ~ day of~ _ .. No. ~l-(~-i. 03;~ Estate of ~ M. ~m , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated [ ~. i C[ C[ d) described therein be admitted~o probate and filed of record as the last will and Letters ~ ~7 ~k i~ \~ ,~7)~1~ ~ are hereby granted to ~NI ~ ~.~ [4m0/~75 ' "~/") ~ , in consideration of the petition on FEES Probate, Letters, Etc .......... TOTAL ~il~d ................................... / Register of Wgls '~J ~ [' } ~/ I II ) A~ORNEY (Sup. Ct. I.D. No.) P. O. ~x 11~7 ~,~: ~a ]7]~]~7 ADD,SS 717--~1731 PHONE PETITION FOR PROBATE and GRANT OF LETTERS Estateof Jean M. Roth No. also known as To: Register of Wills for the · Deceased. County of ~land in the Social Security No. 162-26-3555 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executrix named in the last will of the above decedent, dated l',love~i~er 20 and codicilma(s)~ted P~l~,tard H. Rol'h dim O6/M/?OC~_ Prior alternate executors, Rjohh~d' W. Cleckner and Dennis J. Shatto have teen--raced. PetiPic~er is, therefore, the most senior surviving_ partner in the law firm of Plw_knor aM (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in ~rland County, Pennsylvania, with h er last family or principal residence at 1013 Ttm-ak-~mod Lane, Fast (Sst stree[, number, Twp. or Bore.} Decedem, then years of age, died ~pt~r 26 , ~ 2~ , at her hm · Except as follows, decedent did not marry, was not ~vorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent 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: 1/2 inker~.qt' in r~al nrnr,~art'~- gil-ll~l~-o in Wayne Township, Mifflin Count%,, P[nn~ylv~nia WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters test-an~"ntary (testamentary; administration c,t.a.; administration d.b.n.c.t.a.) theron. - Ann g. Rhoads 119 Locust Street P. O. ~ox 11847 H~r~ ~ha~rotj. PA Sworn to or affirmed and subscribed r-~'~''~ abefore me this 12.--__ __ day of OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } COUNTY OF_ ('.~.~'yh-~E~LP~D ss The petitioner(s) above-named swear(s) or 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ARNING: It is illegal to duplicate ,his copy by photostat or photograph. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS · CERTIFICATE OF DEATH Jean M. Roth machine o~erator .~erk Foods Inc. 1013 Teakwood Lane a£SIDEHCE Enola, PA 17025 UNOE. 0^~ ' ~o, mm. ' a Female ,.1 62 --26 -- 3555 ~eptember 26,2000 ! ch 9,1932 ~Franklin Twp pA~,~.,~ E~O ........ ~ Oo~[~ [~ a.~.~.] ~.~ ~ E. P~ro ~. ~1013 T~ ~e jf .................. Charles A. McDanell ,,"°~+~a s,~,,~,Anna May~'~Tressler Mr. Edward H. Roth {'~ 1013 Teakwook Lane Enola~ PA 17025 o,~.,~s~,~=.,,~ 5} ~eptember 29, 2000 z,~hurchville Cemetery ~,~herlin, PA 17113 ~i~/~ {a~ 012453 -L ~.F Stone F~n~r~l l~2c~N'In~H~r.~sbur~ Street A. David Froehlich PA 17043 u TM r-':~0 · JEAN M. ROTH Cumberland Dennis J. Shatto, of Administration Ann _~E. P~h_gads Sworn to and subscribed before me this ~ day of November, 2004, Notary/Public 119 Locus~ Street !larrisburg, PA 17103 x,x \ LAST WILL AND TESTAMENT OF JEAN M. ROTH I, JEAN M. ROTH, of 1013 Teakwood Lane, East Pennsboro Township, Enola, Pennsylvania, being of sound and dispos-ing mind, memory and understanding, do hereby make, publish and declare this ~o be my Last Will and Testament, hereby revoking and making void, any and all Wills or Codicils made by me at any time heretofore. ITEM 1: I hereby direct that all of my funeral expenses, estate and inheritance taxes be paid ~$y my Executor as soon after my death as may be found convenient. ITEM 2: I give, devise and bequeath unto my son, JOHN R. ROTH, of Steelton, Pennsylvania~ [ny house located at 1013 Teakwood Lane, East Pennsboro Township, Enola, Pennsylvania. In the event that my son, JOHN R. ROTH, does not survive me, I direct my hereinafter named Executor to sell said house and divide the net proceeds received therefrom equally between my daughter, WANDA J. ENDERS, of Elizabethville, Pennsylvania and my daughter, LYNDA D. TONOFF, of Millersburg, Pennsylvania. ITEM 3: I give, devise and bequeath in equal shares unto my daughters, WANDA J. ENDERS and LYNDA D. TONOFF, all of my jewelry as they may agree among themselves. If they cannot agree on any specific item, that item shall be sold and the net proceds received therefrom shall be divided equally among my two named daughters. ITEM 4: I give, devise and bequeath unto my daughter, LYNDA D. TONOFF, my house at 133 South Fourth Street, Steelton, Dauphin County: Pennsylvania. survive stirpes. In the event that my daughter, LYNDA D. TONOFF, does not me, I give, devise and bequeath said house to her issue per ITEM 5: I give, devise and bequeath unto my daughter, WANDA J. ENDERS, the sum of Forty Thousand Dollars ($40,000.00). In the event that my daughter, WANDA J. ENDERS, does not survive me, I give, devise and bequeath said sum of Forty Thousand Dollars ($40,000.00) to her issue per stirpes. ITEM 6: I give, devise and bequeath in equal shares to my three children, WANDA J. ENDERS, LYNDA D. TONOFF, and JOHN R. ROTH, my property situate in Mifflin County, Pennsylvania, comprising approximately ten acres. It is my direction and specific condition that said real estate may not be sold unless agreed to by all three of my said children. In the event that any of my named children shall predecease me that deceased child's share shall be divided equally among my other children surviving at the time of my death. ITEM 7: Ail the rest, residue and remainder of my estate, whether real, personal or mixed, of whatsoever nature, wheresoever situate and from whatsoever source derived, I give, devise and bequeath in equal shares unto my children, WANDA J. ENDERS, LYNDA D. TONOFF and JOHN R. ROTH. In the event that any of my said children shall predecease me that deceased child's share shall be divided equally among my other children surviving at the time of my death. ITEM 8: I hereby nominate, constitute and appoint my husband, EDWARD H. ROTH, as Executor of this my Last Will and Testament. In the event that he has predeceased me or is otherwise unable to serve, I nominate, constitute and appoint RICHARD W. CLECKNER, ESQUIRE as Executor of this my Last Will and Testament. In the event that he has predeceased me or is otherwise unable to serve, I nominate, constitute and appoint the most senior surviving partner in the law firm of Cleckner and Fearen who resides in the Harrisburg area at the time of my death. No personal representative shall be required to furnish any bond or other security in any jurisdiction, or if a bond is required, the personal representative shall not be required to furnish any surety thereon. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~Y~ day of ~/~/~l_-~ , 1990. JEAN M. ROTH Signed, sealed, published and declared by the above-named Testatrix, JEAN M. ROTH, to be her Last Will and Testament, who, in our presence, at her request and in the presence of each other, we believing her to be of sound and disposing mind, memory and understanding, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA : COUNTY OF DAUPHIN : SS: We, JEAN M. ROTH, Testatrix, and ~/_~J_~ ~~ , witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each Testatrix, knowledge, or older, of the witnesses, in the presence and hearing of the signed the Will as witnesses and that to the best of their the Testatrix was at that time eighteen (18) years of age of sound mind and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by JEAN M. ROTH, the ~ : by Testa~.r~x, and subscribed and sworn to before me %1d_~,3 __~- ~-~£~.~zK~f ~--- and__ __Z/~J/~- ~/~AJ , 1990. "CERTIFICATION OF NOTICE · UNDER RULE 5,6(a) - Name of Decedent: Date of Death: JEAN M- ROTH SEPTEMBER .26, 2000 Will No. 2oO4 .- 01033 Adm. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the O~hans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 12/2/04 · : Name Address Wanda Enders, P. O. Box 631, Elizabethville, PA 17023 L~da Tonoff, 461 Un~on Street, Millersburg, PA 17061 John R. Rotht 461 Union Street, Millersbur9, PA 17061 Notice has now been given to all persons entitled thereto under Rule 5.6a) except: · Date: 12/2/O4 L/,: E d (Signature) · Name:. Ann E. Rhoads- ' ' ~'~ Address: P.o. Box 11847 9- q~n Telephone (71~ Capacity: HarrisburG, PA 17108-1847 238-1731 x Personal Representative x Counsel for Personal Representative Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court -.- '~~....., . .,. a~l::E"~-.. . .1' i.~ . _~ _ .......... ~ _ O.JlJi~)1 Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE ANN RHOADS PO BOX 11847 InvoiceN 0: Invoice Date: Estate of: Estate No: 235 2/25/2005 lean M. Roth 21-2004-1033 Bill To: vz HARRISBURG, PA 171081847 Qty 1 Fee Description Short Certificates Fee T otai 4.00 $4.00 T otai: $4.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. .f~~.. ht{jJS i WiLLS li'~ . he", !.l~t:~; @ ~ij~!:1_ a. tF."~~il" "'........... ~ ~ ! -~ 1:"I,j fE ill "'."~ ..,0 ~'?S>u ~1"h,J~ O~:Nn ",,,,,,,,:S "1.._,,,,,,'2: 7~G~ P 28 Pi'j 12= 54 CLERK OF 0rJr)I!/I\W'\ \~/I ,~ , <, .... - cC :E en en cC "- " .... <D Z 00 0 Q w "- n: ;;: <( <( W <( t- u. ..J ~ Z I- " <( 0 <( ~ > ..J en Z '" x >- <( >- 0 '" w m Z a: n: z z w a: 0 w Z 0 ~ <L - " I- (j U l- II. <( a: w :J ...J <D U '" a: a: <( I ~ .": i'I"1 ~ ,:'1" , oS'oS'b)v "".... .0< ~. , ~ ~ .' ~ IZl <1.1 B tl~ :;:BIZl l3u~~ ~~:~ ~8~ ... 0.0: O!i!iS"" &ljS~ E-lP:O<l.l <I.IIZlUH ~~!;J~ p:80u ... ... o I- ~ ~ ~ <4lI 4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RHOADS ANN E CLECKNER AND FEAREN POBOX 11847 111 lOCUST ST HARRISBURG, PA 17108-1847 nn_u_ fold ESTATE INFORMATION: SSN: 162-26-3555 FILE NUMBER: 2104-1033 DECEDENT NAME: ROTH JEAN M DATE OF PAYMENT: 03/28/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/26/2000 NO. CD 005126 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $202.05 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 94 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WillS $202.05 GLENDA FARNER STRASBAUGH REGISTER OF WillS EIJ.15DOEX:6-00', COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 N,P.I~,O REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT w "' ~~(/.l u"'" w"U ,,00 u"'-' .." .. " I- Z W C w u w c DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) RarH, JEAN M. DATE OF DEATH (MM-DD-YEAR) OFCICIAL USE ONL) FILE NUMBER 2 1 - 0 4 01033 DATE OF BIRTH (MM-DD-YEAR) 09/26/2000 03/09/1932 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) RarH, EDWARD H [X] 1, Original Return D 4. limited Estate l;!K] 6, Decedent Died Testate (Attach copy alWill) o 9. litigation Proceeds Received D 2, Supplemental Return o 4a. Future Interest Comprom'lse {date af death alter 12-12-62) o 7, Decedent Maintained a living Trust {AttachcapyofTrust) D 10. Spousal Poverty Credit (dateo/death between 12-31.91 itnd 1-1-95) COUNTY CODE NUMBER YEAR SOCIAL SECURITY NUMBER 162 - 26 3555 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death priorta 12-13-82) o 5, Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election 10 tax under Sec, 9113(A) (Attach Sch OJ 'V- "' z w o z o .. '" w '" '" o u NAME ANN E. RHOADS COMPLETE MAILING ADDRESS FIRM NAME (If Applicable] CLECKNER AND FEAREN TELEPHONE NUMBER 717-238-1731 119 Locust Street P. O. Box 11847 Harrisburg, PA 17108-1847 z o < ...J ~ l- ii: <( u w 0:: 1. Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7, Inter -VilJos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (1) 16,000.00 (2) 0.00 (3) 0.00 (4) 0.00 (5) o 00 (6) 0.00 (7) 0.00 (8) (9) 11.510.00 (10) 0.00 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses &. Administrative Costs (Schedule H) 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13, Charitable and Governmental Bequests/See 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 z o !;;: I-' ~ ll. ::E o u g 15, Amount of Line 14 taxable at the spousal tax 0.00 rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) 16, Amount of Line 14laxable at lineal rate 4,490.00 ,,0 45 (16) 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) 19, Tax Due (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT OFFiCi1>:LlTsE6N{V .k, , " 16,000.00 (11) (12) (13) 11,51>0.00 4,490.00 o no (14) 4,490.00 0.00 202.05 0.00 0.00 202.05 Decedent's Complete Address: STREET ADDRESS 1013 Teakwood Lane .~ CITY I STATE PA I ZIP 17025 Eno1a Tax Payments and Credits: 1. Tax Due (Page Hine 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 202.05 Total Credits (A + B + C 1 (21 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 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 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 0.00 0.00 202.05 0.00 202.05 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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 December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which contains a beneficiary designation? .... Yes ....0 ......0 .......0 ......0 No IX] I!J ecJ IX] IXJ IXJ Under penalties of perjury. f declare that I have examined Ihis return, including accompanying schedules and slatements. and 10 the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. . ~I\lN~TURE OF PERSON RESPONSIBLE FOR FILING RETURN \J'r'\...;r.. ~. ~~h ANN E. RHOADS ADDRESS 119 Locust Street, P.O.Box 11847, Harrisburg, PA 17108-1847 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE D~ -'/~-o~ ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on tne net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (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. 99116 (al (1.1 I (iI) The statute does not exemDt 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 the surviving spouse is the only beneficiary. For dates of death on or affer 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 paren or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J. 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. 99116(1.2) [72 P.S. 99116(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. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) - COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ROTH, JEAN M. 21-04-01033 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price 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 I. DESCRIPTION VALUE AT DATE OF DEATH One-half interest as tenant-in-comrnon in real property situate in Wayne Township, Mifflin County, Pennsylvania known as Lot No. 37 on Plan of Jack's Mountain Development See agreement of sale attached. 16,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 16,000.00 (If more space IS needed, insert additional sheets of the same size) AEV-1511 EX+ (12-99) . ft,,!t, ~k COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF RarH, JEAN M. FILE NUMBER 21-04-01033 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. James F. Stone Funeral Home, Inc. 112 N. Harrisburg Street 5,448.00 Steel ton, PA 17113 2. Churchville Cemetery - grave opening 525.00 B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions Name of Personal Representative(s} Ann E. Rhoads Social Security Number(s)/EIN Number of Personal Representative(sl 800.00 Street Address 11Q T(Y"llClt ~t-r,::lo~t. P () ~,...y " 1147 City Harrisburg State ~ Zip 17108-1847 Year(s) Commission Paid: 2005 2. Attorney Fees Cleckner and Fearen 800.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Edward H. Roth Street Address 1013 Teakwood Lane 3,500.00 City F.n()l~ State 1'A--- Zip 17025 Relationship of Claimant to Decedent husband 4. Probate Fees Register of Wills 11/12/2004 72.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills - short certificates and filing fees 40.00 8. Cumberland County Journal - legal advertising 65.00 9. The Patriot News - legal advertising 100.00 10. One-half realty transfer tax 160.00 TOTAL (Also enter on line 9, Recapitulation) $ 11,510.00 (If more space is needed, insert additional sheets of the same size) C, "",/> h".'{',I','!(\ '~V~ SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ram, JEAN M. FILE NUMBER 21-04-01033 RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSONIS) RECEIVING PROPERTY Do Not ListTrustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and translers under Sec. 9116 (a) (1.2)) 1. One-half interest in real property specifically devised to: NUMBER I A. John R. Roth 191 S. Front St. RID. 3, 3rd Floor Steel ton , PA 17113 B. Lynda D. Tonoff 461 Union Street Millersburg, PA 17061 C. Wanda Enders 59 S. Market Street P. O. Box 631 Elizabethville, PA 17023 This was only asset Decedent had at time of death Son Daughter Daughter AMOUNT OR SHARE OF ESTATE 1/3 1/3 1/3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 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 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REY-1500 COYER SHEET $ (11 more space is needed, insert additional sheets of the same size) .~ '\ ~ ,~ \ \ '~ .~ LAST WILL AND TESTAMENT OF JEAN M. ROTH I , ROTH, of 1013 Teakwood Lane, East Pennsboro JEAN ~1. Township, Enola, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking and making void, any and all Wills or Codicils made by me at any time heretofore. ITE~l 1: I hereby direct that all of my funeral expenses, estate and inheritance taxes be paid by my Executor as soon after my death as may be found convenient. ITE~l 2: I give, devise and bequeath unto my son, JOHN R. ROTH, of Steel ton, pennsyl vani a, my house located at 1013 Teakwood Lane, East Pennsboro Township, Enola, Pennsylvania. In the event that my son, JOHN R. ROTH, does not survive me, I direct my hereinafter named Executor to sell said house and divide the net proceeds received therefrom equally between my daughter, WANDA J. ENDERS, of Elizabethville, Pennsylvania and my daughter, LYNDA D. TONOFF, of Millersburg, Pennsylvania. CLECKtlUl. 8t FEAP,EN ~ \ ,,'LI.,',o, Al \-I,\\, . .,~'I"I..U'I(" r!:I'H,sn.\lI\}IIA ~\ ~ " ~ '" ,) ~.' \:~ J(:) ITEM 3: I give, devise and bequeath in equal shares unto my daughters, WANDA J. ENDERS and LYNDA D. TONOFF, all of my jewelry as they may agree among themselves. If they cannot agree on any specific item, that item shall be sold and the net proceds received therefrom shall be divided equally among my two named daughters. ITEM 4: I give, devise and bequeath unto my daughter, LYNDA D. TONOFF, my house at 133 South Fourth Street, Steel ton, Dauphin County, Pennsylvania. In the event that my daughter, LYNDA D. TONOFF, does not survive me, I give, devise and bequeath said house to her issue per stirpes. ITEM 5: I give, devise and bequeath unto my daughter, WANDA J. ENDERS, the sum of Forty Thousand Dollars ($40,000.00). In the event that my daughter, WANDA J. ENDERS, does not survive me, I give, devise and bequeath said sum of Forty Thousand Dollars ($40,000.00) to her issue per stirpes. ITEM 6: I give, devise and bequeath in equal shares to my three children, WANDA J. ENDERS, LYNDA D. TONOFF, and JOHN R. ROTH, my property situate in Mifflin County, Pennsylvania, comprising approximately ten acres. CLU'::KnU{ & fEMIEH ArlQltliC\'S AT ll\W iIO.I'fi!SGUl?'~, ?HU,S',I.-VI\lilll. ~) ~ ~ ~ .~ It is my direction and specific condition that said real estate may not be sold unless agreed to by all three of my said children. In the event that any of my named children shall predecease me that deceased child's share shall be divided equally among my other children surviving at the time of my death. ITEM 7: All the rest, residue and remainder of my estate, whether real, personal or mixed, of whatsoever nature, wheresoever situate and from "hat soever source derived, I give, devise and bequeath in equal shares unto my children, WANDA J. ENDERS, LYNDA D. TONOFF and JOHN R. ROTH. In the event that any of my said children shall predecease me that deceased child's share shall be aivided equally among my other children surviving at the time of my death. ITEr1 8: I hereby nominate, constitute and appoint my husband, EDWARD H. ROTH, as Executor of this my Last Will and Testament. In the event that he has predeceasea me or is otherwise unable to serve, I nominate, constitute and appoint RICHARD W. CLECKNER, ESQUIRE as Executor of this my Last will ana Testament. In the event that he has predeceased me or is otherwise unable to serve, I nominate, constitute ana appoint the most senior surviving partner in the law firm of Cleckner and Fearen "ho resides in the Harrisburg the time of death. personal at my No area representative shall be required to furnish any bond or other Cl.iCCKNCR & Fi:Ail.EN AIIOld.liS AT 1/,1\' 'hIOilJlJl,C;,)'U'IISH-I.,11:1,\ security in any jurisdiction, or if a bond is required, the personal representative shall not be required to furnish any surety thereon. IN WITNESS WHEREOF, I have hereunto set my hand and seal this (~OyA day of ~~~ ,1990. #~ 7?? /P' ~ M. ROTH (SEAL) * * * Signed, sealed, published and declared by the above-named Testatrix, JEAN M. ROTH, to be her Last will and Testament, who, in our presence, at her request and in the presence of each other, we believing her to be of sound and disposing mind, memory and understanding, have hereunto subscribed our names as.witnesses. ~. // L~ ___~~ /L~. OF L7 r2 --t~ '4J ," +-f )~~, A1 OF CLeCKNeR Ii fEM1EH ,HTOIIl;L'IS ~1 U,W ,\I:iiloUlJI1G,I'UIN"nVI'.!l\!I. COMMONWEALTH OF PENNSYLVANIA : SS: COUNTY OF DAUPHIN We, JEAN M. ROTH, _--L~ d~ 7J t!;d}tI eJJ Testatrix, ~~ev witnesses, l.J, C.U;'(?I.av-S4- and respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as he~ free and voluntary act for the purposes therein expressed, and tha t each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge, the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. 9~ ;>;:;? /f'o~~ ~~~OTH - Testatrix .;;2;5 v3;?~LG?-.- ~. ~;;/ J?~ Subscribed, sworn to and acknowledged before the Testatr.ix, and subscribed and sworn __'KlLUIu2JoL-L. - Ct.(C(:IUY~~ and LIM)':; witnesses, this d<()...fJl day of /1/~~ me by JEAN to before Vef1veJ.J , 1990. M. ROTH, me by AlTOIlN[,'S AT LAW _.""~.u,_=~"_".,,._,, ",' . . ...-] r 1,;orM;ti<c, ^i,_ cll,il.,l~i14N K, ~HMFt,P,. ... , (' J '- ',~ HlJiFii:;.t\!J!ii".1, l),(~i,,:i!.:!^ ' t' L'l-"'-''''''\~,''''I';l':',.(':I-''rr'''~!iI':': ,I' ,'1 ~~~.,:,~::.:.:.:~'.;,:~:':""-_. ~. tJ7U I:'. CV;) ~/j/L.,/ OTARY PUBL~' ClECKtJER iX FEAUEN IlAI1RI!iOURG,PElUlSYLVArJIA r/;i,\1"t,f ,';;',. '.f".,i':llia f~;': -- AGREEMENT FOR THE SALE OF REAL ESTATE THIS AGREEMENT is made and entered into this -1L day of December, 2004, between ANN E. RHOADS, Executrix of the Estates of JEAN M. ROTH, Deceased and of EDWARD H. ROTH, Deceased, P. O. Box 11847, Harrisburg, PA 17108-1847 "Seller", and JOHN G. PARSON', -:ft... EILEEN.. PARSON' il_d o6m4 G. ,,"AIt~6!~~, III. collectively "Buyer". S Buyer hereby agrees to buy the following property: unimproved tract of land consisting of 10 acres, more or less, situate in Mifflin County, Pennsylvania, Tax Parcel No. 21-02-237, known as Lot #37, Jack's Mountain Development, upon the terms and conditions as follows: 1. PRICE ....................................... . $32.000.00 Check ~ Note 0 Cash 0 at signing of this Agreement, receipt of which is hereby acknowledged $ 1.000.00 Cash, cashier's check, or certified check at set tlement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $31.000.00 T.:)TJ~-,"L PRICE. . _ . 532,000.00 THIS AGREEMENT IS NOT CONTINGENT UPON BUYER OBTAINING FINANCING. 2. SPECIAL CLAUSES: 3. SETTLEMENT: Upon the failure of Buyer to make settlement by paying the purchase money in full on or before February 28, 2005, or within any extension of the settlement date, this Agreement shall be void, and the amount paid by the Buyer shall be forfeited as liquidated damages. Formal tender of deed is hereby waived. 4. TRANSFER TAXES: Real estate transfer taxes shall be paid as follows: --11 by Buyer; 1~ by Seller. 5. POSSESSION: Possession shall be given at settlement. 6. STATUS OF WATER AND SEWER: Seller makes no warranty that this property is serviced with water or sewer. 7. MUNICIPAL IMPROVEMENTS: Seller has no improvements (such as sidewalks, curbs, etc.) notice except of municipal 8. ADJUSTMENTS AT SETTLEMENT: Taxes, rents, water and sewer rents and all other periodic claims and charges upon the above-described premises shall be apportioned at the time of settlement. Purchase price includes fuel oil remaining in the tank at time of settlement. 9. RISK OF LOSS: Seller shall bear the risk of loss from fire or other casualty until time of settlement. In the event of damage to the property by fire or other casualty, Buyer shall have the option of rescinding this Agreement and receiving hand money paid on account or of accep'ciIJ.'zf th,.~ propect,y in its thel':. condition with the proceeds of any insurance recovery obtainable by Seller. 10. TITLE: Seller shall convey to Buyer by Executor's deed good and marketable title (which can be certified by Buyer'S attorney or insured at standard rates by a title company regularly insuring titles in Pennsylvania) subject to building, zoning and deed restrictions, and easements of record or visible by inspection. 2 11. REJECTION OF TITLE: In case material defects are found in the title and reported to Seller, then, if such defects are not cured by Seller within sixty (60) days, the contract shall become null and void, and monies paid by Buyer shall be returned, at the option of Buyer. Seller agrees to the application of so much of the purchase money as required to the payment of liens and encumbrances at settlement. 12. INSPECTION: It is understood that Buyer has inspected the property (or has waived the right to do so) and is not relying upon any repre:Jentation by Seller, his Agent or Broker. 13. LEGAL RESPONSIBILITY: THIS IS A LEGALLY BINDING CONTRACT. IF NOT UNDERSTOOD, CONSULT YOUR ATTORNEY. IN WITNESS WHEREOF, the said parties have hereunto set their hands and seals, intending to legally bind themselves, their heirs, administrators, executors and assigns. All parties hereby acknowledge receipt of a fully executed copy of this Agreement. WITNESS: ~ .E.~ E'K'ctSEALl ANN E. RHOADS, ExecUtrix'bf the Estates of Jean M. Roth, Deceased and Edward H. Roth, . Deceased - Seller ~~(;G.~A~ ter (SEM,) :1((. [L",d ~~ EILEEN/'. PARSON' - .. v (SEAL) Buyer ~ _ "'~~_ r--.~~tAL) "" ~"oJ Jol'lNJG. R NS, III - uyer 3 prevIous eOlllons arq Otlso!qte lOTmnu",.'j \Jloo/rllfnIlIlUUU\lIl.....U".A - A. Settlement Statement u.s. Department of Housing and Urban Development OMB No. 2502-0265 rexolres 9/30/2006\ LANDTRANSFER B. TYPE OF LOAN 1. DFHA 2. DFmHA 3. DCony. Unlns. 4. nVA 5. nCony.lns. e-mail: set1le@londlronsferco.com 6. FILE NUMBER 17. LOAN NUMBER 51253L 8. MORTGAGE INSURANCE CASE NUMBER C. Note: !.~~~.!~'~~.'.s urn. 1.f0 gNe J..~u a 8Ul;t8itJem: of ae UB "llIem'~~~0.8~,:!:,,~~~un . pa!';I. ~~ a ~~,~ Y_ \n~e_ e~\~em~ .g!!m~IrD liinown. l TitleExpress Settlement Syslem lIems marked "(p.o.c.)" were paid outside the closing; they lire .hown her. fOf Information purpose. and are not Included In the totals. WARNING: It Is II crime to knOWlng~o~ake false ,tatem.nls to the United Slates all this or.~ other similar rorm. Penaltle. upon Prinled 0311612005 al 08:26 DRM convictIon can Iftclude a fine and 1m r1.onment. For detail. see: Title 1B U. S. Code Section 1 01 and Section 1010. D. NAME OF BORROWER: John G. Parson, Jr. and Eileen S. Parson ADDRESS: 167 Bethesda Church Road W Holtwood PA 17532 E. NAME OF SELLER: Jean M. Roth Estate and Edward H. Roth Estate ADDRESS: Cleckner and Fearen POBox 11847 Harrisbura PA 17108.1847 F. NAME OF LENDER: ADDRESS: G. PROPERTY ADDRESS: L.37 Jacks Mountain, Jack's Mountain Development, Mifflin County, PA Township of Wayne o Princloal Residence n Other Real Estale H. SETTLEMENT AGENT: Land Transfer Co., Inc., Telephone: 717.397.3300 Fax: 717.397.6283 PLACE OF SETTLEMENT: 53 North Duke Street. Suite 320 Lancaster PA 17602 I. SETTLEMENT DATE: 03116/2005 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales orlce 32 000.00 401. Contract sales orice 32000.00 102. Personal pronerty 402. Personal Pmne.rty 103. Selllement charnes 10 borrower lline 1400\ 880.50 403. 104. 404. 105. 405. Adlustments for Items oaid bY seller In advance Adlustments for Items oald bv seller In advance 106. City/town laxes 03/16/051012/31/05 12.85 406. City/town taxes 03116/051012/31/05 12.85 107. County taxes 031161051012/31105 142.91 407. CounlY taxes 03116/051012/31105 142.91 lOB. SchoolT axes 03/16/05 to 06130105 62.69 40B. School Taxes 03/16105 to 06/30/05 62.69 109. 409. 110. 410. 111. 411. 112. . 412. 120. GROSS AMOUNT DUE FROM BORROWER 33 098.95 420. GROSS AMOUNT DUE TO SELLER 32218.45 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deoos" or earnest moneY 1 000.00 501. Excess Deoosillsee instructions) 1 000.00 202. Princioal amount of new loans 502. Selllement charnes 10 seller lline 14001 982.96 203. Exislino loanls) laken sublect tn <m I=vi(1tinn l,.,o::ln!C!' f-:,),t>n "",hi"", In ....'..VIVU'" 8QIIIOnS are oDsolOlo US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT File Number: 51253L form HUO.113IB6j rof Handbook 4305.2 PAGE 2 TitleExnress SeWement Svstem Printed 0311612005 at 08:26 DRM L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESIBROKER'S COMMISSION based on nrice $32.000.00@0.000" BORROWER'S SELLER'S Division of commission lline 700\ as follows: FUNDS AT FUNDS AT 701. $ to SETTLEMENT SETTLEMENT 702. $ to 703. Commission naid at SeWemen! 800. ITEMS PAYABLE IN CONNECTION WITH LOAN BOt Loan Orinination Fee % B02. loan Discount % B03. Annraisal Fee B04. Credit Renor! B05. lender's Insnection Fee 806. Morlnane Annlicalion Fee B07. Assumnlion Fee 80B. 809. Bl0. Bl1. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Inlerest From to ~ Ida" 902. Morlnane Insurance Premium for 10 9Q3. Hazard Insurance Premium for 10 004. 005. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo.'"'~ /mo 1002. Mortnane Insurance mO.1m ~ Imo 1003. Citv ProMr!v Tax mo~ 1.34/mo 1004. Counw Pronertv Tax mO.'"'t 14.94 /mo 1005. School Taxes mo.ml$ 17.82 Imo 1009. Annrenate Anal"sis Adjustment 0.00 0.00 11 00. TITLE CHARGES 1101. Settlement or ciosinn fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Prenaration to Land Transfer Co.. Inc. 95.00 1106. Nolan' Fees to Nolarv 2.00 2.00 1107. Attornev's fees !includes above items No: \ 1108. Title Insurance to Land Transfer Co. Inc. 434.50 {includes above items No: , 1109. Lenders Polic" , 1110. Owner's Policy 32,000.00 - 434.50 1. .WAN M _ Q(Y(1R deCea:led one-half interest as tenant-in-common in real property situate in Wayne Township, Mifflin county, Pennsylvania known as Lot No. 37 on a plan of Jack's Mountain Development 16,000 00 TOJ'AL $16,000 00 'C'"j COMMONWULTH 0' PENNSYLVANIA 'l COUNTY O' DAUPHIN "' -: ) ~ .1 '. ANN E. RHOADS b.ill9 d~Iy "",,,rn ..ccordill9 10 r..w. d.p"'" alld "Y' Ih..I she ;" llxecutrix of th. E.t.I. of Jean M. Roth I..t. 01 -Eaat J?enoaoorQ..l'Q.\ffi.;lh.iI?___ --_ . Cumb.rland COUII/y, Pa.. d.cused and Ihal Ih. wilhill is an inventory mad. by Ann E. Rhoads . Ih. ,aid Executrix of the .ntire e,Iate of IIid deced.nl, co",iltiIl9 of ..II the p.nonal pro"..rty and r..1 ..Iale, excepl rul e.lale ouhide the Commonweallh of P.nn'ylvania. and thaI Ihe figures oppo,ile each item 01 Ihe Invenlory repr.,ent it', fair ...olue .. of Ihe dafe of d.c.dent', dealh. Sworn .tD and lublcrib.d b.fore me, /J1A.rJ, It.. .;;.o()~ ~ , ~.., a ~ ~.2A~~ eucotofix ~!IIblr ANN E. RHOADS 119 Locust St., P.O. Box 11847 NOTARIAL SEAL JENNY A TOBIAS. Notary Public City of Hamsburg. Dauphin County My Commission Expires Februa 15. 2009 Harrisburg, PA 17108-1847 Addu.. Oat. of Dealh 26th o.Y September MCl"fh 2000 Y.., INSTRUCTIONS I. _ An in...entory must b. li1.d within Ihr.e moMhs "fter appointment of p.rsonal r.pr..entaii..... 2~ ~ suppl.ment ir\Ventoryrnus! be filed within thirty days of dis.covery of additional o...ts. 3. Additional she.ts may b. aHached as to personalty or realty 4. SH Article IV, Fiduciaries Ad 011949. I ",I HI I :c' ! ..., ~ I >- . [;l I- W w 0:: l- . H I >- w < . ~ ~ "- I- ~ u . , 0 V1 . 0 0 '" >- ~ I w 0:: w :C' g '" . l- I ... t;; 0.. c , .... ..J <L. U) '" - .. ~ I z < 0 0:: il 0.. U) 0 u.. ..J ~ :l: UJ 0 < w :i ~ > Z 0:: :;:, ~I ~I<( c I Z 0 0 ~: " .. V1 Z 0 0:: ~l u z w < "', ~ OJ 0.. I ..., i " ~ - ..! , 0 ~ . .c ..., ->< d . E - . 0 " .. " Glenda Farner Strasbaugh Register of Wiils and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: ANN E. RHOADS, ESQ. 119 LOCUSTST P.o. BOX 11847 HARRISBURG, PA 171081847 Qty 1 Fee Description Additional Probate Total $10.00 Fee 10.00 Total: $10.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 317 4/15/2005 lEAN M. ROTH 21-04-1033 JA Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: ANN E. RHOADS, ESQ. 119 LOCUSTST P.O. BOX 11847 HARRISBURG, PA 171081847 Qty 1 Fee Description Additional Probate Fee Total 10.00 $10.00 Total: Cfuc K- # /0/ $10.00 Checks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. 1" 317 4/15/2005 lEAN M. ROm 21-04-1033 JA I 11'1' I:', '-: I rs1 t1) 'I~: g I I I -,: I i I .~ I I g ..: , I, t) Pl t1) i:: .-I ~ 0 ~ 8 r-- H .-I ~ .ce t) fit PI ~3 .. rs1 ~ ~ ~ t1) ~I~ t!J ~ tl t) .- .- ('I 1:::- () I.) UI (fl I ('I Ul ('") F) +. ('") .".) "- V CO Z I CO W 0 0:: "- < ~ w ti ~ LL III ,... Z ~ It: V ~ 0 Iii ell Z ;.J Ul Iii ~ ~ <( >- 1&1 ::I lD Z 0:: z u z W II: 9 ci 1&1 Z 0 CJl Ii IL ~ ~ ~ - 6 U 0( II: :J W m ....J III U it: II: 0( :J: () r... "00) CLECKNER AND FEAREN ATTORNEYS AT LAW 119 LOCUST STREET P.O. BOX 11847 HARRISBURG, PENNSYLVANIA 17108-1847 TELEPHONE: 17171238-1731 FAX: 17171238-8481 RICHARD W. CLECKNER (1926 - 2004) RETIRED: WILLIAM FEAREN ROBERT D. HANSON DENNIS J. SHATTO ANN E. RHOADS June 24, 2005 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: Estate of Jean M. Roth File #21-04-1033 Dear Ladies and Gentlemen: I enclose the inheritance tax statement stub and a check in the amount of $41.82 in payment of the balance due on the inheritance tax for the above-referenced estate. Thank you. Very truly yours, CLECKNER AND FEAREN ~ Ann E. Rhoads AER: lnm Enclosure cC H Z cClI.I >:>> ...IZ >11.1 (I)> Zll.l i:5D: D.IL ILO 01- zZ 1-11.1 ...Iz: cCl- II.ID: 3cC ZD. 011.1 z:A z: o u III U ZX .c.c SI- o ... I<.. X"'O .c.c I-CI)I- I-IZ IIlQIIl U :I: Zlt:CI) .cOCl) I- III I-IIIlCl) It:UCI) IIlZ.c ::c.c ZSQ I-IOZ ....c 1<..... O.cCl) Z III "0 UI-I-I I-IZI- I-IIlU 0:1::) ZIIlQ Cl)1Il I-IQ .c It:1<.. a.. 0 a.. .c CI) III X .c I- "'z ... .co 0 :).... '" QIIl 0 1-1.... I >~ ~ I-ICl ... Q .... ~~...: oD.. I<..LIJ'" O~:~ ~~~~ Wl:lrl::OIoool ~i:! a:lMc..::z: ~ III o I '" o ~ z: D.. .... cr X LIJ .... ... III ... 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" CD n.. 0 ....., ., .. III III - III COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005489 RHOADS ANN E CLECKNER AND FEAREN POBOX 11847 119 LOCUST ST HARRISBURG, PA 17108-1847 ACN ASSESSMENT CONTROL NUMBER AMOUNT ____n__ fold 101 $41.83 ESTATE INFORMATION: SSN: 162-26-3555 FILE NUMBER: 2104-1033 DECEDENT NAME: ROTH JEAN M DATE OF PAYMENT: 06/27/2005 POSTMARK DATE: 06/24/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/26/2000 TOTAL AMOUNT PAID: $41.83 REMARKS: CHECK#103 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS DEPARTMENT OF REVENUE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005491 RHOADS ANN E CLECKNER AND FEAREN POBOX 11847 119 LOCUST ST HARRISBURG, PA 17108-1847 ACN ASSESSMENT CONTROL NUMBER AMOUNT n_U___ fold ESTATE INFORMATION: SSN: 162-26-3555 I FILE NUMBER: 2104-1033 I DECEDENT NAME: ROTH JEAN M I DATE OF PAYMENT: 06/27/2005 I POSTMARK DATE: 06/24/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 09/26/2000 I I TOTAL AMOUNT PAID: $41.82 REMARKS: CHECK#103 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 101 $41 82 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DisALLOWANCE DF DEDUCTIONS AND ASSESSHENT OF TAX 06-20-2005 ROTH 09-26-2000 21 04-1033 CUMBERLAND 101 APPEAL DATE: 08-19-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REy:is47-Ex-AFP-io3:osi-NOTICE-OF-INHERITANCE-TAX-APPRAISEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JEAN M FILE NO. 21 04-1033 ACN 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN BUREAU OF INDIVIDUALTAXE$ INHERITANCE TAX DIVISION PO BOX Z8060l HARRISBURG PA 171Z8-0601 Pi) I: 54 i I .'"'...t".... ANN E RHOADS CLECKNER & FEAREN PO BOX 11847 HBG PA 17108 ESTATE OF ROTH *' REY-1547 EX AFP (06-05) JEAN M TAX RETURN WAS: (X I ACCEPTED AS FILED DATE 06-20-2005 I 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 DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (11 (21 (31 (41 (51 (61 (71 16.000.00 .00 .00 .00 .00 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitab1e/Govern..ntal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Est.te Subject to Tax NOTE: I~ an assess.ent was issued previously, lines reflect ~igures that include the total ~ ALL ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rat. (15) 16. A~unt of Line 14 taxable at Line.l/Class A rat. (16) 17. AmOWlt of Line 14 at Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due DI + INTEREST/PEN PAID (-I .00 DATE 03-17-2005 NUHBER CD005126 ~ BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-18-2005 (91 1101 11 ,510.00 NOTE: To insure proper credit to your account, sub.it the upper portion of this form with your tax paYllent. 16,000.00 11.~10 00 4,490.00 .00 4,490.00 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 202.05 .00 .00 202.05 202.05 .00 41.82 41.82 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATIDN OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOHN FOR INSTRUCTIONS. I .00 1111 1121 1131 1141 .00 X 00 = 4,490.00 X 045 = .00 X 12 = .00 X 15 = 1191= AHOUNT PAID 202.05 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE IIUftAlI 01' IIIJIVIDUAL TAX~r.nRDFD Qt:r:ICE nC :INHER:ITANCE TAX JIlItERITAIICE TAX DIVISIIII ;:;;:~:r~;:n r,~' .I'STATEMENT OF ACCOUNT PO lOX 210601 rd-, i:,l: "'~1 \ .t- _1SIURll PA 17128-0601 -.- - . - ~ *' REV-1607 EX AFP (05-05) 2005 JUL 22 PIll 2: 12 DATE ESTATE OF DATE OF DEATH FILE NUlmER COUNTY ACN 07-18-2005 ROTH 09-26-2000 21 04-1033 CUMBERLAND 101 ~t R_lttllCl JEAN M CLERK OF ORn'-i.h;\lJ!"\ (,(~llR~ llr'tl,:) \j\)U \\ ANN E RHOADS CUil!:':!" "'-:': Pt\ CLECKNER a FEAREN PO BOX 11847 HBS PA 17108 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To In..... p,"-r crllCllt to your _t, subotlt the _r portion of thla fOI"ll with your t.x ~t. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS ... --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF ROTH JEAN M FXLE NO.21 04-1033 ACN 101 DATE 07-18-2005 THIS STATEIlENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACIl IN THE NAMED ESTATE. SHlMl BELOlI IS A SUIlItARY OF TIlE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYltENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PIlO.IECTEO INTEREST FIIURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-20-2005 PRINCIPAL TAX DUE: 202.05 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AM.OUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-17-2005 CD005126 .00 202.05 06-24-2005 CD005491 41.82- 41.82 TOTAL TAX CREDIT 202.05 BALANCE OF TAX DUE .00 INTEREST AND PIN. .00 . IF PAm AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN tl, NO PAVltENT IS REtlUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (eR), YOU KlY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXft:CORDED OFFICE OF INHERITANCE TAX ~"":~T=orAX DIVISIlIN Pf:(;!SFR (': "jl'l STATEMENT OF ACCOUNT _ISIIURIl PA 17128-0601 '-'" - .,I, '. '* REV-1607 EX AFP (03-05) CLER1< OF ODr" ""\"" rl" 'RT IIr'nL;'d.,:j I._-,.,)U \ ANN E RHOADS CUilJ:':::'" T PA, CLECKNER & FEAREN PO BOX 11847 HBG PA 17108 I MAKE CHECK PAYABLE ANDREMtT PAYMENT TO: 07-18-2005 ROTH t9"2~'-2000 21 04-1033 ,ClAMBER LAND 101 ......t '_1 ttllCl JEAN M 2005 JUL 22 PI'1 2: 12 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN REGISTeR OF WILLS CUMBERLAND'CO COURT HOUSE CARLISLE, PA 1~013 IlOTE: To Insure pr_r crllClU to your ...caunt, subIIU the _r portion of this fa... with your t.lC P.Q~t. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS ... --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF ROTH JEAN M FILE NO.21 04-1033 ACN 101 DATE 07-18-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SIIOlIN BELOW IS A SUIlItARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PRO.JECTED INTEREST FI8UIlE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: ~6-20-2005 PRINCIPAL TAX DUE: 202.05 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AHPUNT PAID DATE NUMBER INTEREST/PEN PAID (-) , ,,',' '. " 03-17-2005 CD005126 .00 202.05 06-24-2005 CD005491 41. 82- 41.82 , . , TOTAL TAX CREDIT 202.05 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 , .00 . IF PAID AFTER THIS DATE, SEE REVERSE ' , TOTAL DUE SIDE FOR CALCULATION' OF ADUITI_.:;, INTEREST. ( IF TOTAL DUE IS LESS THAN .1, ~ PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YDU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ U, (__:'.i Ct:: t , _ (..::. C21 11.1- C~.) ~~,S' . t,; ;. c: Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: JEAN M. RarH Date of Death: September 26, 2000 Estate No.: 2004 -01033 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: Yes 0 No@ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3-6 months 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 9/8/05 ~~v~ Signature r-- -.t. Ann E. Rhoads Name 119 Locust Street Harrisburg, PA 17101 Address (' -,j C._ C....,.l -; r'--) f:~ c:--) C'J 717-238-1731 Telephone No. ( Capacity: 0 Personal Representative o Counsel for personal representative Q;~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/30/2005 RHOADS ANN E CLECKNER AND FEAREN POBOX 11847 119 LOCUST ST HARRISBURG, PA 17108-1847 RE: Estate of ROTH JEAN M File Number: 2004-01033 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 9/26/2005 Your prompt attention to this matter will be appreciated. Thank You. ~nceretYJy 6-Ld# ~~"j~ GLENDA FARNER STPASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge Q;~ Cumberland County - Register Ot Wllls One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 RHOADS ANN ELIZABETH ESQUIRE CLECKNER & FEAREN 119 LOCUST ST PO BOX 11847 HARRISBURG, PA 17108-1847 RE: Estate of ROTH JEAN M File Number: 2004-01033 Dear Sir/Madam: This notice is to serve as a reminder that the StatU:3 Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 9/26/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, / r.4J, Lt-L.__Jl j~U~U~-/ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - ~eglsLer UL W~~~b One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 RHOADS ANN E 119 LOCUST STREET HARRISBURG, PA 17108-1847 RE: Estate of ROTH JEAN M File Number: 2004-01033 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 9/26/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, 1;'7 . (~; ,b- / /J ~Z;~~a",~ lJ,~~JJ.tt?MU~'-' , (! Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel t l. C)( L-LJ c"' ,.,1,__ c51- ~~. c:c: (:.~I (~ UJ c:= . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: \3€..~~ ~. ~,~ Date of Death: CP\ \ ~\C\ ~ .. " Estate No.: doC'-\, - D lD33 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 a~D;istration of the estate is complete: Yes 0 No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: lo. \Y"\ C:><"'\ ~ 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~~D~ ~~.~ Signature ~" E.. ~~ ~\~ ~C-.\J.- ~~ ~~. r?o ~~~~~~~ ~~ \\\\:)~ -\ tMJ Address \ co ~:;! \ \ "( -:;:L3S - fl '3 ) Telephone No. Capacity: bPersonal Representative ~Counsel for personal representative ~,.....,.. c-" I ~~_'l +~~) =- ~ <2__ - PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARL Y UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: JEAN M. ROTH September 26, 2000 Estate No.: 01033-2004 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: Yes X No 2. If the answer is No, state when the personal representative believes that the administration will be complete: (date) 3. If the answer to NO.1 is yes, state the following: A. Did the personal representative file a final account with the court? ~ ~ X B. The separate Orphans' Court No. (if any) for the personal representative's account is: (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 offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~ .;l."\ \, 0 ~ ~ .t.~o~ Signature Ann E. Rhoads Name (Please type or print) 'v,\(\f\ , . . i:~jl' 'tl \J '.,.i;' ,'. . 4"~'--\ IUO ~u -..' -- ('" \:_,1 00 \\.:,C\\ )',,j 0'\' 'e ' .l-L, " Vri1 \J ,. ~ '-... ....... Cleckner and Fearen, 119 Locust St. P.O. Box 11847, Harrisburg, PA 17108-1847 Address I c_yWflUUI +t \ ~ \ \'\0 ;j , . (717)238-1731 Telephone No. Capacity: ~ Personal Representative Counsel for Personal Representative \ qj IN RE: C I d l' I _.J . I u,.... IN THE COURT OF COMMON PLEAS OF DAUPHIN COUNTY, PENNSYLVANIA ESTATE OF ORPHANS' COURT DIVISION JEAN M. ROTH, NO . 01033 - 2 004 DECEASED AGREEMENT TO INDEMNIFY, RECEIPT AND RELEASE Filed on behalf of: Ann E. Rhoads, Executrix of the Estate of Jean M. Roth, Deceased CLECKNER AND FEAREN 119 LOCUST STREET P. O. BOX 11847 HARRISBURG, PA 17108-1847 (717) 238-1731 ~-{,/t'r.t '7 ,..: \. \ ~ AGREEMENT TO INDEMNIFY I RECEIPT AND RELEASE THIS AGREEMENT, entered into this ~/'-f;- day of f:bc Q fY\-D.v , 2006 by and between ANN E. RHOADS, individually and as Executrix of the Estate of Jean M. Roth, Deceased; LYNDA D. TONOFF, and WANDA J. ENDERS. WHEREAS, Jean M. Roth, late of East Pennsboro Township, Cumberland County, Pennsylvania, died September 26, 2000, having left her Last Will and Testament dated November 20, 1990, which was duly admitted to probate by the Register of Wills of Cumberland County at the above number and term on November 12, 2004; and WHEREAS, Jean M. Roth was married at the time of her death; her husband, Edward H. Roth, however, died on June 4, 2004, and the latter's Last Will and Testament was admitted to probate by the Register of Wills for Dauphin County, Pennsylvania (No. 937 of 2004); and WHEREAS, Ann E. Rhoads was duly appointed as Executrix of the Estate of Jean M. Roth, Deceased, on November 12, 2004; and WHEREAS, the parties in interest under the Last Will and Testament of Jean M. Roth, Deceased, are: (1) John R. Roth - Son (2) Lynda D. Tonoff - Daughter (3) Wanda J. Enders - Daughter and - 1 - WHEREAS, the original proofs of publication of the grant of Letters Testamentary are marked "Exhibit A", attached hereto and incorporated herein by reference; and WHEREAS, partial distributions of the estate of Jean M. Roth were made as follows: 07/25/2005 - Lynda D. Tonoff - Cash - $4,000.00 07/25/2005 - Wanda J. Enders - Cash - $4,000.00 08/05/2005 - John R. Roth - Cash - $4,000.00 The Releases for these Partial Distributions are marked "Exhibit B", attached hereto and incorporated herein by reference; and WHEREAS, John R. Roth died on September 22, 2005, before administration of the Estate of Jean M. Roth could be completed. A true and correct copy of John R. Roth's death certificate is marked "Exhibit C", attached hereto and incorporated herein by reference; and WHEREAS, no estate has been opened for John R. Roth since his death; and WHEREAS, the Executrix of the Estate of Jean M. Roth has received a claim from the Pennsylvania Department of Public Welfare against John R. Roth's share of said estate. A true and correct copy of a letter dated October 10, 2006, stating said claim is marked "Exhibit D", attached hereto and incorporated herein by reference; and - 2 - WHEREAS, Lynda D. Tonoff and Wanda J. Enders paid the expenses of their brother, John R. Roth's funeral, which totaled $1,425.00. True and correct copies of the statement for those expenses are marked "Exhibit E", attached hereto and incorporated herein by reference; and WHEREAS, the total claim of the Pennsylvania Department of Public Welfare against John R. Roth has been paid by the Estate of Edward H. Roth (Dauphin County, Pennsylvania; No. 937 of 2004); and WHEREAS, each of the parties to this Agreement has been furnished with a complete listing of the estate assets, receipts and disbursements during the administration of Ann E. Rhoads as set forth on the accounting attached hereto and marked as "Exhibit F"; and WHEREAS, no person has contacted Ann E. representative of John R. Roth's estate since September, 2005; and WHEREAS, It is the desire of the parties to this Agreement that final distribution of this estate be accomplished without a formal accounting to the Orphan's Court Division of the Court of Common Pleas of Cumberland County , Pennsylvania, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting. Rhoads as his death a in - 3 - NOW, THEREFORE, in consideration of the mutual promises, covenants and agreements recited herein and with the intention to be legally bound, the parties do agree as follows: 1. Ann E. Rhoads, Executrix, shall distribute the balance of the estate in accordance with the following: a. On behalf of John R. Roth: To: Lynda D. Tonoff, in partial repayment of funeral expenses 240.44 To: Wanda J. Enders, in partial repayment of funeral expenses 240.44 b. To: Lynda D. Tonoff $480.87 $480.87 $480.87 c. To: Wanda J. Enders 2. Lynda D. Tonoff and Wanda J. Enders, do each for themselves, their executors, heirs and assigns, release and forever discharge Ann E. Rhoads, individually, and as Executrix from any and all liability which may arise from time to time in connection with her services as Executrix of the Estate of Jean M. Roth, Deceased. The parties do further agree to indemnify and hold harmless said Ann E. Rhoads from any and all liability which may arise against the Estate of Jean M. Roth or the Estate of John R. Roth from creditors or other claimants. 3. Each of the parties does hereby acknowledge receipt as set forth above of the assets described in the exhibits attached hereto. 4. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings - 4 - and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. WITNESS: \7L'1 ,f 7c'PL d~ ~ 'i:...~~ ANN E. RHOADS , Individually and as Executrix of the Estate of Jean M. Roth, Deceased / ~ , \4/i",-/ /; 72/"tdl I ~ 0, q-~ A D. TONOFF \J. i /1 /' If' r;'//{ d(} I v~~~ WANDA J. ERS - 5 - PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYL VANIA ss. COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues ofthe said Cumberland Law Journal on the following dates, VIZ: FEBRUARY 11, 18,25,2005 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Roth. Jean M., dec'd. Late of East Pennsboro Township. Executrix: Ann E. Rhoads, P.O. Box 11847, Harrisburg, PA 17108-1847. Attorneys: Cleckner and Fearen, 119 Locust Street, P.O. Box 11847, Harrisburg, PA 17108- 1847. SWORN TO AND SUBSCRIBED before me this 25 day of FEBRUARY 2005 SEAL LOtS E. SNYDER, Notary Public Carlisle Boro, Cumberfand County My Commission Expires March 5, 2005 EXHIBIT A All-STATE"' INTERNATIONAL THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss James L. Clark, being duly sworn according to law, deposes and says: That he is the Accounts Receivable Manager of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Metro editions which appeared on the 8th, 15th and 22nd day(s) of February 2005. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION Qi .......................... /..;...... ~.l......................................................... I Estate Notices (West) Sworn to and subscribed before me NOTARlA1. SEAL Terry L. Russell. Nota aty of Harrisburg, Dau My Commission expires June ,2 A PUBLIC Memb.r.P.nnsylvanlaAnocl~emffitfl~~ion expires June 6, 2006 COpy ESTATE NOTICE NOTICE IS HEREBY GIVEN that Letters of Testamentary In the Estate of Jean M. Roth, Io1e of East Pennsboro Township, Cumberland County, PennsYlvania. de- ceased (died September :16. 2000) hcMl been granted ta the underslllllecl. and all PIlf'SOns IndebIecI to said Estate are requIred to make Immedlofe payment and those havIng claims will present ftIern for settlement to. Am! E. RIllIads, ex.cuIrIx . P.O. Box 11147 Hwr1sIIurlI, PA ~1147 or CIIIcIIneI'.... ~ 119 ~ street P.O. Box 11147 H.-r......... PA m..ll47 AttomeyS . CLECKNER & FEAREN ATTN: DENNIS SHATTO 119 LOCUST STREET P.O. BOX 11847 HARRISBURG, PA. 17108-1847 Statement of Advertising Costs To THE PATRIOT-NEWS CO. For publishing the notice or publication attached hereto on the above stated dates 126.27 Publisher's Receipt for Advertising Cost The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. By.................................................................... RELEASE FOR PARTIAL DISTRIBUTION KNOW ALL MEN BY THESE PRESENTS, that I, LYNDA D. TONOFF, for and in consideration of Four Thousand Dollars ($4,000.00) to be paid by the Estate of Jean M. Roth, the receipt of which is hereby acknowledged as of the date of this instrument, payment of which constitutes a partial distribution of my share as legatee under the Last Will and Testament of Jean M. Roth, and to the extent of $4,000.00 do hereby remise, release and forever quitclaim unto Ann E. Rhoads, her heirs, executors and administrators, any and all manner of actions, causes of actions, debts, dues, claims and grants, both at law and in equity, against her in her capacity as Executrix of the Last Will and Testament of Jean M, deceased, and against the Estate of Jean M. Roth, deceased, whether as a legatee under the Last Will and Testament of the said Jean M. Roth or in any other capacity I have had, now have, or ought to have for or by reason or means of any matter or thing from the beginning of the world to the day of the date of these presents. I hereby agree to refund to said Executrix, pro rata, any amount which may be necessary in the future to discharge any liabilities of the Estate upon notice thereof from said Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 22. day of -::JulY , 2005. r/;.4rM $?~~~OFF ( SEAL) ~'11 ~'. nWj LL'lf/"t,,~ ~ .> EXHIBIT l3 All-STATE" INTERNATIONAL RELEASE FOR PARTIAL DISTRIBUTION KNOW ALL MEN BY THESE PRESENTS, that I, WANDA J. ENDERS, for and in consideration of Four Thousand Dollars ($4,000.00) to be paid by the Estate of Jean M. Roth, the receipt of which is hereby acknowledged as of the date of this instrument, payment of which constitutes a partial distribution of my share as legatee under the Last Will and Testament of Jean M. Roth, and to the extent of $4,000.00 do hereby remise, release and forever quitclaim unto Ann E. Rhoads, her heirs, executors and administrators, any and all manner of actions, causes of actions, debts, dues, claims and grants, both at law and in equity, against her in her capacity as Executrix of the Last will and Testament of Jean M. Roth, deceased, and against the Estate of Jean M. Roth, deceased, whether as a legatee under the Last Will and Testament of the said Jean M. Roth or in any other capacity I have had, now have, or ought to have for or by reason or means of any matter or thing from the beginning of the world to the day of the date of these presents. I hereby agree to refund to said Executrix, pro rata, any amount which may be necessary in the future to discharge any liabilities of the Estate upon notice thereof from said Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ;"5 -h day of riu If , 2005. UL/J/1/ a. ~b WITNESS 1)~rg.~ WANDA . E ERS (SEAL) RELEASE FOR PARTIAL DISTRIBUTION KNOW ALL MEN BY THESE PRESENTS, that I, JOHN R. ROTH, for and in consideration of Four Thousand Dollars ($4,OOO.OO) to be paid by the Estate of Jean M. Roth, the receipt of which 1S hereby acknowledged as of the date of this instrument, paYment of which constitutes a partial distribution of my share as legatee under the Last Will and Testament of Jean M. Roth, and to the extent of $4,000.00 do hereby remise, release and forever quitclaim unto Ann E. Rhoads, her heirs, executors and administrators, any and all manner of actions, causes of actions, debts, dues, claims and grants, both at law and in equity, against her in her capacity as Executrix of the Last Will and Testament of Jean M, deceased, and against the Estate of Jean M. Roth, deceased, whether as a legatee under the Last Will and Testament of the said Jean M. Roth or in any other capacity I have had, now have, or ought to have for or by reason or means of any matter or thing from the beginning of the world to the day of the date of these presents. I hereby agree to refund to said Executrix, pro rata, any amount which may be necessary in the future to discharge any liabilities of the Estate upon notice thereof from said Executrix. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,/L /j ~ day of &(/('vS I- , 2005. U a~4 /J10~~ / ~ ~ ;?-cl-d (SEAL) HN R. ROTH ~ IV.l.MLl Kt:. V IIU:-l This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~.!.. 'if ~?' Cl q C) h q ..' f "~... L~tj No. /J/Y)~. fJ) ~1/t.I-~~ . . :? Local Registrar Fee for this certificate, $6.00 p SEP 2 3 2005 Date 3.144Rev.1/91 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) ,e. l2or/./ STATE FILE NUMBER SEX SOCIAlSECURrTY NUMBER 2. fl')f.1LIL. 3. .;loa .. (p';;> - oC, (~8 BIRTHPLACE (City and PLACE OF D~ATH (Check only one see instructions on other side) SIBte or Foreign Counlry) HOSPITAL: ///-Ie{-2I.:>iS(/':;:~J;' p. Inp.t~nt 0 DOA 0 7. 8a. FACILITY NAME (If not institution. give street and number) DATE OF DEATH (Month, Day, Year) .. September 22, 2005 UNDER 1 DAY ~b:fy)O Houn:; Minutes DECEDENT'S USUALOCCUPIVION (~Iv::ti~~\~r~d~~tu~~r~~~r~~r .. 11a. ()l.,J E:,n Pl--'~"i fc...b 11b. DECEDENT'S MAILING ADDRESS (Street. CityfTown. Slate, Zip Code) (.)\.r-\ ()r:~A~-('. ,:,~'r: KINO OF BUSINESSlINOUSTRY MARITAL STATUS. Married "'ever Married, WIdowed, . . Divorced (Spocify) 14. 61 t10 k!.r:.I<...J.':J RACE. American Indian, Btack., White. etc (Speoify) td If I{" ,;:- 10. ~- SURVIVING SpOUSE ~f Wife, give maiden name) 'c. Derry DECEDENT'S ACTUAL Old RESIDENCE decedent 1"1), '-.<.le ,;2.:':' '.::SU c.b- /)"., ,. '7 (; (~., I (See;nsltue'On, '''.. ICl L' >:). JJ r-i llvelna 16. I CI1 other side) 17b. Count t) 1 r H township? 17d.D ~~~e~~~7~1~~ 01 FATHER'S NAME (First'Middle. last) I MOTHEA'S NAME (First, Middle, Maiden Surname) l 1.. [1.'::.i:JA,Z-':::. I. k?On-J 1.. ...)f.::j.!r.J ,rrMi.:?Lntj,{?tf:., ,ry)c.. f)/-i tV/JEL INFORMANT'~NAME(Type/Print) INF2:~M~'SMAIUNGADDRE:3S(Slreet,~~ty~~n,State,ZiPC_ode) _ ...")~{'.. n .. . 20a /. Y lJ t) ;:1 ('::,. I 6/J 0 r-r:: 20b f (,..1 tiN i(y.J ...:J ' . /') II/"_L..';: <<s.;:, I:.~ \.1 ~.:.{s /1:) METHOD OF DISPOSITION . PLACE OF DISPOSIT10N . Name of Cemetery, Crematory lOCPJION . CltyfTown, Stale. zip Code BrlalO Cr at'l)iR IIromSta,O orOtherPI.celtlu.'~"". 'J l"A Ot~er(SPecffy\ em Ion amove e 0 21b;)t::PT:- c~)~I, C?a:J::> 2~!.<:'vU _iF~t-ITr~_... ~~Kt:':;/~:, 7';~\ ~;;:f.j /1 ,: ;::~i':.'JZ t':;!,,~tC.i.'; i ,~~LSE~~9.!=_U~ENSEr ~ PE~SON ACTING AS SUCH lICEN~~.NUMBEA::? \i ::). _ . NAME~.!"DA~~AESS..OFFACIL1r:.~:- . 1/..), IlJ. i~hqJi;?J2iS l.s(k1t1". ,Sf' . J2d<?:::;'" ,,~L-I(,__ 22b,l-t'J ;~)<._".),,:j, 22<J.J-. ,:5'0,.)<':- I-ly.J\;.L:.i.?i, /#i'1iC f/.JC:, S7iH'.<...7'Z"d :)4 17/'.::':, To the best of my knowledge, death occurred at the time, dale and place stated. LICENSE NUMBER DArE SIGNED (Sl~inature and TItle) (Month. Day, Year) 1. (jPp E'K... PA'X T(J,..j twp. cltylboro. 7ot" I 2311. T1MEOFOE.Ji;TH ronounce: DATE PRONOUNCED'DEAD(Mooth, Day, Year) 24.12:26 AM M. 25. September 22,2005 27. PART I: Enter the diseas88, injuries or complications which caused the death. Do not enter the mode of dylng. such 8S cardiac or respiratory arrest, shock or heart fallunl. Ustonly one cause on each line, 23b. 23e. WAS CASE REFERRED m MEDICAL EXAMINER/CORONER? Yes IZJ I~?::, J"I~ NoD Pending DUE 10 (OR PS A CONSEOUENCE OF). 26. ,Approximate : inteNal between I onset and death I i PART II: Oth8r significant conditions contributing to death, but nol resu1t\ng In the Underl.y\ng cause given In PART I. b. DUE TO (OR AS A CONSEQUENCE OF): e. DUE 10 (OR AS A CONSEQUENCE OF): o Homicide 0 Aceldent 0 Pending Investigation 1KI 08. 30b. M. No 0 Ve.s 0 No [R] Suicide 0 Could nol be determined D ~~7~~~~~~~~~tt home, farm, street, factory, OffiCEl 2811. 28b. 29. 3De. CEATIAEA (Check only one) "CERTIFYING PHYSICIAN (Physician certifylng cause of de::lth when another physician has pronounced dea1h and completed Item 23l To the best of my knowtedge, death_occumtd due to thf.' cauae(.) and manner aa stated. . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . .. . . d. WERE AUlOPSY FINDINGS AVAILABLE PRIOR TO COMPlETION OF CAUSE OF DEArH? MANNER OF DEATH DATE OF INJURY (Month, Day, Year) TiME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Natural Ye, 0 NcO .ll")~"(,~(J""" ,.;""'" ~/ EXHIBIT (2 o .~:~=~r;y~~;:~~~.<:::~~~~i~~~:~ ~~e;~~~~~ ~=~~~C~~~~~S:dO~~~r.. stAlted... . . . . . . . . . . .. . . . . . . . . . . . 0 "MEDICAL EXAMINER/CORONER On the b.sls of examination and/or Investlgatlon,l" my opinion, d manner 88 stated.. . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . 31.. REGISTRAR'S SIGN,.;ruAE AND NUM6EA /} 'h-1 -;1""/ U.-:"2...~.,..t,~. / .'/ >~Z....r,~:I" e to the cause(s) and ~ .... All-STATE" INTERNATIONAL COMMONWEALTH OF PENNSYLVANIA OFFICE OF INSPECTOR GENERAL October 10. 2006 101 SOUTH SECOND STREET HARRISBURG, PA 17101-1303 Ann E. Rhoads, Esquire Attomey-at - Law POBox 11847 Harrisburg, PA. 17108-1847 RE: John Roth, Deceased 09/22/05 Case No. 50-0032200-D-RE-06 Estate of Jean Roth and Edward Roth, Deceased 09/20/00 and 06/04/04 Dear Ms. Rhoads: Under 23 Pa.C.S. Chapter 46, the Commonwealth of Pennsylvania has a claim against the estate named above for payment of cash assistance benefits paid to the heir, John Roth, from 06/14/05 to 09/10/05. The claim amount is $629.22. The heir estate is liable for reimbursement of assistance granted. An assignment of the heir's interest was made to the Commonwealth of Pennsylvania. The Commonwealth will not consent to the wavier of its claim. Payment on this claim can be made by fOlwarding a check, payable to the Commonwealth of Pennsylvania, to the Office of Inspector General, P.O. Box 8016, Harrisburg, Pennsylvania 17105. Write the above case number on the check. Be advised that checks with "full andfinal settlement" noted on the check will be rejected. If you have any questions, you may telephone me at (717) 787-3449. Thank you for your cooperation. OIG Ltrllb 10/05 EXHIBIT o All-STATE" INTERNATIONAL James :F. Otone Junera{ J-{ome, Inc. 112 :N. J-{arris6urg St Stee{ton, 'Fa. 17113 717-939-1304 Jolin 'Tfiomas J-{aa; StgJervisor September 30, 2005 Funeral Services for John R. Roth September 27,:.:2005 Lynda D. Tonoff 461 Union Street Millersburg, Pa. 17061 Received from Wanda M. Enders and Lynda D. Tonoft~ 1 check each, in the amount of$575.00 each for a total of$1150.00 in return for the services and additional death certificates on John R. Roth. These checks were received on September 23.2005. This represents payment in full. Thomas Hall E 'Buria{ and Cremation Services .J!..vaifa6{e 'Pre-Pfanning and 'Pre-Paid Arrangements '1Jie difference is in the attention to the detaiCs Over 130 years of service to the Community EXHIBIT ALL-STATEI!IINTERNATIONAL g; ~ 9 <t) f/) ;E ~ -~~ o j::: (.) LU 9: o !:!2 ~ o ~ .... MONEY ORDER RECEIPT - NON NEGOTIABLE Store: 01304 Agent.: 253415 Cashier 13040106 Date: 10/21/2005 tiMe: 09:59=31 At-IOI.mt: $275.00 RJ.R*1HtMC~D~Y fIVE DOLLARS AND ZERO CENTS *"** ) _ . 'r l'!I;IiF"; "J:.I'''~ ." J...-" *45816517773 ~ . r- ~ o ~ <is S! ~ '" (") ::i ~ ~ (;) (/) '6 I'T1 !ii . RECEIPTS, DISBURSEMENTS AND DISTRIBUTIONS OF THE ESTATE OF JEAN M. ROTH, DECEASED No. 0937 - 2004 Period of Accounting: November 12, 2004 - November 30, 2006 RECEIPTS Net Proceeds, Sale of one- half (~) interest as tenant- in-common in real property situate in Mifflin County, Pennsylvania, known as Lot No. 37 on Plan of Jack's Mountain Development $15.617.75 TOTAL RECEIPTS $15/617.75 DISBURSEMENTS Administration Expenses 11/12/2004 Register of Wills $ 72.00 01/04/2005 Recorder of Deeds - copies 10.00 01/27/2005 Cumberland Law Journal - legal advertising 75.00 02/22/2005 The Patriot-News - legal advertising 126.27 03/03/2005 Register of Wills - short certificates 4.00 03/17/2005 Register of Wills - filing fee/Inv. & Inh. Tax Return 30.00 04/22/2005 Register of Wills - add'l probate fee 10.00 08/08/2005 Register of Wills - short certificates 4.00 331.27 Federal and State Taxes 03/28/2005 - State Inheritance Tax 06/23/2005 - State Inheritance Tax $ 202.05 41. 82 243.87 EXHIBIT F All-STATES INTERNATIONAL Fees and Commissions 07/25/2005 Cleckner and Fearen - legal fees $800.00 07/25/2005 Ann E. Rhoads - executrix fee 800.00 DISTRIBUTIONS TO: JOHN R. ROTH 8/4/2005 - Cash TO: WANDA J. ENDERS 7/25/2005 - Cash TO: LYNDA D. TONOFF 7/25/2005 - Cash TOTAL DISTRIBUTIONS BALANCE ON HAND Cash Value $1,442.61 $4.000.00 $4.000.00 $4.000.00 1.600.00 $ 2,175.14 $4,000.00 $4,000.00 $4.000.00 $12,000.00 Fiduciary Acquisition Value $1,442.61 DENNIS J. SHATTO ANN E. RHOADS CLECKNER AND FEAREN ATTORNEYS AT LAW 119 LOCUST STREET P.O. BOX 11847 HARRISBURG, PENNSYLVANIA 17108-1847 TELEPHONE: (717) 238-1731 FAX: (717) 238-8481 December 27, 2006 RICHARD W. CLECKNER (1926 - 2004) ROBERT D. HANSON (1916 - 2006) RETIRED: WILLIAM FEAREN Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Jean M. Roth No. 01033-2004 Dear Ladies and Gentlemen: I enclose the following for filing in the above-referenced estate: (1) Original and one (1) copy of Agreement to Indemnify, Receipt and Release (2) Original and one (1) copy of Status Report under Rule 6.12 (3) Check in the amount of $20.00 for filing fee. Please date-stamp the copies and return them to me ln the self-addressed, stamped envelope provided. If anything additional is required to complete these filings, please contact me. Thank you. Very truly yours, CLECKNER AND FEAREMJ c;o \~A \"_____3 ~3 1'-) !~~ c:.::.:-,;. -..J c_ Ann E. Rhoads "";.~,<'. ..-.'.' r 0'1 ""D AER: lnm Enclosures ... cc: Lynda D. Tonoff (w/encl.) Wanda J. Enders (w/encl.)