Loading...
HomeMy WebLinkAbout08-12-13 t 15�561014d �.�'� REV-1500 EX {a2_„>tF�> PA Department of Revenue 6FFlCtAL USE ON�v Bareau of tndividuai Taxas Cou�ty Code Year File Number r�o eox zaoso� INHERITANCE TAX RETURN 2 1 1 3 0 2 3 2 Hamsbum PA t712e-060t RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Num6er Date of Death MMDDYYYY Date af BiRh MMDDYYYY 1 1 1 Z 2 {] 1 2 1 2 1 3 1 9 2 6 DecedenYs Last Name Su�x DecedenYs First Name MI F R A K E R F L 0 R A Qf Applicable)Enter Surviving Spouse's Information Below Spouse s Last Name 5uffix SRouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN QUP�ICA7E WITH THE REGISTER OF WILLS ! FILL IN APPROPRIATE OVALS BELOW Q t.Or4ginai Retum � 2.SuRp�ementai Return � 3.Remainder Retum(Date of Death Prior to 12-i.-82} � 4.limited Estate � 4a.Future interest Compmroise{date of � 5.Fede�al Eskate Tax Return Required death after 12-12-62) �X 6.Decedent 6ied Testate � 7.Decedent Maintained a Livin9 T�ust Q 8.7ota1 Number of Safe Deposit Boxes (Attach Copy of WiII) (Attach Copy of Trust.j � 9.titigation Proceeds Received � 14.Spousal Poverty Credit(Date of Death � 71.Election to 7ax under Sec.9113{A) Between 12-31-91 and t-t-85} (Attach Schedute O) CORRESP4NDENT-THiS SECTiQN MUST BE COMPLETE6.AlL C6RRESPdN4ENGE AND CONFIOENTIAI.TAX INFORMATION SHpUtA BE DIRECTED T0: Name Daytime Telephone NumtgT ,�.� J 0 H N B • F 0 W L E R , I I I 7 1 � �? 4 3"'3 � d�-,' 1 3.• _' '�y �t _ c_ I RE�T�TY OF WILI.S�USE ON�LY�} � �? t= t.".. �` ;-! ( � i"' t, N , ... Firs[�ine a(Address � �' �' ' c'. ^:�' j 5. �� `-. .- v' , 1 � E A S T H I G H S T R E E T ( ,, , . - --� �', Second Line of Address I ��% �''! � �', <1 -;y, City ot'PaSt OffiCe State ZIP CMle I ,`� DATE FIL.ED _ _ C A R L I S L E P A 1� ? 0 1 3 Correspontlen£s e-meil address: JFOWLER(n7MARTSONLAW.COM Under penaiiies of perjury,i declare that i have examineG this retum,iacYUtling accompanym4 g�uies antl statemenis,and to the besi af my Knaviedge and 6elief, it is true,corred antl complete.Declaretion of preparer other than the personal representative is based on all information of whiqh preparer has any knowledge. S�GN{�TURE OP PE SON RESPONSBIE F R FI�iNG RETt7RN OATE Y � � '9" l3 ADD 2 0 T MARKET STREE MECHANICSBURG PA 17055 SI ATU OF PR T ER THAN ESENTATIVE j„QAT�r/� � EAST H3GH STREET CARLISLE PA 17013 PLEASE USE ORIG{NAL FORM ON�Y Side 1 � 15�561�14� 150561Q14Q � !� `�'� Cantinuatian of REV-15001nheritanae Tax Return Resident Decedent Ft6RA FRAKER 21 13 0232 DecedenPs Name Page 1 File Number Correspondents Name Deytime Telephone Number First line of a8dress Second line of address City or Post Office State ZiP Code CorreapondenPs e-mail address: Under penaities ot pe�ury,I deciare ihat I have ezamirred this retum,including accampanyi�sche6vies and statements,and ta the L�ast of my knowiedge and 6eliei, it is Uue,corted and wmplete.Declarelion of preparer other ihan the personal representaLVe is baeed on all infprmation of which preparer has any knowledge. SIGNr�g E Of PERSON RESP SBCE F R FI4�NG ftETURN DATE �=-�_- -- �.-a��'. �'f,G'/z d/..� 58R (1EADE DRIVE CARLIS�E PA� J 15fl561�240 REV-7500 EX{Fp DecedenYs Social 5ecurity Numtrer o�a¢�eSN��: FL4RA FftAKER RECAPITUIJ�TION t. Real Estate(Schedule A) . � , � n . . . . . .. . . . . . ... .. . . . . . . . . . . . . . . . .. . . . . . . . . 1. 2. Stocksand Bonds(Schetlule B) . . . . . ... . . .. .. . .. . .. .. .. . . ... .. .. . .. . . 2� ' 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. . . 3. • 4. Mortgages and Nr�tes Receivable(Schedule DJ . . .. ... .. .. . . . .. . . .. . . . . . . 4. � 5. Cash,Bank Deppsits antl Miscellaneous Personal Praperty(Schetlule E). . . .. . . 5. L 1 1 6 7 . 4 2 6. Jointly Owned Property{Schetlule F} ❑ 5eparate Billing Requested . .. .. . . 6. • 7. Inter-Vivos Transfers&Misceilaneous N n-Probate Pmperty (Schedule G) � Separate Billing Requesled . . . . .. . 7. • 8. ToWI Gross Assets ttota!Lines 7 through 7) .. . . . ... . . .. .. ... .. .. . . . .. . 8. 1 1 1 6 7 . 4 2 9. Fu�erai Ezpenses and Rdministrative Costs(Schedule H) . . . . .. . .. .. .. . .. . . 9� 1 4 7 2 q . 3 9 70. Debts of Decedent,Mortgage Liabilities,and�iens{SchedNe 1) . 10. 6 � 7 1 5 . 5 8 1 i. Total 4eductions(totai lines 9 antl 10) . .. . .. .. . .. . . ... .. .. . .. .. . . . . . . i t. 7 7 4 4 4 . 9 7 iz Nee vaw�at Eszaee t��ne a m;�,�s u�e>>} . ... .. . .. .. ... . . .. .. ... .. . .. �z. - 6 6 2 7 7 . 5 5 13. Charitable and Governmental BequestslSec 9113 Trusts For which an eiection to tax has not 6een made(Schedule J} . ... . . . . .. ... .. . .. .. .. �3. • i4. Net Value Subject to Tax(�ine i2 minus Line 53} .. ... . . .. .. ..... ... .. . 74. - 6 6 2 7 7 . 5 5 TAX CALCULA7idN-SEE fNSTRUCTIOhS POR APPLlCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9516 (a){12)X.0 _ 0 . 0 0 �5. 0 . 0 0 16. Amount of Line 14 taxabie ac rr,eaE rate x.oas 0 • 0 0 �s. 0 • p 0 17. Ampunt of Line 14 tazable 0 . 0 0 n. Q . [] 0 at sibiir�g rate X .12 18. Amount of Line 14 taxable at wilaterai rate JC .15 � • � n 18. � • n � 19. TAX 4UE .. . . . . .. . ... . ... . . . . . . .. . .. . . . . .. .. . .. .. .. .. .. . .. .. . . . 19. � . � � 24. PIIL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 � 15�561�240 7�5�5610240 J REV-15tlo Ex{FI) Page 3 File Number DecedenYs Complete Address: 2� �� oz3z DECEDEN7'S NAME F'LdRA PRAKER _ _ _ _ STREETADDRESS � Id i OLD GAP ROAD _ __ ._ _ GTY � . . ... .. .. ... .. � STATE .. .. . . ' ZIP .. _ . _ CARLISLE PA 17013 Tax Payments and Credits: i- TaX�ue(Page 2,tiine te} {�) o.00 2, CreditslPayments A.Prior Payments 8-Discount Totai Gretiits(A+ e j {�} p pa 3. Interas� ��) 4 If Line 2 is greater than Line 1 +Line 3,enter the tlifference.This is the OVERPAYMENT. FiII in ovai on Page 2,6ine 26 to request a refund. {4} o.aa 5, ii Line 1+Line 3 is greater ihan Line 2,enter the difference.This is the TAX DUE. {5} 0.04 Make check payable to: REGlSTER OF WILLS, AGENT PIEASE ANSWER THE FOLLOWfNG QUE5710NS BY PLACING AN "X" IN THE APPRdPRIATE BLOCKS 1. Did decedeni make a transfer snd: '?es Na a. retain the use or income af the property transferred .............-......_.............................._............... ❑ � b. retain the right to designate who shall usa the property transferred or its income ............................. ❑ 0 c retainareversio�aryinterest ...-..............................._..._...__..._......._............._--..._.......----.... ❑ � d. receive ihe promise for life of either payments,benefits or care? ....................................................... ❑ � 2. if death occurred after December 12, 1982,did decedeni transfer propedy within one year of dea#h withoutreceivingadequateconsideration? ................................_............_....._-.............._-....._-...... ❑ 0 3. Did decedenl own an"in trust for"or payabie-upon-dealh bank account or security at his pr her deaih? ......... ❑ QX 4. Did der,edent own an individuai retirement accounf,annu�ky or other non-probate pra�rty,whlch co�tainsabeneficiarydesignatian?.........._......_.............................................................................. ❑ � IP THE ANSWER TO ANY 4F THE ABOVE QUESTIONS IS YES,YOU MUST CpMPLETE SCHEOULB G AND FILE IT AS PART qF THE RETURN. For dates of death on or after July t, 1994,and before Jan. 1,1995,the tax rate imposed on the net value af traasfers to flr(or the use of the surviving spouse is 3 percent[72 P.S.§9116{a){1.�)(I)]. For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value o(transfers tp or for the use of the surviving spouse is 6 percent [72 P.S.§9116{a}{1.1}(iij].The statute does nat exempt a transfer to a surviving spouse from tax,and the statutory requirements ior disclosure of assets antl fling a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: + The tax rate imposed on the net value af transfers from a deceased child 21 years of age ar younger at death to or far the use of a natural parent,an adoptive parent or a stepparent of the child is p percent[72 P.S.§9116(aj(1.2)}. • The tax rate imposed on the net value of transfers to ar for the use of the decedenPs Vinea(beneficiaries is 4.5 percent,except as noted in�2 g.s.§s�yo{aM})J • The tax rate imposed an the net vaiue of transfers ta or for the use af the decedenYs siblings is 12 percent{72 P.S.§9116(a)(1.3jj.A si6ling is defined, under Section 9102, as an individual who has et least one parent in common with the decedent,whether by blood or adoption. REV-15Q2 EX*{12-12) pennsylvania SCHEDULE A �EPARTMENT OF REVFNUE REAL ESTATE INHFRtTANCE TAX RETURN RESIOENT CIECEDENT ESTATE Of: FILE NUMBER: FLORA FKAKER 21 13 0232 All real properly owned solely pr as a tenant in common must be repoAed at fair market value.Fair market value is defined as fie price at which praperty uauid be exchanged behveen a w411ing tiuyer and a willing seller,neither being competled to buy or sell,both having reasonable knowledge of(he re�evant facis. Reai praperly that is jointlyowned w(th right of aurvivorship must be disclosed on Schedule F. Attach a capy of the semement sheet if!he property has been soid. ITEM Indude a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE NUMBER OFDEATN DESCRIPTION I. Real estate improved with brick ranch type dwelling house and detached twp car garage and 0.60 Iocated at l�i] 41d Gap Raad,Narth Middieton Tawnship,Cumbcriand Counry,PA,known as Tax Parcel No.29-07-0471-029,being described rn Deed dated 10/OS/1987 and recorded in Cumberland Covnty, PA, Deed Book Y32,Page 1068,and bei�g conveyed To William A,Fraicer and Flora A. Fraker,his wife. William A. Fraker died on 9/28/1944 leavin�title solely vested in Flora A. Fraker. * Suspend asset until sale of real estate, iacluding costs of sale and of maiakenance,etc.,during ' estate aArninisCrati�n pending sale af sard re�I esta[e. TOTAL(Also enter on Line 1,Recapitulation.) $ 0.00 If more space is noeded,use additional sheets of paper of the same size. � uev-asoa�c*{oe-yza pennsylvania SGHEDULE E oepaRrMeNroFaeveNUe CASH, BANK DEPOSITS & MISC. INHERItANCE tAX REA�RPI RESioENTnECEOFNr PERSONAI PRdPERTY ESTATE OF: FtLE NUA46ER: PLC)RA PRAKER 21 13 0232 inciutle the proceeds of Iitigation and the date the proceeds were reaeived by the estate. All properLy jointly ow�ed with right of survivorship must be disClosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PNC Bank checking account no. 50-05714726($9,96737 plus 0.05 accrued interest) 9,967,42 Sze attached. 2. t 485 Chavrotet truck-not running 100A0 3. 1942 Oldsmobile sedaa-not running 1 QOAO 4. Household gvods and parsonal property I,OOp.00 TOTAL(Also enter on Une 5,Recapitulation) 5 1 I,1 G7.43 If more spaCe is needed, use additional sheets of paper of ihe same size. REV-1517 EX+{10-tl9) pennsylvania SCHEDULE H oEPaRTM��T oF RE�EN�,E FUNERAL EXPENSES AND �wHFRiTnr�cE cnxrzeruRH A6MINISTRATIVE COSTS RESIDENT OECEDENT ESTATE dF FILE NUtABER PLC7RA fRAKER 21 13 0232 Decedem's debts must be teported on Schedule 1. ITEM NUMBER �ESCRIPTION AMOUNT A. FUNERA�EXPENSES: 1. Hoffman-Roth Funeral Home&Crematory,lnc. 13,d8098 2. Maria Abe,minisierial hanorarium lOU.QQ 3. First Cl�urch of the Brethren,funeral reception 277.9I B. ApMINISTRATIVE CQSTS: 1. Persflnai RepresentaHve Commissions: Name(s)of Personal RepresentatWe(s) SlreOt Add�055 Ciy State ZiP Year(s)Cammission Paid: p, Attomey Fees: Martson Law Offices(estimated based on assets reported on this retum} 782A0 3. Famly Exemptron:(if decedenYs adilress is not the same as claimanYs,atfacfi exptanation.y Claimant Strest Adtlress City Siaie Z�P Reiallonship of Claimant to Decedent 4. Probate Fees: Register of Wills, Cumbertand County 363.50 5 Accountant Fees: 6. 1'az Return Preparet Fees: 7. Irwin� McKnight,P.C.-estate consultation 125.QQ TOTAL(Also enter on Line 9,RecapiWtatian} $ 14 72934 if more space is needed,use additbnat sheets o`paper of the same size. REU-1512 Ex+(t2-i2} pennsylvania SCHEDULE I oePaRrmetir oF�eveNUe DEBTS OF DECEDENT� �NNERirnNCerAxaeTUaw MORTGAGE LIAB1l.ITIES$� I.IENS RESIDENT DECEDENT ESTATE OF FILE NUMBER FLORA FRAKER 21 13 0232 Report debfs incurred by the deceden#pdor ta death that remained unpaid at tfis date of deatb,including unreimbursed medicai expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF pEATH i. Sarah A. 'Codd Memorial Home,account payabte b09.2A 2. Departnrent af PvbNc Welfare,Ci5#9703Q8345 58>842.28 See attached. 3. Outstand'rng check an PNC Sank acsount no.50-05714726 upon date of death �,264.06 TOTAL(AlsoenferanLine16,Recapitnistion} S b2775 �8 if more space is needed,insert additionai sheets of the same size. LAST WI�LL AND TESTAMENT OF FLOxA A. FRAKER 1,FLOI2A A.FRAKER,of 141 Qld Gap Raad,Carlisle,Cumberland County,Pennsy(vania. being af sound and disposing mind,memory and understandirsg,da rnake,publish and dectaze this to be my Last Will and Testament,hereb}=revaking and rnaking void al!previous Wiiis and Codicils heretofora rnade by me. 1 I order and direct my personal representative hereinafter named Co pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my person�l representative need not accalerate and pay those �nmatured obligations which, in his. her or its apinion, iI might be proper and more advantageous ta retain ar renew and pay as they become due and payable. If I do not own a burial plat c�r a grave marker at the time of my death,l authc�rize rny persanal representative, in liis, her or its sote discretion,to purchase a burial ploi and to erect a suitabie grave marker at my grave,and ta expend sums from my estate for this purpose. *.� 2 I give, devise and bequeath all oi'my estate, both real and personal property, together with � all insurance proceeds thereon of whatever nature and wheresoever situate in equal shares to ruy children.WILLIAM L.FRAKER,of 1861 Walnut Bottarn Road,Newville,Cumb�riand Counry, � Yennsyl�ania, JAMES E. F12AKER, of 5 Matthew Court, Carlisle, Curnberland County, Fenns�ivania,PHYLLIS J.MINNiCfi,of 225 North Market Street,Mechanicsburg,Cumberland 1 LAST WIi,L AND TES"CAMENT OF FI,ORA A. FRAKER County,Pennsylvania, CARL L. FRAKER,t>f 163 flak Hiii Raad, Cariisle, Cumberland Counry, Pennsylvania, and DIANE E. HARROLD,of 816 Fairview=Road„ Carlis(e, Cumbertand County, Pennsylvania who survive me by sixty(bd}days per stirpes. It'ss further my desire#hat my persanal representative, after consultation with any heir or heirs of rnine who survive me, and in his, her or its own discretion,choose such artictes from rny tangibie personal property(exclusive of cash,stock certificates, bonds, and all other Cangible evidences of intangible p4rsonai properry) as he, she or if believes will be useful to such heir or heirs or desirable for him or her or them to have, either from a sentirnenta!point of view or otherwise,and to deliver such articles to such heir ar heirs pr among such heirs in equal �r unequal shares as determined by the further exercise of his, her or its discretion,provided na ather heir objects to khe distribution. All tangible personal property not so distributed is to be sold, either publicly or privately, by mv persona! representative, adding the proceeds of such sale or sales ta my residuary estate and ta be dispased af in equai shares amang my surviving heirs after payment of my estate debts,taking inta accaunt the tangsble personal property otherwise provided to them. I have specifically excluded 'a"TELLA L. SMITH and t2UTH BOYER frorn this Last Will and Testament as I have provided for bath of them in other ways during my lifetimc.. 3 I nominate,constitute and appoint PHYLLIS J.MINNICH and JAMES E. FRAKER as guardians of any property which passes to any beneficiary wha is under the age of T W ENTY-ONE (2I}due to my death� Said guardians shali have the power and authority in their discretion to apgly `'� income ar principal to the support and education of said beneficiaries, and to make payrnents for � ihese purposes. I direct that no Guardian shall be required ta give or past band for the faiihfu] � performance of the Guardian's duties in this or any other jurisdictian. �t 2 LAST WII..L AND 'TESTAMENT OF FLdRA A. FRAK�R � Any devise or distribution under ih'ss Last Wil( and Testament which is payabCe to any beneficiary who may be under TWENTY-ONE(21}years of age ar,in the judgment of my personal representative, menCally disabled, sha11 be held in a separate trust by my personal representative as trustee until such benefrciary reaches TWENTY-ONE (21) years of age during such period af disability. During the term of any trust created pursuant to this Pazagraph,the Trustee is authorized to expend and apply so much of the net income and principal of each sach trust as the 'I'rastee shall consider advisable For the bealth,maintettance,supportr and education(including coll�ge education„ undergraduate and graduate�of each such beneficiary until he or she atts�ins TWENTY-ONE (21) vears of age, or unti4 all such amounts are paid aut of trust� I direct that no Guardian shall be required to give or past bond for the faithful pertbrmance of the Guardian's duties in this ar any ather jurisdictian. 5 t grant my personal representative the fotlowing pawers in addition ta and nat: in limitation of such powers as my personat representative shall hofd by law: (a) To retain all property received including the stack of any corporaCe fiduciary acting hereunder, provided such property remains productive. f b) To join in any corporation, partnership, recapitalizatio��, merger, reorganizatipn or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but nat limited to,the voting af shares. (c To mana e,o rate,re air, im rove, mart a e or leasa pn an terms an real estaCe � ) g Pe P P � � Y Y held or owned by my estate. '� id} To operate any business that I may own at my death. 3 � LAST WILL AND TESTAMENT OF FLORA A. FIt�KER {e} To invest an� funds of my esCate in anv stocks, bonds, notes or other securities ar property, real or persana{, withaut regard to the principie of diversification or any other staznte ar general rule of law in his,her or its abso4ute discretion, it being my intention to give my personal representative the broadesi investment powers possible, providing such investments do not unnecessarily prevent the prompt settiement ofmy estake. (fl To sell or otherwise dispose of any property, real or personal,tangible or intan�;ible, at any tirne forming a part af my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her, ar its absolute discretion. {�;} Ta borraw money for the paymeni of t�es ar for any other proper purpases in the administration of my estate. and to martgage or pledge estate assets as security. (h} To compromise claims withaut court appraval ineluding, but not limited ta, any controversies with the Un'sted States of America ar ttre Commonwealth af Pennsyivania cancerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testamenz. (i) To distribute in aash or in kind upon any division ar disCribution of my estate. (j) Ta undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management af the settlernent of my estate_ (k) In �enerai, ta exercise afi powers in the mana�;ernent of my estate which any individual covld exercise sn the management af similar property owned in his own right, upan such terrns and canditions as to him, her or it ma}` seem besi and to execute and deiiver aIl instruments and to do al} acts which he, she ar it deems necessary or prpper to carry avt the purposes o€this, my Last Will and Testament. 4 I�1 LAS"I'WILL AND TESTAMENT OF FLORA A. FRAKER 6 No interest of any bc�neficiary of my estate, either in income or in principaf, shalt be sabject ta anticipation ar pledge, assignment,sale ar transfer in any manner,nor shall any benefsciary have tlye power in any manner to eharge or encumber his inCerest either in income or principal, nc�r shall the interest of any beneficiary be liable ar sub,ject in any manner while in the passession of ray persona( representative for the 4iability of such beneficiary. I 7 1 nominate, constitute and appoint rny daughter, PHYLLIS J. MINNICH and my son, JAMES E. FRAKER, as Co-Executors af this my Last Will and Testament. In the event PHYLLIS J. MINNICH and JAMES E.FRAKER,are deceased,unabie or unwiVlin�to serve or s11a11 cease Co secve for any reason whatsoever, then I nomiizate, constitute and appoint my son, WILLIAM G FRAKER, as personal representative of this my Last Will and`I'estament. I direct that my persana]representative sha13 not be required to give or post band for the faithful performance pf his, her ar its duti�s in this or any other jurisdiction. & I hereby declare it to be rny expressed desire that my persanal representative employ the law firm of Michael J. Hanft, Esquire, af Cumberland County, Pennsylvania, for legal advice and assistance regarding this my Last Wiil and Testament, they having considerable kn�wledge of my affairs,views and wishes respecting any matters that rnay arise at the probate of this instrument,the administration of my estate, and the execution of the powers herein mentioned. Any� menfron of Michaei 3. Hanfr, Esquire in this m}r Last Will and Testament, is my free and votuntary act and through no influence by any person. 5 � LAST WILL AND TESTAMENT OF FLORA A. FRAKER IN WITNESS WHEREOF,I have hereunto set my hand to this my Last Will and Testament this��day of /�a`�`�^ ��` , 1999. WITNESS: � �� � ��� Flora A. Fraker � � 6 LAST WILL AND TESTAMENT QF FLORA A. FRAKER ACKNOWLEDGMENT COMMONWEALTH OF PHNNSYLVANIA . : SS. COUNTY OF CUMBF.RLAND . � I, FLORA A. FRAKER, the Testatrix whose name is signed ta the attached or foregoin�; instrument, having been duly qualified accordin�to law, do hereby acknowledge that I signed and executed the instrumenk as my I.ast Will and TesYament that T signed it willingly, and that I signed it as my free arrd voluntary act for the purposes therein expressed. �����A ��.,�.� iora A. Fraker �Swarn ar �rmed and acknawledged before me by Elora A. Fraker the 'Testatrix this �day of ���h��� , ]499. ��Y.fi'��.Q..__��� ��.� y Notarial Seal Qublic 4enise l.Nye,Notary gp�utt�MWNeMnTwp.,Cumbertarxf Counry My Commission Explrea Feb.26,2001 MMtiber,Pe�nsyNan4�AeWabhQnoiNWaAes ? LAST WILL AND TESTAMENT OF FT.ORA A. FRAKER AFFII}AVIT COMMQNWEALTH OF PENIVSYLVANIA . � : SS. COUNTY OF CUMBf:RLAND . W E. M �C�f kE2 �� f�A-n��; and ��� i i.� �, �„X�.��, ,the witncesses whose names are attached to the fore�aing document, being duly qualified according to law, do depose and say that we were present and saw Flora A. Fraker, the Testatrix si�n and cxecute the instrument as her Last Will and TestatnenY; thaC she si�ned willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each subscribing u itness in the hearing and sight of the Testatrix signed the Last V4�i11 and TesYament as witnesses and that to the besi of our knowledge the Testatrix was ai the time 1$ or mare yeazs of agc, of sound rnind and under no constraint or undue influence. _ �� ,,� , �i��e� /�y�n io� Sworn or affirrned and subscribed before me by /1i1�Cr��c2- � f1'¢^���_ and l 1 C,l I��S.�"�e( �this��y ofl�YVl�!.l�-Y _, 1999. � �� �u��_����--_ N4tadat Sea� � Deniee L.Nye, Notary PubliC SouthMlrltllelonTwp.,CumbeAanu�o2�} AAy Commusion Expres Fetr.26, Merr�der,pennsyWyoia pgsoGgtrn nt Notanes � P4ber IbldeMirm DOCA�WdI&E�18h`U9G�IfaCwlll 8 May. 9. "[�13 ?0: 31AM PNC Bank to, ;. : , � .�; ��� '.v1ay 9, 2013 Martson Law OFfices 14 E Higb St Cazlisle PA 17013 ! kE: Plora A.Pcaker SSN: i62-22-1�38 T�OD: iI(1212Q12 Llear Sir134fadazn_ In response to your request for Z7ate of Death(T7{)3J}bal�nces for the customar noted al7ove,our records show the faliowing: C'hecking Aceouht Account#54Q5714726 Established: ]0/22l2007 PLORA A FRAKBR DOS7 balance: S 9,467.37+p.p� accrued intexest Please note ehat this office provides date of death balances for deposit accounu(TRP.s,CDs,Checking a�id Savings}. ti�'e da noi proeess any 5naxicial trans�ctions or provide sta#ements. If pou need asszstanet with any af these items,please call l-�8$-PNGBANK(1-8$8-762-2265)ar stop by your local PNC Bank branch c�ff;ce. $incerely, National Financial Services Center PNC Bank,N.A. MemberFD1C Thrs r.ressage rs�ntended for the use of the individual vr entiiy to which it is addressed and may contain information �hat is pr�vileged, confidentiut and exempt jrom drsclosure under applicabie taw. If th�re¢d�r of this mess¢ge is not the inrended recipient ar the�mgloyee or ageat responsible far delivering this message t0 the ir�tendetY recipient,ypu nre hereby rrntified that any dissemination, distiibulion or capying Pf tl�is commuttications is strTCtty prohibited ifyou have received this commttnicaizon in error,ptease no#fy me irrrmediately by reply ar by telephane at 80D 7G2-1775 and immediaiely destroy lhr.s fitxed document. Page 1 of] SC�. �.. �_�rr, f , pennsytvania bEPANTMENT OF PU9LIC WELFApE December 21, 2012 - !i°:,n:�_� _.�:�J IRWIN & MCKNIGN7 PC se:L �' 4= .:::;;' MATTHEW A MCKNTGHT ESQUIRE W POMFRET PROFESSIpNAl BLDG r,twi+it=tv�e;i��FGn� 60 W P4MFRET ST �4�I'1Ffb"�:� CARLI5LE PA 17013-3222 Re: Flora Fraker CIS #: 970348345 SSN: ###-##-1338 Date af Death: 11i12/2022 Dear Attorney McKnighk: Piease be advised Chat Che Department of Public We{fare maintains a claim in the amount of 458.842.28 against the above-mentioned estate. This claim is for restitution of medical assistance grarrted on behaif of the decedent for wh3ch khe Probate Estate is now responsible to reimburse the pepertment according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, etfective aune 30, 1995. Enciased is the DepartmenYs itemized sYatement of claim. A portion of thls medicai expense, namely 525.718.00. was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Cade, 2d Pa. C.S.A. 3392(3). The balance of tha claim, namely 533.124.28, is to be entered as a priority Class 5.1 claim against the estate. Piease acknowtedge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is compiete, piease provide a capy. If ttfe estate cantalns real estate, piease pravide copies of the deed, the latest tax assessment, and a current appraisai, if available. Sincerely, /� ���,"'��Il�t�.- � I r�+j�.�L.��-. Angela D. Gerter Claims Investigation Agent 717-772-6612 717-772-6553 FAX Enclasure eureau af Program InTegrity � DiviSion ofi Thirtl Party tiahAity i Retovery Sectifln PO Box 8466 � Harrisburg, PennSylvania 17I05-8466 � SGh . � , .s.-��n �