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Home My WebLink About04-1063REGISTER OF WILLS OF CUMBERLAND COUNTY PETITION FOR GRANT OF LETTERS Estate of DORIS E. BRUBAKER also known as DORIS E. BRUBAKER , Deceased NANCY BAKER Petitioner(s), who i~am 18 yearn of age or older, apply(les) ~r: Social Security No. 205-09-9592 (COMPLETE "A" OR "B" BELOW:) ] A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut RIX Decedent, dated 8/6/2003 and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritata) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship ~ idence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 106 EARL STREETr SOUTH MIDLETON TOWNSHIP BOILING SPRINGS, PA (llst street, number and municipality) Decedent, then 83 years of age, died AUGUST 20 ,2004 , at BOILING SPRINGS, PA Decedent at death owned property with estimated values as follows: (Location) (if domiciled rn PA) AIl personal property ......................................... $ 25r000.00 (if not domiciled in PA) Personal property in Pennsylvania .................... $ 0f not domiciled in PA) Pemonal property in County .............................. $ Value of mai estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ Real Estate situated as follows: 106 EARL STREET, SOUTH MIDDLETON TOWNSHIP, BOILING SPRINGS, CUMBERLAND COUNTY, PA 100~000.00 125,000.00 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: J ~__~ /~, \ /.,~ ~'~ Typed or printed name and residence ~ ~d~C.~ [~/ 415 KAUFFMAN STREET BOILING SPRINGS~ PA 17007 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and afffirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and th~rso_nal representative(s) of the Decedent, Petitioner(s) will we~l and truly administer the estate accord~g to law. A t nd affirmed and subsCribed "tL (~ ~ L'~.N~. DECREE OF REGISTER Estate of DORIS E. BRUBAKER Deceased also known as Social Security No: 205-09-9592 Date of Death: 8/20/2004 AND NOW, ~,v~, ,~,,~-~o*_ ~ t?~ 2004 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary r-I of Administration (c.t.a.. d.b.n.c.t.; pendenle lite; durante absentla; durante are hereby granted to ~ANCY BAKER in the above estate and that the instrument(s), if any, dated 8/6/2003 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... Short Certificate(s) ............... Renunciation .......................... Affidavit ( ) ....................... Extra Pages ( ~ ) .............. Codicil ................................. JCP Fee ................................. inventory & Tax Forms ............. Other ...................................... TOTAL ............................. $ ~,,~ ~q. O0 Attorney: MARK A. MATEYA I.D. No: 78931 Address: P.O. BOX 127 BOILING SPRINGS PA 17007 Telephone: (717) 241-6500 DATE FILED: ~ RW-7A his is to certify that the information here given is correctly copied from an original certificate of death duly filed with ine 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. Fee for this certificate, $2.00 P 10589830 No. Local Registrar AU6 2 ~ 200,~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORD8 CERTIFICATE OF DEATH LICENSE NUMBER LAST WILL AND TESTAMENT I, DORIS E. BRUBAKER, of 106 Earl Street, Boiling Springs, South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all death taxes (whether such taxes may be payable by my estate or by any recipient of any prope~y) shall be paid from my residuary estate as soon as practicable a~er my decease and as part of the administration of my estate. My Executrix shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. I give, devise and bequeath all '..'-_: :~ --..-'~J - __~_ ::::.a~a~c. of my estate in equal shares unto my daughters, DORIS E. HOLMES and NANCY K. BAKER, absolutely. 4. In the event my daughter, DORIS E. HOLMES, shall predecease or fall to survive me by thirty (30) days, then her share of my estate shall pass to my daughter, NANC~ K. BAKER. In t~e event my said daughter, NANCY K. BAKER, shall predecease or fail to survive me by thirty (3~) days, then her share of my estate shall pass to her husband, PAUL BAKER. I nominate, constitute and appoint my daughter, NANCY K. BAKER, as Executrix of my ~tate. In~e eve~ ~my said daughter shall be unable or unwilling to serve in such capacity, then ! appoint my son-in-law, PAUL BAKER, to act in such capacity. [Initials] Page 1 of 3 Pages I direct that my Executrix or her successor shall not be required to file a bond to secure the faithful performance of her duties in any jurisdiction. 7. I authorize and empower my Executrix, or her successor, in her sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as she may deem advisable; to borrow money for any purposes connected with the protection and preservation o fmy estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my Executrix or her successor considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my Executrix or her successor shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this ~"/ day of SIGNED, SEALED, PUBLISHED AND DECLARED bythe above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses there in the presence of the said Testatrix and of each other. Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :SS. ) We, DorisE. Bmbaker, CarlC. Risch, and /~4~_4filer~,D. ]n/a_t}~[~ ,theTestatrix and the witnesses, respectively, whose names are signed to the 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 that the Testatrix has signed willingly, and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. i°)1 C._~~estatrix Witness Subscribed, sworn to and acknowledged before me by Doris E. Bmbaker, the Testatrix, and subscribed and swom to before me by Carl C. Rischand ~t~.,a.~a~e,e-~'-. /"/a.~t~/e'~- ,the witnesses, this ~'Jkday of ~.~af , N~m'~Public ~/ I NOTAR!AL SEAL I I NOTARIAL SEAL ~ ~ORi-;{i~ '~:~. NOTARY PUBUC I I CORRINE L MYERS, NOTARY PUBU{['C~~I:{LISL~ ? ~ , ..v OF CUMRERLAND I ICA. L.S~,~O~O, COUm OF C~,S~.Lq~I ~ CO~,~,~, ~:. ~ES ~AY ~7. 2007 I I MY COMMISSION EXPIRES MAY 27, 2007 Page 3 of 3 Pages CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DORIS E. BRUBAKER Date of Death: 8/20/2004 Will No. Admin. No. 21-04-1063 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served an er mailed to the following beneficiaries of the above-captioned estate on 11/19/2004 : Name Address NANCY K. BAKER DORIS E HOLMES 415 KAUFFMAN STREET BOLLING SPRINGS 2626 VALLEY ROAD CLARKSON VALLEY PA 17007 MO 63005 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: 11/19/2004 Signature Name: MARK A. MATEYA. ESQUIRE Address: P.(~. BOX 127 BOILING SPRINGS PA 17007 Telephone(717) 2416500 Capacity: Personal Representative X Counsel for Personal Representative IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF DORIS E. BRUBAKER, : DECEASED : No. 21-04-1063 NOTICE OF CLAIM Claremont Nursing and Rehabilitation Center, files this claim against the Estate of Doris E. Brubaker in the sum of $8,000 in accordance with the invoices attached hereto. This Claim is a non-priority claim under 20 Pa. C.S.A. § 3392(6). LATSHA DAVIS YOHE & MCKENNA, P.C. Date: /' ~'/~(-~ ~ By: Attorney No. 32934 Steven M. Montresor, Esq. Attorney No. 74244 P.O. Box 825 Harrisburg, PA 17108-08 (717) 761-1880~,~ Attorneys for Claimant, ::* Claremont Nursing and ? Rehabilitation Center 94893 S)lb,~r~GB, · :X)9-,~ /J. 'CD 'gYlO 'll~K~V 9/. 'ON df"~O~lD ~3~VI:InSNI ~g ] · ' OD ~ 'NIIdd , NOmlVO09 t:Lq~:)'ldfl3 99 3WVN l:t::IAOgdl'G ~g ~t9 S~:~10~__ NOU. YZIU(~4UI¥ J, N31~LLY=JHI I 31~1 dr1OUD ~g 'ON OI ' 'DIH - NSS- 'J.l~]O 0g I:f"dAVd C OIVd 10' ~J/.., T I. ~6c-66~g¢35 'ON OI ' 'OIH ' 'OD 'DYIO 'Nil:Jo $300~ NOU. V'ZIUC~U.O¥ .LN3RLLV31:LL 3WVN $,03UI~NI :llVO 'AU~IS ~ S3i~d / S'OdOH 'ON 1:1301AOUd IS AOYHHYHd NOU~IUOS30 ~ 06 0~I I NOLLVOO1 t~3AO3d~t] m 31AIVN dflO~9 &9 t ,S.LN3rIAVd wOIbl ~,~ SLINfl 'A~{35 9~ ~1¥0 'AH3S ~ 'Off OI - '31H ' ~ - 'J.1:139 'ON Id3OIAl~dd tS )O'~LI 31~flO3'JOl~ 'lVdlOHlUd 09 '~¥i0 'NIUd /'9 ,.~'qW~ J.N3LLYd g '00 'A3~ ~ IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF DORIS E. BRUBAKER, : DECEASED : No. 21-04-1063 CERTIFICATE OF SERVICE The undersigned hereby certifies that on this date a true and correct copy of the foregoing Notice of Claim was served via Certified Mail, Return Receipt Requested and First-Class United States mail, postage prepaid, upon the following: Dated: Mark A. Mateya, Esq. Law Office of Mark A. Mateya P.O. Box 127 Boiling Springs, PA 17007 (Counsel for the Estate of Doris E. Brubaker) Nancy Baker 415 Kauffman Street Boiling Springs, PA 17007 (Executrix) 94893 cJ J - d-i - 10<..a3 LATSHA DAVIS YOHE & MCKENNA, l?C. ATTORNEYS AT LAW PLEASE REPLY TO, Harrisburg WRITER'S E. MAIL smontres@ldylaw.com V::-_' May 6, 2005 C,.) G Register of Wills Office Cumberland County 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Doris E. Brubaker, Deceased Claremont Nursing & Rehabilitation Center Our File No.: 453-05 Dear Sir or Madam: We are writing to request that the Register of Wills kindly mark Claremont Nursing & Rehabilitation Center's claim filed against the above-referenced Estate as satisfied. Our client is in receipt of the full amount due and payable on this account. Please time-stamp the additional enclosed copies of this letter and return them to us in the self-addressed, stamped envelope provided. Also enclosed with this letter is a check in the amount of $10.00 for the filing fee. Thank you for your cooperation in this matter. If you have any questions or require additional information, please contact my office. ." Sf] Steven M. Montresor Enclosures cc: Mary Kimmel, Finance Manager Kimber L. Latsha, Esq. 98333 Post OffiCe Box 825 . Harrisburg, PA 17108-0825 4720 Old Gettysbmg RQad, Suite !OI . Mechanicsburg, PA 17055 . (717) 761.1880 . FAX (717) 761.2286 350 Eagleview Boulevard, Suire j(JO . Exton, PA 19341 . (610) 524-8454. FAX (610) 524.9383 3000 Atrium Way, Suite 251 . Mt. Laurel, NJ 08054. (856) 231.5351 . FAX (856) 231.5341 Maryland Telephone, (410) 72 7.2810 Personal Representative(s) of the above Estate, deceased, verify that the Items appearing In the following Invenlofy include all of the personal assets wherever sllllate and aD of the real estate in the CommonweaJlh of Pennsylvania of said Decedent, that the valuation placed opposite each Item of said invenlofy represents lis fair value as of the date of the Decedenrs death, and that Decedent owned no real eslate outside the CommonweaJlh of Pennsylvania except that which appears In a memorandum at the end of this Invenlofy. IlINe verify that the statemenls made In this invenlofy are true and correct. IlINe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relallng to unsworn falsification to authorities. --:~~~ ~t..v... I ~Wf.>. 7 INVENTORY Estate of DORIS E. BRUBAKER No. 21 04 1063 Date of Death 812012004 Social Security No. 205-09-9592 also known as DORIS E. BRUBAKER NANCY BAKER , Deceased Name of Attorney: MARK A MATEYA LD.No.: 78931 Address: P.O. BOX 127 BOILING SPRINGS Telephone: (717) 241-6500 Dated PA 17007 Description REAL ESTATE LOCATED AT 106 EARl STREET BOILING SPRINGS, PA 17007 Value 123.000.00 HOFFMAN-ROTH FUNERAL HOME, INC. PREPAID FUNERAL ACCOUNT PERSONAl/HOUSEHOLD EFFECTS AUCTION LIST ATTACHED PNC ADVISORS CUMBERLAND COUNTY EMPLOYEE RETIREMENT FUND FINAL PAYMENT o Co 5::;0 ':0-0 nl::r:O ~12 ~Fn '". :z; ::0 "?:W^ ':')00 C~O.,., OC ::=::: ji1 ~91.10 = "" :::II: ",.. -< N o Total (Attach Additional Sheels If necessary) 131,777.11 NOTE: The Memorandum of real estale 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 Invenlofy. RW-4 8.106.26 579.75 -0 :It ~IJ rTl Cl l.J -:J:~ ::J 23 C~ j .-n -n (:"5 c- rn eno -n .r:- o -.l s-L ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96l RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MATEY A MARK A PO BOX 127 BOILING SPRINGS, PA 17007 ---nn-fold ESTATE INFORMATION: SSN: 205-09-9592 FILE NUMBER: 2104-1063 DECEDENT NAME: BRUBAKER DORIS E DATE OF PAYMENT: OS/20/2005 POSTMARK DATE: OS/20/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/20/2004 NO. CD 005356 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,734.11 I I I I I I I I TOTAL AMOUNT PAID: $2,734.11 REMARKS: MARK MATEY A, ESQ CHECK# 101 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS REV-1500EX+(6-00) '* C~M~W~~H~ PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INIT BRUBAKER DORIS E. DATE OF DEATH (MM-DD-VOIO) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 4 1 0 6 3 ""iXiUrffi'Ci56E -YEAR- - - 'iMmR-- SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Ve..) 2 0 5 - 0 9 - 9 592 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 08/20/2004 04/15/1921 (IF APPLICABLE) SURVVlNG SPOUSE'S NAME (LAST, IRST, AND MIDDLE INITIAl) W !C ~ii:;2 u..u WOO %0:.... U8:lXI .. 00 1. Original Retum D 4. Limited Estate 1816. Decedent Died Testate _..,ofWll) D 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER D 2. Supplemental Retum o 4a. Future Interest Compromise (dale of deaIh aftBr 12-12-82) o 7. Decedent Maintained a Living Trust (Altachcopy of Trust) D 10.SpousaIPOYet1yCredttl""'of__12.31.91"'\-1.9~ o 3. RemainderRetum (daleOfdeath priortl 12-13-821 D 5. Federal Estate Tax Retum Required _ 8. Totai Number of Safe Deposit Boxes D 11. Eleclion to tax under Sec. 9113(A) _h Soh 0) THIS SECTION MUST BE COMPLETl!D Al.LCORllESPONDENCE AND CONFIDENTIAL TAX INFORrMl1ON StlOULDBE DIRECTED TO: NAME C~PLETE MAILING ADDRESS MARK A. MATEYA ESQUIRE P.O. BOX 127 FIRM NAME (II Ap~<able) .... z W a z o .. rll 0: 0: o U z o j: c( ...I ::l l- ii: c( o w II:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or BoI Proprietorship 4. Morlgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposils & Miscellaneous Perso al Properly (Schedule E) 6. Jointiy Owned Properly (Schedule F) o Separate Billing Requested 7.lnter.Vivos Transfers & M~oellaneous Non.P (Schedule G or L) 8. Total Gross Ass'" (total Lines 1.7) (8) 9. Funeral Expenses & Admin~trative Cosls (S (9) 10. DebfsolDecedent Morlgage Liabilities, & L. ns(Schedulel) (10) 11. Total Deductions (total Linesg & 10) 12. NelValue ofEstale (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 113 TlUsls for which an election to tax has not been made (Schedule J) 14. NelValue Subject to Tax (Line 12 minus Li e 13) SEE INSTRUCTIONS ON REVERSE IDE FOR APPLICABLE RATES TELEPHONE NUMBER 717 241-6500 (1) (2) (3) (4) (5) BOILING SPRINGS 123,000.00 PA 17007 OFFICIAL USE ONLY ....., C;:';I C:::~ Cfl o '0 ..:.OC) .r:,,_ en "Ii ^ ;:.: .....';.J'O -< r-.) C-J '--) 8,777.11 " ::r. (6) (7) C> -' (jF) 131,777.11 34,487.83 36,531.29 (11) (12) (13) 71,019.12 60,757.99 (14) 60,757.99 Z 15. Amount of Line 14 taxable elthe spousai tax 0 rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X _(15) 0.00 j: c( 16. Amount of Line 14 taxable at lineal rate 60,757.99 X .045 (16) 2,734.11 I- ::l 0.00 0.00 D.. 17. Amount of Line 14 taxable at sibling mte X .12 (17) :i! 0.00 0.00 0 18. Amount of Line 14 taxable atcollateralmte X .15 (18) 0 ~ 19. Tax Due (19) 2,734.11 I- 0 20. <"~ ~ REV.1502 EX + (6-98) * SCHEDULE A COMMONWEAlTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ,1= 71 Cl.4 1nR"l All real properly owned solely or as a tenant in comn (on 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 wil I n9 seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts, Real D"'oertv whit islolntiv.owned with rioht 01 survlvorshiD must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 106 EARL STREET 123,000.00 BOILING SPRINGS, PA 7007 CONTRACT SALES PRI I;E - SEE ATTACHED SETTLEMENT STATEMENT TOTAL (Also enteron line 1, Recapitulation) $ 123000.00 (If more space is needed, insert additional sheets of the same size) A. Settlement Statement u.s. Department of Housing and Urban Development " T"nD nf I non n"" "'n . .."n.1 (3/86\ L DFHA 2. DFmllA 3. Deonv. Unin . I 6. File Number I 7. Loan Number 8. Mortgage Insurance Case Number 4. nV4 s. nConv. Ins. S 100-234 0000809497 C.Note: This fQnYl is furnished 10 give you a statem n t of actual settlement costs. Amounts paid 10 and by the settlement agent are shown. \ TitleExpress Settlement System 1I9ms marked "(p.Q.c.r were paid outside I e closing; they are shown here for information purposes and are not included in the totals. WARNING:1tisacnmelom~~yma\l. 1 6l~ S\a\emen~!? '!~~I~~ States on thIS ,?r anv other similar 10llTl. Penalties upon ".n. k_~ D. NAME OF BORROWER, Crai R. Orff ADDRE<S, P.O.B ox 3092 Shiremanstown PA 17011 E. NAME OF SELLEK The state of Doris E. Brubaker ADDRESS, F. NAME OF LENDER, Ame ~can Home Mortgage ADDRE<S' 520 roadhollow Road Melville NY 11747 G. PROPERTY ADDRESS, 106 arl Street, Boiling Springs, P A 17007 Sou h Middleton Townshin H. 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Guarantv/PA RE. 55 art Title Guarantv/PA RE 55 F~n ~,.. n~c~ ..64.50 230.00 230.00 .. .. .... Cum: ~rland Countv Recorder of Deeds tn Jud~ Camnbell. Tax Collector In Sal mann Huahes P.C. t", Sal mann Huahes P . C . I.... SOU h Middleton Townshiv tn Tax Claim Buearu t... Gilllert I s Pest Control. In ChaJ: les Bretz 2 Davs \ . PAID FROM BORROWER'S FUNPS AT SETTLEMENT 195.00 LR LR LR LR LR LR LR 325.00 8.25 21.70 430.00 3.95 74.00 15.00 LR 33.48 LR 72.75 LR LR LR 53.46 1 062.93 -168.30 10.00 973.75 150.00 35.00 103.00 1 230.00 20.50 10.00 50.00 PAGE 2 .no "O~ PAID FROM SELLER'S FUNDS AT SETTLEMENT 7 380.00 125.00 0.00 250.00 1. 230.00 17 .00 213.82 15.50 358.86 1 589.27 1. 931.. 37 1,500.00' -. . .-.----.. ---- -~, PAtiE3 C:ETTI EM""'T !".T"TE""''''T REV,ll1JD.' ()186' , ' "CO ITEMI71\.T)n'" f"lF H'ID UN" 1308 Icon . ~F ~.nn" O"VCD <"" "" I,",' 0', -", .. ~_." .... Ti 0 thy Lebo Plumbint'Y , Heatint'T 545.00 11;n? M"r"'i 'n C~ rmont Nursincr & Rehab Center v 8 000,00 1,",' ''"'' '505. . CO" IOn7 1508. 'coo .o;,n "" 101> "" '51' ,,,. ",.. ..n 10" '"'0 ">n 71'''' ~"n 545.00 8 000.00 REV-1508 EX + (fl.4l8) *' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIOENT OECEDENT ESTATE OF FILE NUMBER Rl>1 :E 71 nA 1063 Indude e proceeds oflitigation and the date the proceeds were received by the estate. All prope . iointly-owned with right of survivorshIp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. HOFFMAN-ROTH FUNE lAL HOME, INC. 8,106.26 PREPAID FUNERAL EX ENSES ACCOUNT NO. 14349-1 ~9 2. PERSONAL HOUSEHOL P EFFECTS 579.75 SEE ATTACHED SETTL FMENT SHEET FROM HMR'S AUCTION 3. PNC ADVISORS 91.10 CUMBERLAND COUNn EMPLOYEE RETIREMENT FUNDS FINAL PAYMENT TOTAL (Also enter on line 5, Recapitulation) $ 8777.11 (If more space is needed, insert additional sheets of the same size) Date: 03-22-2005 www.haat.s.com Settlement Se 11 et': 7973 It em / HAAR'S AUCTION 71 7 -lI3~'i--82/+5 Page: 1 NANC BAKER . ,," 1<-15, AUFFMAN':ih BOIL NG SPRIN"GS PA'." 17007 Desc iption' Pt'ice Qty T at a 1 ------------------------ ------------------------------------------------------- Glue gun 1 7. el0 Sct'a.ers 1 1. ~j0 Clam 1 2.00 Nai'l 1 0.2cl00 Nail 1 1. 00 Box ot--p.~llet' 1 4.00 Boxl t 1 Ill. Z~50el Case knife 1 12.00 Vase 1 0. ,'~500 Hatc et 1 I :~. 51Z1 Nai 1 pullet' 1 el. ~00el Sct'e ,.. 1 0.2500 ~ Deco 1 14.00 Sanding block 1 0. <:";00 Plan 1 1.00 Thet' os 1 5.00 Wt'en 11 set 1 15.00 Sock 10s 1 0. 'j001Zi Tot'c 1 7.00 Tools 1 1. 00 Chisels 1 1. 00 Pipe wrench 1 3.00 Tin snips 1 1. 00 Plane 1 l, , liJ0 Vise 1 1.00 Bits-tools 1 1.50 Sto e 1 0. 750e' Tools 1 0. 75Ql1Zi Soc et set 1 0.500el Squ' t'e 1 2.00 Wre ches 1- 2.00 Cut er 1- 1. 50 Too s 1 0.7500 Sol er iron 1 0.2500 Wre ch 1- 1. 00 Ham et- 1 1. 50 Too s 1- 1. 00 Ext nsion 1- 3.00 Tt-a and lot 1 3.00 Too s 1- 0.5000 Box lot-tools 1 0.2500 Too s 1 0. "000 Too s 1- 0. 5~)00 Rat het 1 7.00 Vis 1 0.25lZ10 Plu -light 1 4.00 !~ Date: 03-22-2005 ;.<.Iww. haat"s. com Settlement Selle,': 7973 It em HAAR'S AUCTION NANC BAKER 415 K UFFMAN'ST BOILING SPRINGS P~l l. 7121e'7 Desc,'iption Oil light Wire strippe,' Rayo light Box "lot Tools-saws 3 de oys Fishing reel Fishing "eel Wood box-c,'ate Wood box Ceda, box Ga,'b ge can Pr'une,' Fishing ,'od Fishing rod Fishing rod Fishing rod Fishing ,'od Fishing rod Fishing rod Fishing rod Fishing ,'od Qui 1 track Quilt ,'ack D,'op leaf table Clothes tree Chest of drawers Lawn chair Ca,'d table Blanket chest Flag pole Libr l'y table Maple bed Wash tubs Wheel barrow Commissio at. 40.000~ www.haa..s.com HAAR'S AUCTION Items: 717-l132--8E:/+f, Price en,' 1 l. 1 l. l. 35.00 3 l. 1 1 l. l. l. l. l. 1 1 l. l. 1 l. l. 1 l. 1 l. 1 1 1 1 l. 1 1 l. 1 1 8l. Amount: 231. 901 Less adjustments: Net due to seller: Page: 0::. Total 1.50 2. 5~~1 -231. ':l121 347.135 7l. 7-432-8<~45 REV-1511 EX+(12-99) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BR" ITEM NUMBER A. 1. B. 1. 2. 2. 3. 4. 5, 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. :" FILE NUMBER ?1 n.. Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: HOFFMAN-ROTH FUN RAl HOME, INC ADMINISTRATIVE COSTS: Personal Representative's Co missions Social Securify Numbe~ )/EIN Numberol Personal Representative(s) Street Address 415 kAUFFMAN STREET City BOILING SPRINGS State PA Zip 17007 Yea~s) Commission Pai: 2005 AttomeyFees MARK A. M~TEYA, ESQUIRE Family Exemption: (II decedenfs ddress is not the same as daimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claiman to Decedent Probate Fees CUMBERU ND COUNTY REGISTER OF WillS Aooountanfs Fees Tax Return Prepare(s Fees PATRIOT NEWS - lEGAL ADVERTISEMENT OF ESTATE CUMBERLAND LAW OURNAl - lEGAL ADVERTISEMENT OF ESTATE HAAR'S AUCTION - ~ UCTIONEER COMMISSION MARK A. MATEYA, El:;QUIRE - DEED PREPARATION FOR REAL ESTATE COLDWEll BANKER - REAL ESTATE BROKER COMMISSION COLDWEll BANKER - TRANSACTION FEE REAL ESTATE RECORDING AND TRANSFER CHARGE RECORDING FEE FC R LIMITED POWER OF ATTORNEY FOR R1E SETTLEMENT PA REAL ESTATE SElTTlEMENT SERVICES, llC - OVERNIGHT MAil CHARGE DOUG'S LAWN JOBS - TRASH REMOVAL PRIOR TO R1E SETTLEMENT CONNIE LEHMAN - P~RSONAUTRASH DISPOSAL SERVICE CARL & RUTH BLUM I..NSTOCK - FINAL CLEANING SERVICE TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) in",., AMOUNT 8,926.80 6,589.00 7,724.00 269.00 199.63 75.00 231.90 250.00 7,380.00 125.00 1,230.00 17.00 15.50 225.00 800.00 200.00 34487.83 Continuation of ~EV-1500 Inheritance Tax Return Resident Decedent BRUBAKER, DORIS E. Decedenfs Name Page 1 21 04 1063 File Number Schedule H - Funeral Expenses & Ad Ininlstrative Costs. 87. ITEM NUMBER 19. DESCRIPTION IESI- TRASH DUMPST~R RENTAL SERVICE AMOUNT 230.00 SUBTOTAL SCHEDULE H-B? 230.00 REV.1512 EX + (6-96) * SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 21 RIS E. Include un,elmbuBed medical expenses. ITEM NUMBER DESCRIPTION 1. M&TBANK MORTGAGE ON REAL STATE ACCOUNT NO. 160237 0001 2. SOUTH MIDDLETON T NSHIP FINAL WATER/SEWER ILL 3. CUMBERLAND COUN TAX CLAIM BUREAU SOUTH MIDDLETON SC OOL DISTRICT 2004 TAXES 4. GILBERTS PEST CONT OL TERMITE INSPECTION ND TREATMENT ON 7/10/04 ACCOUNT NO. 01-9100 5. CHARLES BRETZ ELECTRICAL SERVICE I PREPARATION OF SALE OF REAL ESTATE 6. CLARMONT NURSING REHAB CENTER FINAL NURSING HOME ILL 7. MARTSON DEARDORF WILLIAMS & OTTO PREPARATION OF WIL 8. MET-ED ELECTRIC SERVICE 9. SHIPLEY ENERGY FINAL FUEL BILL 10. WASTE MANAGEMENT TRASH SERVICES ACCOUNT 00006-23917 2007 11. JUDY CAMPBELL, TAX OLLECTOR 2005 COUNTY TAXES 12. STEVE MEREDITH'S LA N SERVICE LAWN CARE SERVICES FROM 8/4/04 - 10/26/04 13. SHIPLEY FUEL HEATING FUEL COSTS 14. L1TITZ MUTUAL INSU CE COMPANY HOME OWNERS INSU NCE ON RESIDENCE TOTAL (Also ente,on line 10, Recapitulation) $ (I more space is needed. insert additional sheets of the same size) VALUE AT DATE OF DEATH 21,780.38 358.86 1,589.27 1,931.37 1,500.00 8,000.00 300.00 235.77 112.73 71.89 213.82 233.20 113.00 91.00 36531.29 REV.'513EX+I* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF on, .-. .~-- NUMBER I. II. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF P RSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pnclude 0 fright spousal d~lributions. and lIansters under Sec. 911 (a)(1.2)1 FILE NUMBER ')1 n"- RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 1. NANCY BAKER 415 KAUFFMAN STREET BOILING SPRINGS, PA 17 07 DORIS HOLMES 2646 VALLEY ROAD CLARKSON VALLEY, MO l3005 Lineal Lineal 2. 1nR"t AMOUNT OR SHARE OF ESTATE 30,379.00 30,378.99 ENTER DOLLAR AMOUNTS FOR D~IrRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDE~ SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERN MEN AL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOT L NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ If more space is needed, insert additional sheets of the same size) F\FILE$IDAT AFILEIEstale Planning\6439-1.will.4 to){P)f LAST WILL AND TEST AMENT I, DORIS E. B UBAKER, of! 06 Earl Street, Boiling Springs, South Middleton Township, Cumberland County, ennsylvania, being of sound and disposing mind and memory, do hereby make, publish and decl e this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils mad by me. 1. I direct that all y legally enforceable debts, funeral expenses, testamentary expenses and all death taxes (whethe such taxes may be payable by my estate or by any recipient of :h"1)' property) shall be paid from my esiduary estate as soon as practicable after my decease and as part of the administration of my e ate. My Executrix shall have no duty or obligation to obtain reimbursement for any such tax so pai ,even though on proceeds of insurance or other property not passing under this Will. I give, devise unto my daughters, D n~ 2. , $ Jf~ d bequeath all .111 OM'. -!8Mhllulli..sl..8lI.ller of my estate in equal shares RIS E. HOLMES and NANCY K. BAKER, absolutely. 4. daughter, DORIS E. HOLMES, shall predecease or fail to survive me by thirty (30) days, then h r share of my estate shall pass to my daughter, NANCY K. BAKER. In the event my said daughter, NANCY K. BAKER, shall predecease or fail to survive me by thirty (30) days, the her share of my estate shall pass to her husband, PAUL BAKER. 5. I nominate, co titute and appoint my daughter, NANCY K. BAKER, as Executrix of my estate. In the event my said daughter shall be unable or unwilling to serve in such capacity, then I appoint my son-in-law, PAUL BAKER, to act in such capacity. p~ [Initials] Page 1 of 3 Pages 6, I direct that m Executrix or her successor shall not be required to file a bond to secure the faithful performance 0 her duties in any jurisdiction. 7. I authorize and mpower my Executrix, or her successor, in her sole and absolute discretion, to purchase or otherw' e acquire and retain any investments of which I die seized or any real or personal property of y nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or ail property of any kind forming a part of my estate for such terms and such prices as she ay deem advisable; to borrow money for any purposes connected with the protection and preserv ion of my estate; to mortgage or pledge any real orpersonaI property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate ainst others or of others against my estate; to make distribution in kind and to cause any share to e composed of cash, property or undivided fractional shares in property different in kind from ny other share; to employ agents, attorneys and proxies and to delegate to them such power as y Executrix or her successor considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver su h instruments as may be necessary to carry out any of these powers. In addition, I direct that y Executrix or her successor shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. HEREOF I have hereunto set my hand and seal this ,,-!Iv day of ~-t ~-A~~J e~<-; -~.. Doris E. Brubaker (SEAL) SIGNED, SEA ED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and T e tament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses there (')" x-' ) in the presence of the said Testatrix and of each other. iJ." iJ, r2dL Ci -,,'<,-"'tll 'A f-I.-,' c{/ 0', ' J :; Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA ) : SS. ) We,DorisE.B baker,CarlC.Risch,and j-t-e,;.+h.-,r--.J. th'l.,/eff I ,the Testatrix and the witnesses, resp ctively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby decI e to the undersigned authority that the Testatrix signed and executed the instrument as her last ill and that the Testatrix has signed willingly, and that the Testatrix executed it as her free and volun ary act for the purposes therein expressed, and that each of the witnesses, in the presence and heari g of the Testatrix, signed the Will as a witness and that to the best ofhislher knowledge the Testatri was at that time eighteen years of age or older, of sound mind and under no constraint or undue in uence. ,IP~ f! ~ ,jJ,; .It/I..( L Witness -J. <JJ?rl. ~Ji(;tL j (J subscribed and sworn t before me by Carl C. Risch and witnesses, this 6-*"da of ~..t , Oloo3. Subscribed, sw rn to and acknowledged before me by Doris E. Brubaker, the Testatrix, and J.I~~ ::T. f/~~/eft ,the ~'~ ""-~ _....dIJ No Public NOTARIAL SEAL CORRINE l. MYERS, NOTARY PUBU CARLISLE BORO, COUNTY OF CUMBERLA D MY COMMISSION EXPIRES MAY 27.2007 on-co. L1S'e ... MY COMM,,,~ ... . NOTARIAL SEAL . C:"'" NOTARY PUBLIC v OF CUMBERLAND jES MAY 27.2007 Page 3 of3 Pages COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE pC(',"'.~r,Cn r;~~fr~~ nC NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUA~ ,lAliESL.!-~ ~. ,I'~~'!!APPRAISE"ENT ALLOIlANCE OR DISALLOlIANCE INHERITANCE TAX DIVISION C'=(>~ ;':.~, :".::, (: OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX Z8D6Dl I I HARRISBURG PA 17128-0601 08-15-2005 BRUBAKER 08-20-2004 21 04-1063 CUMBERLAND 101 APPEAL DATE: 10-14-2005 ( See reverse side under Objections) Amount Rellitted 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 _ Riy:is47-ix-AFP-'[oi:osi-NOTIci-oF-INHiRITANci-TAx-APPRi.IsiMiNT:-ALLOWANci-oR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DORIS E FILE NO. 21 04-1063 ACN 101 2005 i~;~JG 12 Pi; I: 05 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN OI~C MARK A MiCTEYA ESQ PO BOX 127 BOILING SPRING PA 17007 ESTATE OF BRUBAKER *' REV-1547 EX AFP (06-05) DOlUS E TAX RETURN liAS: I X I ACCEPTED AS FILED DATE 0&-15-2005 I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..1 Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) ct. Mortg.geslNotes Receivable (Schedule DJ S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets III 121 131 141 151 161 (7) 123.000.00 .00 .00 .00 8.777.11 .00 .00 181 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern..ntal Bequests; Non-elected 9113 Trusts (Schedule J) 14. N.t Value of Estat. Subject to Tax I~ an assessment was issued previously, lines 14, 15 and'or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ returns assessed to date.. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 .t Sibling rat. (17] 18. Amount of line 14 taxable at Collateral/Class Brat. (18l 19. Principal Tax Due 191 1101 NOTE: 34,487.83 36.531.29 1111 1121 1131 1141 .00 X 60,757.99 X .00 X .00 X 00 = 045 = 12 = 15 = 1191= NOTE: To insure proper Cn8dlt to your account, subnit the,upper portion of this fora with your tax payment. 13-1.777.11 7.1~AJI Q l' 611:,757.99 .00 6~,757 .99 .00 61734. 11 .00 .00 2'.734. 11 TAX CRI"DTTS: (" ~UNT PAID DATE _BER INTEREST/PEN PAID I-I 05-20-2005 "'.CD005356 .00 2,734.11 TOTAL TAX CREDIT 2,734.11 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A nCREDITn ICRI, YOU "AY BE DUE _/ A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.~~~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 BAKER NANCY 415 KAUFFMAN STREET BOILING SPRINGS, PA 17007 RE: Estate of BRUBAKER DORIS E File Number: 2004-01063 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.1, for decedents dying on or after July 1, 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: 8/20/2006 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, c.~ Ilt. ~ /J L?tz/a'ff,-<,_j j17';;-ACt'~, / f Glenda Farner Strasbaugh/ Clerk of the Orphans' Court cc: File Counsel ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 MATEYA MARK A PO BOX 127 BOILING SPRINGS, PA 17007 RE: Estate of BRUBAKER DORIS E File Number: 2004-01063 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 I 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: 8/20/2006 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, Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) o STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WillS, COUNTY OF CUMBERLAND , PENNSYLVANIA Name of Decedent: DORIS E. BRUBAKER Date of Death: 8/20/2004 File No. 2004-01063 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES_ NO~ 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 1/1/2007 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_ NO_ b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? YES_ NO_ d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 8/18/2006 \ (\ . ~~~ Signature -- - MARK A. MATEYA. ESQUIRE Name (Please type or print) P.O. BOX 127 Address ki BOILING SPRINGS PA 17007 9., :7 If I V v i-,d I ~ ('."" ,., r' n -, / "Ii j"'" "'~!!/ v V! f JVV\I 717-241-6500 Tel. No. i ';' 'I .:. '.~/ ;.~'j 1'--)1 i i/......; (i-~{ii rr\,.....'JI : J0 J:U u.:A,;OU,).JU Capacity: _ Personal Representative ~ Counsel for personal representative C/