Loading...
HomeMy WebLinkAbout04-0801 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION also known as To: Register of ~[,ills fc~r th~ Deceased. County of LA_~Cf~p.j IC'~ ~ in the Social Security No. I ~ L~ - ! ~ ~ 0 ~ ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl H for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in(~] ~ --~'c~r'h~ Je }/ _ Cou.nty, Pennsylvan~ia, with h last family or principal residence at ~/~:~ /'\1 ~:,~.~ c~. (list street, number and municipality)'J Decendent, then ~- ~-~ years of age, died ~'~LI ~ ~ ,/1<~2~O0 at " Decendent at death owned property with estimated values as folllows: (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: Petitioner after a proper search ha ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: [1.). ~, Name c-. ~oR~[.~tionship. ~ Residerlce THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. ~o OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH,:. .OF , PENNSYLVANIA } COUNTY OF :_/,/fr31~-f(c~f~C/ 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 representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affi;r~d and~ subscribed F ~/~-~-~ ~{ '0~'~ before me this Ct~'~e~3LL~ day of, ] ~ No. Estate of , Deceased GRANT OF LETTERS OF ADMINISTRATION AND N~ ['/~b/~ 6~rlJ'~r' , in consideration of the petition on the reversersl~te hereof, saris, factory proof having_been presented before me, IT IS DE~EED that ~{1'~./3 P3,'l~: is/are entit~ to Letters of Administration, and i~ccord with such finding, Letters of Administration are hereby ~snted to ~.~/3 / ~'tld V ~(x, Ft C in the esta~ of Register of Wills ~,/1~. FEES Letters of Administration ..... $ Short Certificates( ) .......... $ ATTORNEY (Sup. Ct. I.D. No.) Renunciation ................ $ a~ss TOTAL ~ $~ Filed ..................... A.D. 19 ._ PHONE Bond #104014226 BOND AND OATH IN RE ESTATE OF IN THE COURT OF Mildred N. Coho COUNTY, THE STATE OF Pennsylvania NO. COUNTY OF Cumberland KNOW ALL MEN BY THESE PRESENTS, That we Karen M. Squiric as Principal, and the. Travelers Casualty and Surety Company** as Surety are held and firmly bound unto Cumberland County Court ,X~g~;:g~; Cumberland County, PA , an~ their successors in off]ce, in the sum of $.100,000 , cor, ditioned that the above bound Principal, who has been appointed by the Judge of said Court as. Administrator shall well and truly perform the duties required of him by law under such appointment. ~',~t-o f America Witness our signature, this 9th day of November , 2004 Karen M. Squiric Clerk's Stamp Principal Travelers Casualty and Surety Company** "-~ BY: :..~ Connie A. Unger ~/ Attorney-in-Fact APPROVED, this day of It is fur~er ordered that all other bonds in force in this cause at this time are hereby cancelled on the approval of this"b6fid, and the Sureties on said bonds are hereby relieved of all further liability for the future acts of the Principal. Judge, Court, County, OATH I ~ ,,~,( ,._.,,irrupt:,C, do solemnly swear that I will faithfully discharge the duties of e-.~.¢.~?rr, ~. of the estate of r~ ;I ~cv.,-~ ~. ~0~ 0 , according to law. Signature CLAUDIA A. BREWBAKER, NOTARY PUBLIC Carlisle Boro, Cumberland County My Oommission Expires April 4, 2005 TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA TRAVELERS CASUALTY AND SURETY COMPANY FARMINGTON CASUALTY COMPANY Hartford, Connecticut 06183-9062 POWER OF ATTORNEY AND CERTIFICATE OF AUTHORITY OF ATTORNEY(S)-IN-FACT KNOW ALL PERSONS BY THESE PRESENTS, THAT TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, corporations duly organized under thc laws of thc State of Connecticut, and having their principal offices in thc City of Hartford, County of Hartford, State of Connecticut, (hereinafter the "Companies") hath made, constituted and appointed, and do by these presents make, constitute and appoint: James C. Byerly, Mary Anne Brennan, Richard C. Atkinson, James F. Cuff, Jr, Allen T. Miller, Jr., Peter J. O'Connell, Connie A. Unger, of Lemoyne, Pennsylvania, their truc and lawful Attorncy(s)-in-Fact, with full power and authority hereby conferred to sign, execute and acknowledge, at any place within thc United States, thc following instrument(s): by his/her sole signature and act, any and all bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking and any and all consents incident thereto and to bind the Companies, thereby as fully and to the same extent as if the same were signed by the duly authorized officers of the Companies, and all the acts of said Attorney(s)-in-Fact, pursuant to the authority herein given, are hereby ratified and confirmed. This appointment is made under and by authority of the following Standing Resolutions of said Companies, which Resolutions are now in full fome and effect: VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indenmity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her. VOTED: That the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary. VOTED: That any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary, or (b) duly executed (under seal, if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority. This Power of Attorney and Certificate of Authority is signed and sealed by facsimile (mechanical or printed) under and by authority of the following Standing Resolution voted by the Boards of Directors of TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, TRAVELERS CASUALTY AND SURETY COMPANY and FARMINGTON CASUALTY COMPANY, which Resolution is now in full force and effect: VOTED: That the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding upon the Company in the future with respect to any bend or undertaking to which it is attached. (05-04) Unlimited },lneeJ},e/'D a!Jel~ ~ '900E 'lsngn¥ jo ,~ep qlLi~ S.Ull pox~l~ omJoq oq o; SleOS omJocho3 .~!oq; ptm luap!saJd aa!A Jo!uas .qoql ,~q pou~!s oq ol luoum.Hsu! S.Rll posn~ OAgq ANVdIAIOD A~LqVflgV~) MO~LDMIIARIV~I pug AMVdIA[O~) A~L~IflS IlMV AJ.TqflgVD S~I~Iq~AV~IJ~ 'VDI}I~II4IV ~IO ANVdI4IOD AJ~IflS {llqV AMIVflSVD S}I~I'-I~IAV~IJ~ '~IO~I~IHA~ $S~llqJ.IA~ MI Travelers IMPORTANT DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE On November 26, 2002, President Bush signed into law the Terrorism Risk Insurance Act of 2002 (the "Act"). The Act establishes a short-term program under which the Federal Government will share in the payment of covered losses caused by certain acts of international terrorism. We are previding you with this notice to inform you of the key features of the Act, and to let you know what effect, if any, the Act will have on your premium. Under the Act, insurers are required to provide coverage for certain losses caused by international acts of terrorism as defined in the Act. The Act further prevides that the Federal Government will pay a share of such losses. Specifically, the Federal Government will pay 90% of the amount of covered losses caused by certain acts of terrerism which is in excess of Travelers' statutorily established deductible for that year. The Act also caps the amount of terrorism-related losses for which the Federal Government or an insurer can be responsible at $100,000,000,000.00, provided that the insurer has'met its deductible. Please' note that passage of the Act does not result in any change in coverage under the attached policy or bond (or the policy or bond being quoted). Please also note that no separate additional premium charge has been made for the terrorism coverage required by the Act. The premium charge that is allocable to such coverage is inseparable frem and imbedded in your overall premium, and .is no more than one percent of your premium. RENUNCIATION the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters WITNESS ~7 hand this t/ ,-~ day of Oa,~¥--., 21) O (Signature) (Address) (Signature) (Address) (Signature) (Address) Not~ry ~u Mad,' CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of i:~/'~ O~ Of'E"f~"-'~ J ss. On /3 (~ ~;~: before me, ~'~' .~.~~,~:~~///~',~' personally appeare~t~ ~) ° Name(s) of Signer(s) ~ersonally known to me ~'proved to me on the basis of satisfacto~ / evidence to be the person~ whose name~~ subscribed to the within instrument and  acknowledged to m~~ executed the sam9 in ~~r authorized _ z capacity~), and that by ~;r/thclr signatur~on the instrument the pers~on~, or ~~ M~a Co~.~ .... [ the entit~ upon behalf of which the person~ acteO, oxecu~t~mont. WITNE~ nd a~off' a~se - ~Signature of Nota~ Public OPTIONAL Though the information be/ow is not required by/aw, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachrnent of this form to another document. Description of Attached~Document Title or Type of Document: ~_z'cA"~ IL,( ~ ~_./{_.~ Document Date: !'"'~ ~" '~)~--~ Number of Pages: / Signer(s) Other Than Named Above: Capacity(les) C~t,m~ S:(~e r Signer's Name: ' ~'~,~*--- Individual Top of thumb here Corporate Officer -- Title(s): [] Partner -- [] Limited [] General [] Attorney-in-Fact [] Trustee [] Guardian or Conservator [] Other: ~ Signer Is Representing: ,ion · 1348631 blic - California ~ ® 1999 National Notary Association · 9350 De Soto Ave., P.O. Box 2402 · Chatswor[h, CA 91313-2402 · www. nationalnotary, org Prod. No 5907 Reorder: Call Toll-Free 1-800-876-6827 PETITION FOR PROBATE and GRANT OF LETTERS fO, tdred also known as To: Register of '~ilis fo~ the~ ~ .... 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 execut/';' × nnmed in the last will of the above decedent, dated : 19 and codicil(s) dated (state relevant circmmtances, e.s. renun~mion, d~ath of executor, etc.) Decendent was domiciled at death in. ~~' ]OL ~ ~ . County, Penmylvan~ with h . last family or principal residence at ~/c/_~ A~.c:~ ,.~-~ (list street, number and munch) after execution of the will offered for probate; wns not the victim of a killing and was never adjudicatcd incompetent: . ,~ . . Decendent at death owned property with estimated vnlues as follows: (If domiciled in Pn.) AIl per~onaJ property $ C)~'~,/00 © (If not domiciled in Pa.) Personnl property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $... Value of real estate in Pennsylvnnia $. situated ns follows: WIiEREFORE, petitioner(s) respectfully request(s) thc probate of the last will and codicil(s) presented herewith and thc grnnt of letters.. th~on. (testamenm~, administration c.t.a.: administration d.b.n.c.t.a.) OATH OF'PERSONAL REPRF~ENTATIVE COMMONWEALTH OF PENN~YLVANI~ '[ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the fo~oin~ petition are true and correct to the best of the knowledse and belief of petitioner(s) and that as pe~onal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or aff'nmod and subscribed ~'~--- f~--~ ~~ ~ before me this 19. day of { // i Register ~ REV-348 EX (8-92) FOR REGISTER'S OFFICE USE ONLY PA DEPARTMENT OF REVENUE County Code I Year File Number ESTATE INFORMATION SHEET DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department. / N ap.~(La~) (F~rst) . (Middle) Decedent's Social Security Number Date of Death Date of Birth TYPE FILING: Enter check (~,) mark to indicate the nature of the return to be filed with the department. I ~ Probate Return r']Joint Assets Only [] Estate Tax Only [] Litigation Purposes (No Other Assets) Enter check (~,) mark to indicate the nature of the proceedings at the Register of Wills LETTERS GRANTED: Office. (Attach additional sheets if explanation is necessary.) ,~]Testamentary r-~Administration [] No Letters ~---]Other (Please Explain) ATTORNEY/CORRESPONDENT Enter all data concerning the attorney or other individual to receive all INFORMATION: tax information and correspondence. Name (Last) (First) (Middle) Supreme Court I.D, # Street Address City State Zip Code Telephone Number PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate INFORMATION: authorized by the Register of Wills Executor/Administrator IName (Last) ~::irst) .J.Middle) Social Security Number Street Ad~ress j~'~~ f~l~[ i~//¢ l/~"/~" ~ ~ ~ I ~ [ ~ ~ '[~ I / ~ State Zip Code Telephone Number Co-Exe~u~r/Ad ~inistrator Name (Last) ~ ~ ~ ~Securit% Numbe~ ~ Street Address ~ ' ~b ~ ~:' ' ' ~ =: :" ~ILL ~ET (~, Tel one Number: Co-Executor/Administrab lB 0t O00. ~ 0 "¥: ~ Name (Last) ~ ~ ~ ~' ~0~ Social Security~umber Street Address J~~~. ~ ~O~ ~ I I [ 5.0 05.0 0 Te,e.,one .ume. /Prepared ~Dat~. ~' ~ 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. Fee for this certificate, $2.00 ~ t~.,,,~.,~..., ,~ ~,~,).~.~ , [~ Local Registrar 1 03'3t No. ~ Date H105 144 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH · VITAL R~RDS '~'"~ CERTIFICATE OF DEATH ,~., (Coroner) SEX S~IAL SECUR TY NU'a~ ~ :"L: ~ ~F D .11dred .. (;oho J:7~male J ~.: ~ ..... ~ ~THiMonlh. Day, YeaO ~ ~ (~0~'l ~n 6ack White. e ~ ~k.~l~.;~u~r~) ] Yes ~ Ne ~ ~ Elementa~lS.~ ~ ~ ~v~Ma~.W~ 0twde, g,vema~en~me) cetary Construction ~ ~- ~ "'~+~ 2 Divorced ACTUAL lTa. S~.,. Pa 445A North 2nd Street .EmO~.C~ m~ '~.~ Wo~leysburg, PA 17043 Edward J. Schwa er ~u,~0,~,~~~omle sbur ~ ~ ~ ,~'~ .............. ~lizabeth E. Clawson Richard P. Mille~ ~ ~ ~ July 13, 200~ ~ Pen~ ~109 urg, PA 17109 ~n ~ Fo~un~s ~ah. D~E PRONOUNCED DEAD (M~th. Day. Y~} ~ ~, e~ ............... 2~. LiMonlyo~cau~oneachline ~u'~oealn~efl~mo~of~mg~~r ~t .~ ~._~ ..... ;2~ ............. Y" ~ No ~ Yes ~ No ~ ~ PendJngl ...... gatmn ~ Yes '~RTI~I~ ~Y~IC~N (Phy~,~ ce~ing c~ o Oea~ ~en anther ~ys~an has ro~ SiGN PRONO~I~ AND C~TIFYING PflYS~IAN (Phys~ian ~h pro~*~ ~ a~ cerhtymg to cau~ ot de.h) ~ ~ ~ I D~E SIGNED (M~th. Day, Y~) O~theb~laof .... Inat~nandlorlnvestlgatlon, lnmyoplnion, death ...... datthetme date andp .... ~duetoth .... ~s)a~ ~ i~.~ RENUNCIATION the above decedent, hereby renounce(s) the right to administer thc estate and respectfully ask(s) that Letters (Signature) (Address) (Signature) (Address) RECEIPT FOR PAYMENT Cumberland Coun.ty - Register Of Wills Receipt Date: 8/27/2004 Hanover and Hiqh Street Receipt Time:09 2: 1:51 Carlisle, PA I7013 Receipt No.: 1037647 GOHO MILDRED N Estate File No.: 2004-00801 Paid By Remarks: RICHARD MILLER JA ........................ Receipt Distribution ........................ Fee/Tax Description Payment Amount Payee Name LETTERS ADM ISSUED 80.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D Check# 602 ~102.00 Total Received ......... 102 00 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of i~ ~ ~ ~' ~c~ ~ cl No. o~J-O['l-" also known as To: Register of Wills for the Deceased. County of ~'ts~'s~/ta~,t:~r in the Social Security No. fi?q' I~ - ~'? o si' Commonwealth o{ P~nsylva~ia The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl q for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in Ct~/~e~~ _ County, Peonsytyania, with h__ last family or principal residence at q~ ~. ~r ~ t~/O/'~/a~,¢j~ta,rOt . (list street, number and municipal~y~ ' Decendent, then ~> ~ years of age, died '~¥ ~ ~ , ~'~, at. Decendent at death owned property with estimated values as folllows: (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: Petitioner.__ after a proper search ha ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: -- Name ~ Relationship ~;:~Resi~, THEREFORE, petitioner(s) respectfully request(s) the grant of letters ofc4~ministr46ion in~ appropriate form to the undersigned. ~ ~~ j~ ~_~_~f '~;i, ~ ~, . OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF 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 representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. L~~~~ Sworn to or aff~rr~_exd and subscribed before me this ~ "'~'~ day of No. _~J- 0qo ~0l Estate of , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW 19 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to in the estate of Register of Wills FEES Letters of Administration ..... $. Short Certificates( ) .......... $. ATTORNEY (Sup. Ct. I.D. No.) Renunciation ................ $ $ ADDRESS TOTAL __ $ Filed ..................... A.D. 19 PHONE Johnson, Duffle, Stewart & Weidner By: Richard W. Stewart I.D. No. 18039 ,-, m. '-, .... -- ,,,, o Attorneys for Petitioners 301 M~ket S~eet P. O. Box 109 Lemo~e, Pe~sylv~ia 17043-010~ (717) 761-4540 IN THE COURT OF COMMON PLEAS OF IN RE: CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF MILDRED N. COHO ORPHANS' CO~T DIVISION : NO. 21-04-801 PETITION TO WAIVE ADDITIONAL SECURITY UNDER SECTION 3351 OF THE PROBATE ESTATES AND FIDUCIARIES CODE TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of Karen L. Squiric, respectfully represents that: 1. Your Petitioner was appointed as Administratrix of the above-named estate. 2. The decedent, Mildred N. Goho, died intestate on July 8, 2004. 3. Your Petitioner was appointed Administratrix of the above-mentioned estate by the Register of Wills of Cumberland County, Pennsylvania. 4. Your Petitioner has filed a bond in the amount of $100,000 issued by the Travelers Casualty and Assurity Company. 5. To the best of your Petitioner's knowledge, the only assets of the decedent were real property located at 443 and 445 North Second Street, Wormleysburg, Pennsylvania, a bank account of approximately $1,500 held at M & T Bank, and an 1982 Oldsmobile sedan of negligible value. 6. Your Petitioner has entered into an agreement to sell the real estate located at 443-445 North Second Street in Wormleysburg Boro to Cropf Rentals for the sum of sixty-six thousand dollars ($66,000). 7. The aforesaid real estate is subject to a lien to M & T Bank, successor by merger to Dauphin Deposit Bank and Trust company, with an approximately balance of seven thousand dollars ($7,000). 8. There are approximately twelve thousand dollars ($12,000) in other outstanding debt of the estate. 9. The sole heirs of the decedent are your Petitioner and your Petitioner's brother, Richard P. Miller. 10. Your Petitioner's brother has joined in and consents to this petition. WHEREFORE, your Petitioner prays that Your Honorable Court enter a decree leaving the entry of additional security and authorizing your petition to receive the proceeds of the sale of the property at 443- 445 North Second Street, Wormleysburg Boro, Cumberland County, Pennsylvania. Respectfully submitted, JOHNSON, DUFFLE, STEWART & WEIDNER Richard W. Stewart Attorney I.D. No. 18039 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioners :241626 12/27/2004 13:21 8283221281 UPS STORE455 PAGE 06/07 Johnson, Duffle, Stewart & Weidner B~ Rich=rd W. Stewart t~D. No, 18039 A~ ~r P~on~ 301 M~ S~ P. O. Box 109 ~o~e, p~l~ia 17C43-01.~ (71~761~5~ , '"' ~ IN THE COURT OF COMMON PLEAS OF IN RE: - CUMBERLAND COUNTY. PENNSYLVANIA ESTATE OF MILDRED N. GOHO : ORPHANS' COURT DMSION . NO. 21-04-801 SWORN to and subscribed before me this __~.. r~ ~ day of Notary Public My Commission Expires: ,~LF~. ,~"/, ~9-0~)~ VERIHCATION I, KAREN L. SQUIRIC the Petitioner named in the foregoing Petition, make this Affidavit and have knowledge of the factg set forth in the foregoing and that said facts are true and correct to the best of my knowledge, informaton and belief. I understand that false statements made herein are subject to the penalties of 18 Pa.C.S. {4904 relating to unsworn falsification authorities. SWORN to and subscribed before me this ~ ,,, day of ~ ~~ ~ ~_ , ~oo~. - z~.. ...... .Y~ NO~ Public My Commission E~ires: ~.~.... ....~V· L00/~00~ ~ser xva st:~t ,00Z/O~/Zt .~l~hnson, Duffle, Stewart & Weidner By: Richard W. Stewart I.D. No. 18039 Attorneys for Petitioners 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 IN RE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF MILDRED N. GOHO ORPHANS' COURT DIVISION NO. 21-04-801 ORDER NOW, this ~ day of .~_.~_._~_..,~__,,,~ , 200~__, upon consideration within petition it is ordered and decreed that Karen L. Squiric, Administratrix of the Estate of Mildred N. Goho, deceased, is authorized to complete the sale of the property of 443-445 North Second Street, Wormleysburg Boro, Cumberland County, Pennsylvania, and is authorized to receive the proceeds of this sale of the aforesaid premises without the filing of additional security. ")~ d. d, 1- OL\ -3D! February 24,2005 Amy L. Frank 4544 Rolo Q. Mechanicsburg, P A 17055 Register of Wills Cumberland County Cowthouse 1 Cowthouse Sq. Carlisle, P A 17013 CJ '........ " ",j Dear Registrar: This lener is in reference to the following Estate: Mildred N. Goho Estate SS# 174-18-0704 445 N. 2nd St. Wormleysburg, PA 17043 Dec. 07/08/04 I wish to file a claim against the aforementioned Estate in the amount of $800.00. In November 2003, I loaned Mildred Goho $800.00 to assist her in paying her outstanding real estatel school taxes. This was a cash transaction that took place at her residence in the presence of myself and a witness, John Mulhearn. Unfortunately, Mildred was unable to repay this debt prior to her death. I became a good friend and neighbor to Mildred 10 years ago when I took residence at 443 N. 2nd St., Wormleysburg. Approximately 5 years ago, I became a caregiver to Mildred when her health began to decline. I helped her managed her affairs and made certain she had food and comfortability. On two separate occasions I have anempted to collect the outstanding debt and recover some personal belongings through the Executor(s) of the Estate, but no success. I was never included in the preparation of her Memorial either. Respectfully, AmyL. Frank cc: Karen Squiric Rick Miller Nancy Miller Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) mdnre-d N. Goh <:J 7/(;1].00'1 I f Date of Death: Will No. Admin. No. (r. I.. #- aooLj~ 00 g- 0 ( ) To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of t1je Orvhans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on I a 1-' &::; /-fl LI : Name Address Ri~.h AlUi ~; llex J 3LfO~ mQI'd f(b r,.on Dr. (OOfse Gold, tJ CA q 30/4 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date:~05 ~:: ~S~ Name J(f.\re.~ f'Aill €-( Squf ri C Address IS LJ <6 10 fh Sf. fV0 uJ ~lo~'j~C c<QCoO \ Telephonef6~g 32L/- 2- 7q 9 Capacity: ~ Personal Representative _Counsel for personal representative L G.., !! 1 ~ In Re: Estate of GOHO MILDRED N ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00801 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: SQUIRIC KAREN MILLER Counsel for Personal Representative: Date of Decedent's Death: 7/8/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine wh~ther sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 7/28/2006 /, 051'.. Lt.- / /J /ibh, ~(JM.j/~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: , / ~---./ A. Si at re ADJ)~ 5{)1 x ..,....~ B. Received by ( Printed Name) C. Date of Delivery D. Is delivery address different from item 1? 0 Yes If YES, enter delivery address below: 0 No 3. Service Type o Certified Mail 0 Express Mail o Registered 0 Return Receipt for Merchandise o Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Yes 2. Article Number e,.4;,A~f~Cs!p~~~ice lab,?I ~./I [1005 II ol~~ lliill,919,g / I fi >>~l~.' ~ 1121 PS Form 3811 , February 2004 Domestic Return Receipt tI OLl V d '~Is~{lBJ ",-'J...I '_~J I v'j J , ,~,..J al'Bnbs gSnoqllTIoJ ~uo ""(:' . pUB{l~qlUnJ 10 AlunoJ L tINOD' r$mr4~O JA ?I~EO pUB SIPM.10 l~ls~g~(l ql3nBqsBllS l~U1Bd BpmIO 1'1 \--'t" ("\.) , \ .-. 109J - nQ . xoq S!4l U! v+dlZ pUB 'ssaJppe 'aweu JnOA lupd aseald :Japuas . o ~ -8 'oN l!Wlad SdSn Pied see::! 'l? eBelsod l!eV'j ssel:)-lSJ!.::I 3JI^~3S l\1'lSOd S31\1'lS 0311Nn Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 NameOfDecedent:~lld<<zo N GOV\ ~ Date of Death: 7 <6 0 Y Estate No.: :;lOOLi - 00 ~D { 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 person rell, sentative reasonably believes that the administration will be complete: I d 81 0 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 offonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be ~L /~ / attached to this report. /l / fA A fll S . Dare:~ 1(=-- ~ ~_ Signature Xf\\f ("\ ft't\\-U SttU1'f\' C Name 15L\<? \OfhSi~ Q\ N LV Address t41'Ct~) Nc 28"bO ( ~~~- ~2'1/2/q3 Telephone No. Capacity: ~ Personal Representative o Counsel for personal representative c. Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7 ) 240 - 6345 Date: 5/31/2006 SQUIRIC KAREN MILLER 1548 10TH PL NW HICKORY, NC 28601 RE: Estate of GOHO MILDRED N File Number: 2004-00801 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: 7/08/2006 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, In ~ J_ A ~ ~, ! ,~Li.- / ". P b I~~ ~~",)d'~~ A / , 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 SQUIRIC KAREN MILLER (") ~O fJ~g 4:.0 Cf) ;;;;:: nc) a--f! r- '-- _ :.0 -o-l :> ~ = = ....... <- c :z: N 0"\ 1548 10TH PL NW HICKORY, NC 28601 > :::t Date: 6/22/2007 -.J RE: Estate of GOHO MILDRED N File Number: 2004-00801 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.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 1S due by: 7/08/2007 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 Strasbau9h Clerk of the Orphans I Court cc: File Counsel cJ In Re: Estate of GOHO MILDRED N ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00801 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: SQUIRlC KAREN MILLER Counsel for Personal Representative: Date of Decedent's Death: 7/8/2004 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 7/30/2007 ~~J~ _, :ig _J Glenda Farner Strasbaugh Clerk of the Orphans' Court C) c;~;8 ;-.'J.o .--.~ Distribution: Personal Representative Counsel for Personal Representative Estate File ,Tl '~J C)Q ) C) --n )~ --I ./., <-., S I (.,) o --. -- C_~) - ".\ . "r:! "'..- . (--) {Ti - - N 0' AUG 152007 ~ IN RE: ESTATE OF GOHO MILDRED N ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00801 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: SQUIRIC KAREN MILLER Counsel for Personal Representative: (') So =~. :n i+e, ; "-i;r: ::~-,,.. :-n Date of Decedent's Death: 7/8/2004 Date of Delinquency Notice: (~.~~ \~~) c:..) ~ The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in ac~~ance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans~~atrt 9 Division, Court of Common Pleas of Cumberland County, that neither the above nirned perso~ representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule6J2, Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Comi is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 7/30/2007 ~A '~Mj.~ Glenda Farner Strasbaugh Clerk of the Orphans' Comi Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled October 1. 2007 at 11AM in Courtroom NO.2. If the Status Report is filed prior to th automatically be cancelled. v\ Edgar B. Bayley, 1. r""""':> C::::1 = --.J :t>>o C G') 0> f-r.-. ! : Pa. a.t. Rule 6,12 STATUS RE.PORT REGISTER OF 'WILLS OF CAA rrla,,< I PD (1\ COu'NTY, PENNSYLVANIA Name of Decedem: rV\i\c\~d N. Go" \J Date of Death :Ji.J'j ~, d.. cp L{ File Number a 00 Y - () 0 '60 \ Pursuant to Pa. O.c. Rule 6.12, I report the follO'wing with respect to completion of the admillistratioll of the above-captioned estate: 1. Stilte whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . .. ~Ye~ D No 2. If the answel~is No, state when the personal representative reasonably believes that the adrninistratioll will be complete: 3. If the answer to No.1 is YES, state the following: a. Did the personal representative file a [mar account with the Court? . . . ... [Jy es ~No b. The separate Orphans' Court No. (if any) for the personal representative's account is: (VIA c. Did the personal representative state an account infol111ally to the parties in interest? ..............:................ .)tYes DNo 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 repOlt. Do,,~l 0 '7 Capacity: blrPersonal Representative 0 Counsel j(~ r1\~\\e.( SiUfn'L JjJ,'?P7(jilill]I::(I1lSI- _ I YHJ! c9~9 7~5 !/,~,1/1/ f71tJ / SS-C; f ?03. ~SJ6 / I Tei~ph:}!;e 217 =Zl!1d L I dJS LDOZ " .=:F/ii "':2J.//~.;D !Oe)). _i(;,/3,.[115 q) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 1 712B-060 1 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 101 I $2,970.00 I , ;i. ' I I I I I , . , I I SECURED LAND ~___h__ told ESTATE INFORMATION: SSN: 174-18-0704 FILE NUMBER: 2104-0801 DECEDENT NAME: GOHO MILDRED N DATE OF PAYMENT: 10/31/2007 POSTMARK DATE: 10/31/2007 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2004 TOTAL AMOUNT PAID: REMARKS: CHECK# 1238775 , , INITIALS: CJ RECEIVED BY: 'SEAL ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) NO. CD 008883 AMOUNT i $2,970.00' '" GLENDA FARNER STRASSAUGH, REGISTER OF WILLS REGISTER OF WILLS . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE, PLAINTIFF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA: VS. CIVIL ACTION - LAW FILE NO. 2004-00801 :-..) ,=~.) ~;) --.J (=) ESTATE OF MILDRED N. GOHO, DECEASED, '.. ..' --1 Co,) RELEASE ~: LD .r- KNOW ALL MEN BY THESE PRESENTS: c.n FOR VALUE RECEIVED, the property hereinafter described is hereby released from the lien, paYment, operation and collectibility of any and all succession, estate, or inheritance taxes, including direct, transfer and collateral inheritance taxes, now due or that may hereafter become due the Commonwealth of Pennsylvania from the Estate of Mildred N. Goho, deceased, who died as a resident of Cumberland County, Pennsylvania. ALL THAT CERTAIN lot of land situate in the Borough of Wormleysburg, County of Cumberland and State of Pennsylvania, bounded and described as follows: BEGINNING at a point on the eastern line of North Second Street on the dividing line between Lots Nos. 100 and 101 as shown on the hereinafter mentioned plan of lots; thence along the eastern line of North Second Street North 38 degrees 15 minutes West 25.21 feet to a point; thence continuing along North Second Street and along the State Highway right-of-way on a line curving to the right with a radius of 30 feet, 54.18 feet to a stake; thence continuing along the State Highway right-of-way North 66 degrees 01 minute East, 57.12 feet to a stake; thence by the same North 66 degrees 05 minutes East 59.57 feet to a stake at an alley; thence along the western line of said alley South 38 degrees 15 minutes East 24.53 feet to a stake on said dividing line between said Lots Nos. 100 and 101; thence by said dividing ~ line South 51 degrees 45 minutes West 150 feet to the place of BEGINNING. BEING portions of Lots Nos. 101 and 102 as shown on Edgewater Plan No. 3 as recorded in the Cumberland County Recorder of Deeds in Plan Book No.1, Page 71. HAVING thereon erected a two story double brick and frame dwelling house and a frame garage, ad being known as Nos. 443 and 445 North Second Street, Wormleysburg Pennsylvania. Excepting from the above described tract of land 443 North Second Street which Mildred N. Goho by her deed dated July 14, 1976 and recoded in the Recorder's Office, Cumberland County, Pennsylvania in Deed Book R-26, Page 628 granted and conveyed unto Elizabeth A. Acri, single person. BEING PART OF THE SAME PREMISES which Edgar L. Goho, by Deed dated October 26, 1972, and recorded November 2, 1972 in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania in Record Book W-24, Page 818, granted and conveyed unto Mildred N. Goho. THE SAID Mildred N. Goho died July 8, 2004. Letters of Administration were granted to Karen M. Squiric on December 6, 2004 and filed to Estate No. 2004-00801. AND IT IS FURTHER AGREED that the plaintiff above will not look to the above described premises, or any part thereof, for paYment of any part of the principal and interest of said above captioned judgment, now or hereafter to become due, or in any way disturb, put to charge or damage, the present, or any future owner or owners, occupier or occupiers of the said above- described premises or any part or portion thereof, for or by reason of the said judgment or any matter, cause or thing, thence accruing or to arise; provided that nothing herein contained shall affect any judgment or its legal validity so far - 2 - as respects all other lands and tenements of the said Estate which are not herein expressly released therefrom. This release of lien is given pursuant to the authority vested in the Secretary of Revenue by Section 809, 810, and 811 of the Inheritance and Estate Tax Act of 1961, Act of June 15, 1961 (P.L. 373, No. 207) (72 P.S. ~ 2485-809-811); the Act of December 13, 1992 (P.L. 1086, No. 255) (72 Pa.C.S. ~ 1775); the Act of December 13, 1982 (P.L. 1086, No. 255) (72 Pa.C.S. ~ 1775); and the Act of August 4, 1991 (P.L. 97, No. 22) (72 P.S. ~ 9175). IN WITNESS WHEREOF, these presents have been duly executed this J~ day of k~~ , 2007. COMMONWEALTH OF PENNSYLVANIA By RO~~ Deputy Secretary for Compliance and Collections Department of Revenue Attest: ~ML"J ~ - 3 - ~ , "011> ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this If/' day ofh& L , 2007, before me, a Notary Public in and for the county and state aforesaid, personally appeared Honorable Robert P. Coyne, Deputy Secretary for Compliance and Collections, Commonwealth of Pennsylvania, Department of Revenue, known to me to be the person whose name is subscribed to the above release, and acknowledge that, being authorized to do so, he executed the foregoing release for the purpose therein contained by signing on behalf of the Commonwealth of Pennsylvania. WHEREOF, I have hereunto set my hand and official seal. c - ~t2J&I/' /' ./ .k~ . ,..~. Notary Publ ic . My Commission Expires: NOTARIAL SEAl CHRISTINE A. STAHL Notary Public CITY Of HARRISBURG,DAUPHIN COUNTY MV Commission expires Jon 28. 2008 eln COMMONWEALT~OF PENNSYLVANIA DEP~M~r OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 '-I.NHERITANCE TAX . RECORD ADJUSTMENT FE] 29 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-19-2008 GOHO 07-08-2004 21 04-0801 CUMBERLAND 101 Pti 12: C;J STEPHANIE E. WITMER 2J SECURED LAND TRANSFERS 485 ST. JOHN'S CHURCH SHIREMANSTOWN PA 17011 Amount Remitted REV-1593 EX AFP (03-05) MILDRED N 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 +-- NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. REV-1593 EX AFP (03-05) ~~ INHERITANCE TAX RECORD ADJUSTMENT ~~ ESTATE OF GOHO MILDRED ACN 101 N FILE NO. 21 04-0801 ADJUSTMENT BASED ON: VALUE OF ESTATE: ADMINISTRATIVE CORRECTION 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 66,000.00 .00 .00 .00 .00 .00 .00 (1) (2) (3) (4) (5) (6) (7) 8. Total Assets (8) DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Administrative Costs/ Miscellaneous Expenses (Schedule H) (9) (10) .00 .00 10. 11. 12. 13. Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (11) (12) (13) (14) 14. Net Value of Estate Subject to Tax TAX: 15. 16. 17. 18. Amount of Line 14 at Spousal rate (15) Amount of Line 14 taxable at Lineal/Class A rate (16) Amount of Line 14 at Sibling rate (17) Amount of Line 14 taxable at Collateral/Class B rate (18) .OOX 00 66,000.00X 045= .OOX 12 = .OOX 15 = (19) 19. Principal Tax Due TAX CREDITS: + DATE NUMBER INTEREST/PEN PAID (-) 10-31-2007 CD008883 .00 02-15-2008 WRITEOFF .00 AMOUNT PAID 2,970.00 514.51 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE DATE 02-19-2008 66,000.00 .00 66,000.00 .00 66,000.00 .00 2,970.00 .00 .00 2,970.00 2,970.00 .00 .00 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS IF TOTAL DUE IS A REFUND. SEE . LESS THAN $1, NO PAYMENT IS REQUIRED. ~ REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE' J REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (6-88) ",. ..... w INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Mildred N. Goho REVIEWED BY ACN 2104-0801 101 Eunice Baker ITEM SCHEDULE NO. EXPLANATION OF CHANGES In accordance with the office of chief counsel agreement of September 5,2007 the following adjustment is issued. This is a release of lien for the above estate. ROW Paqe 1 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) f. _ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-19-2008 GOHO 07-08-2004 21 04-0801 CUMBERLAND 101 MILDRED N STEPHANIE E. WITME~ SECURED LAND TRANSFERS 485 ST. JOHN'S CHURCH SHIREMANSTOWN PA 17011 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF GOHO MILDRED N FILE NO. 21 04-0801 ACN 101 DATE 02-19-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYMENTS. THE CURRENT BALANCE. AND. IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-15-2008 PRINCIPAL TAX DUE: 2,970.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-31-2007 CD008883 .00 2,970.00 02-15-2008 WRITEOFF .00 514.51 TOTAL TAX CREDIT 2,970.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE. SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) '--j J