HomeMy WebLinkAbout02-18-05
HEATH L. ALLEN
N. DAVID RAHAL
CHARLES W. RUBENDALL n
ROBERT L. WELDON
EUGENE E. PEPINSKY. ..JR.
..JOHN H. ENOSm
GARY E. FRENCH
DONNA S. WELDON
BRADFORD DORRANCE
..JEFFREY S. STOKES
ROBERT Ft CHURCH
STEPHEN L. GROSE
R. SCOTT SHEARER
ELYSE E. ROGERS
CRAIG A.1..0NGYEAR
DONALD M. LEW1Sm
BRIDGET M. WHITLEY
..JOHN A. f'EICHTEL
ELIZABETH ..J. GOLDSTEIN
STEPHANIE KLEINFELTER
BRADI..EY A. WALKER
KEEFER WOOD ALLEN & RAHAL,
ATTORNEYS AT LAW
210 WALNUT STREET
P. O. BOX 11963
HARRISBURG, PA 17108-1963
LLP ESTABLISHED IN 1878
OF COUNSEl..:
SAMUEL C. HARRY
WEST SHORE OFFICE:
415 F ....LLOWF1ELD ROAD
CAMP HILL, PA 17011
1717) 612-eeOO
PHONE: (717) 255-8000
EIN No. 23-0716135
www.keeferwood.com
WRITER'S CONTACT INF'ORMATION:
February 16, 2005
(717) 255-8027
E-mail address:
b\vh it!cv(!i ke{'fe[!'\.v(locl.com
'-,
Glenda Farner Strasbaugh
Register of Wills for Cumberland County
Hanover and High Streets
Carlisle, PA 17013
Dear Ms. Strasbaugh:
-,,)
cI:
.2)- ()~~OJ(o~
Enclosed for filing, please find two copies of the Pennsylvania Inheritance Tax Return of
lelsie C. LaRocca, who died on September 16, 2004. No Letters have been issued in this estate,
and therefore, there is no inventory.
I enclose two checks: one in the amount of $3,016 in payment of the inheritance tax, and
$15 for your fee to file the return.
Please confirm the filing of this report by date stamping the enclosed copy of the first
page. I enclose a self-addressed, stamped envelope for your use in returning the confirmation
copy to me.
Thank you for your assistance.
Enclosure
\)--
Very truly yours,
KEEFER WOOD ALLEN & RAHAL, LLP
By: ~,dlU!;
Bridget M. Whitley
,
REV.1500EX (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
05
OLfoY:_
21
COUNTY CODE
YEAR
NUMBER
I-
Z
LU
C
LU
lrl
c
DECEDENT'S N.AME (LAST, FIRST, AND MIDDLE INITIAL)
LaRocca Jelsie
DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DD-YEAR)
9/16/2004 11/16/1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
C
SOCIAL SECURITY NUMBER
171-03-4869
THIS RETURN MUST BE FIL.ED IN DUPLICATE WITH THE
w
>-
::.::g;cn
0.'"
wll-O
",00
011:..1
II-In
II-
'"
[][],
04
06.
0,
Decedent Died Testate (Attach copy of Will)
Litigation Proceeds Received
Original Return
[] 2. Supplemental Return D 3 Remainder Return (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5 Federal Estate Tax Return Required
[K] 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
[J 10. Spousal Poverty Credit (dale 01 deatn between 12.31.91 am 1-1-951 [J 11 Election to tax under See, 9113(A) (Attach SenO)
Limited Estate
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
>-
Z
W
C
Z
o
..
'"
w
a:
a:
o
u
Bridget M. Whitley, Esq.
FIRM NAME (If Applicable)
Keefer Wood Allen & Rahal, LLP
TELEPHONE NUMBER
P.O. Box 11963
HarriSburg, PA 17108-1963
717 -255-8027
1. Real Estate (Schedule A)
o
OFFICIAl USE ONLY
(1)
(2)
1,627
2 Stocks and Bonds (Schedule B)
3 Closely Held Corporation. Partnership or Sole-Proprietorship (3)
o
o
4. Mortgages & Notes Receivable (Schedule D)
5 Cash, Bank DepOSits & Miscellaneous Personal Property
(Schedule E)
(4)
2,108
(5)
z
o
i=
::5
:::l
l-
e::
<C
U
LU
II:
6. J~ Owned Property (Schedule F)
U Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
o
(6)
103,931
(,
107,666
8 Total Gross Assets (total Lines 1-7)
(8)
3,142
37,500
(11)
(12)
(13)
(14)
9. Funeral Expenses & Administrative Cost::> (Schedule H) (9)
10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11 Total Deductions (total Lines 9 & 10)
40,642
67,024
o
12 Net Value of Estate (Line 8 minus Line 11)
13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
67,024
14 Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax 0
Z rate, or transfers under Sec. 9116 (a)(1 ,2)
0
j::: 16 Amount of Line 14 taxable at lineal rate 67,024
'"
>-
=> 0
II- 17 Amount of Line 14 taxable at sibling rate
:l!
0 0
U 18 Amount of Line 14 taxable at collateral rate
X
'" Tax Due
>- 19.
, .0 ~(151
'0 ~(16)
x.12 (17)
, 15 (181
(19)
o
3,016
o
o
3,016
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W46451,OOO
\/'
Decedent's Comolete Address:
STREET ADDRESS
809 North College Street
Cumberland
CllY
Carlisle
, ~~TE
I ZIP
17013-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,016
o
o
o
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + 6 + C) (2)
o
o
o
TotallnterestlPenalty (D + E) (3)
o
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.:
Check box on Page 1 Line 20 to request a refund
(4)
o
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
3,016
A. Enter the interest on the tax due.
(SA)
o
6. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REG1STCR OF WILLS, AGENT
(56)
3,016
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
[j[]
D
D
D
D
D
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [Jg
__-'F T~.~~NSWER TO ANY O~THE ABOVE QUESTIONS IS YES, YOU MUST COMPl.ETE SCHEOULE G AND FILE IT AS PART OF THE RETURN.
. 'n<!er pen(>ities 01 perjur)-, I derlare T~3t I r"w<, examined this retur'l. il1l'illding ar,r.()~.,p<:n'ling ~ch('!,Lrles anu st",,,m0"''', ilnl'1 to tl'>e.heM olrl'Y ~nowled~e arid
b"!lief. it is true, corre-ct and comrl~tp
Declaration of preparer orher than the personal representative is based on all informatiun of which plzparer has any kn~wh,dge
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred:. . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income;.
c. retain a reversionary interest; or ........................
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12. 1982, did decedent transfer property within one year.of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an "in trust for" or payable upon death bark account or security at his or her death?
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
No
D
[]I
[]I
[]I
[]J
[]J
SIGNA
RSONRESPONSIBLE FOR FILING RETURN-
DATE
2/11 / 2005
ADORE S
5 Winchester Ct.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS ~ YJ1. oYU't
P.O. Box 11963
Mechanicsburg, PA 17050
DATE
2/10/2005
Harrisburg, PA 17108-1963
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on thf! net value of transfers to or forthe use of the surviving spouse is 3%
[72 PS !3 9916 (a) (1,1) (i}J.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. !3 9116 (al (1.1) (ii})
The statute does not exempt a transfer to a surviving spouse from tal(. and the statutory requirements for disclosure of assets and filing a tax return are stili applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after Jufy 1,2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-or,s years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. !3 9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use ohhe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !3 9116(1.2) [72 P.S 99116(a)(1)J
!h~ tax rate imposed on the net value of transfers to ?r for the use of the decedent's siblings is 12% (72 P.S. S 9116(a)(1.3)] A sibling is defined, under Section 9102, as an
indIVidual who has at ieast one parent tn common WIth the decedent, whether by blood or adoption.
3W46461.000
'REV.1503EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
Jelsie C. Larocca
2105
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.43 Shares
Metlife, Inc.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,627
Valued at $37.84 per share
3W469610QQ
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,627
REV-1508EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Jelsie C. Larocca
FILE NUMBER
2105
ITEM
NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Capital Blue Cross Refund
99
Refund of unearned premium
2
M & T Bank Checking Account
2,000
3
Uncashed dividend checks paid
by Metlife, Inc.
10
3W46AO 1.000
TOTAL/Also enter on line 5 Recanitulation\ $
(If more space is needed, insert additional sheets of the same size)
2,108
REV-1510EX + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EST ATE OF
Jelsie C. Larocca
FILE NUMBER
0521
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLlOETI-EN"-MEoFll-ETRANSFEREE, THEIR RELATIONSHIP TO OECEOENTANO DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER TI-E DATE OF TI'tANSFER. ATTAQ-tACXJPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IIFAPPLlCABlE\ VALUE
,. Revocable Trust of Jelsie C.
LaRocca dtd October 2, 2000 103,931 100.000 0 103,931
The sole asset of this trust
was decedent's residence. The
trust beneficiaries needed to
sell the residence in order to
pay the claim of the
Department of Public Welfare
for Medicaid recovery.
Accordingly, the residence is
valued at the net proceeds
received on sale, as shown on
the settlement sheet.
I I
! ,
I
TOTAL (Also enter on line 7, Recapitulation) $ 103,931
(If more space is needed, insert additional sheets of the same size)
3W46AF 1.000
,REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Jelsie C. LaRocca
FILE NUMBER
2105
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,. Hoffman Roth Funeral Home 596
B. ADMINISTRATIVE COSTS:
1 Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s) - -
Street Address
City State -- Zip
Year(s) Commission Paid:
2. Attorney Fees 2,500
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimantto Decedent
4 Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7
1 James LaRocca
Reimbursement for fee to
obtain Surety Bond required by
stock transfer agent 31
Total from continuation pages 15
TOTAL (Also enter on line 9, Recapitulation) $ 3,142
(If more space is needed, insert additional sheets of the same size)
3W46AG 1000
Estate of: Jelsie C. Larocca
Item
No.
2
Description
Register of Wills
Fee to file Inheritance Tax
Return
Schedule H part 2 (Page 2)
Amount
Total (Carry forward to main schedule)
15
15
REV-1512EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jelsie C. Larocca
SCHEDULEl
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
0521
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Department of Public Welfare
Division of Third Party
Liability
VALUE AT DATE
OF DEATH
37,500
3W46AH 1000
TOTAL (Also enter on line 10, Recaoitulation) $
(If more space is needed, insert additional sheets of the same size)
37,500
'REV.1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jelsie C. Larocca
SCHEDULE J
BENEFICIARIES
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1 .2)J
FILE NUMBER
2105
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
00 Not List Trustee(s) OF ESTATE
1 Rosalind L. Folkers
16806 Flower Mist Lane
Houston, TX 77095
33.333333% Residue: 22,341
Daughter
22,341
2 Anne L. Herring
4457 East Yates road
Bensa1em, PA 19020
33.333333% Residue: 22,341
Daughter
22,341
I[Total from continuation pages 22,341
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1 000
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space IS needed, Insert additional sheets of the same size)
$
o
Schedule J part 1 (Page 2)
Estate of: Jelsie C. Larocca
Item
No. Description
Relation
Amount
3 James N. LaRocca
5 Winchester Court
Mechanicsburg, PA 17050
33.333333% Residue: 22,341
Son
22,341
Total (Carry forward to main schedule)
22,341
KEEFER WOOD ALLEN & RAHAL LLP
BRIDGET M WHITLEY ESQUIRE
210 WALNUT STREET
POBOX 11963
HARRISBURG PA 17108-1963
Dear Attorney Whitley'
*'
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRO PARTY LIABILITY
CASUAL TV UNIT
P.O.BQX 8486
HARRISBURG, PA 1710~86
December 6, 2004
Re: JELSIE LAROCCA
CIS #: 430152641
Incident Date' 09/16/2004
This letter is to advise you that the Department will accept $37,500.00
as payment in full for the above estate.
Please have check made payable to the Commonwealth of PA and forward to
my attention at the above address.
Sincerely 1
f~,...- ,It("~
Patricia Nace
Claims Investigation Agent
717-772-6616
717-705-8150 FAX
....
".....-..- ~- OMS NO. 21502-0265 ;-,
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.ofHA 2.ofmHA 3.DCONV. UNINS. 4.I&JVA ,.oCONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT MOYER
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished 10 gl\19 you a slatemant of aclusl satlfemllnl cosls. Amounts paid 10 and by the settlement agent are shown.
lIems marked "[POCr went paid outside the closing; they are shown here for infonnstional purposes and are not included in the totals,
" "" [MOYER.PFOiMOYERI5
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
MichaelP. Moyer Rev. Trust of Jetsis C LaRocca The Washington Savings Bank
CarolJ. Moyer James N. laRocca, Trustee 4201 MltcheUville Rd.. Suite '300
111 Ridge Drive Rosalind L Folkers, Trustee Bowie, MD 20716
Carlisle, PA 17013 Anne L. Herring, Trustee
809 North College Slreet
Carlisle, PA 17013
G, PROPERT'( LOCATION: H. SETILEMENT A.GENT: 25.1624515 L SETILEMENT DATE:
809 North COllege Slreet Bradley l.. Griffie, Esquire
Carlisle, PA 17013 November 22, 2Q04
Cumberland County, Pennsylvania PLACE OF SETfLEMENT
200 North Hanover Street
Carlisle, PA 17013
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 115000.00 401. Contract Sale, Price 115000.00
102. PersonalP~ 402. PersonalProoertv
103. Seutement Char es to Borrower Une 1400 7797.89 403.
104, 404.
105. 405.
Adlustments For Items Paid Bv 58/1er In sdvance Acfustments For Items Paid 8v 5e/ler in advance
106. School Taxes 11122104 \0 06f30J05 673.17 408. School Taxes 11122104 to 06130f05 673.17
101 Coun fTownshi 11122104 to 12131/04 52.16 407, Coun fTownshi 11/22104 to 12131f04 52.16
lOll. Assessments 10 408. Assessments 10
109 Coun fTownshl Taxes 409. CounlyfTownship Taxes
110 School Taxes 410. School Taxes
111. 411.
112. 412.
120 GROSS AMOUNT DUE FROM BORROWER 123,523.22 420. GROSS AMOUNT DUE TO SELLER 115.725,33
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. De osit or earnesl mone 500.00 501. Excess De osil See Instructions
202 Princiea\ Amount of New Loan s 116,750,00 502. Settlement Charges to Seller line 1400 8794_36
203. Exislin loan s takensub'eelto 503. Existin loan s laken sub'eet to
204 504. Payoff of first Mortgage
205 505. Pa off of second Mort a e
206. 506.
207 501. De it disb. as emceeds
208. 508.
209. Seller Asslsl 3,000.00 509. Seller Assist 3000_00
Acl"usfmenls For Items Un aid 8 Saller Ad'us/ments Far Items Un aid Bv Se/ler
210. School Taxes 10 510. School Taxes 10
211 Coun fTownshl 10 511. Count fTownshi 10
212 Assessments 10 512. Asse$sments 10
213 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PA/D BYIFOR BORROWER 122,250.00 520. TOTAL REDUCTiON AMOUNT DUE SELLER 11.794.36
300. CASH AT SETTLEMENT FROMfTO BORROWER: 600, CASH AT SETILEMENT TO/FROM SElLER:
301 Gross Amount Due From Borrower Une 1201 123,523.22 601. Gross Amount Due To SeUer (line 420 115725.33
302 less Amount Paid -Bv/For Borrower (line 220) ( 122,250.00) 602. less Reductions Due Saller (line 520) ( 11,794.36
303 CASH ( X FROM)( TO) BORROWER 1,273.22 603. CASH ( X rO)( FROM) SELLER 103,930,97
Tt1e un<lersigned t\ereb'j acknow\e-dge I'1!ceipt of a compteted copy 01 pages 1&2 ollhis slalement & any aUschmanls referred to herein.
Borrower
\l2I,,/k//;/ yJt;~
MI ael . Moyer (j
(?4-4L~~
CarolJ.Mo r
Seller
.o..d M'{..
IC--<-
liQd l. Fo ke ,Trustee
(--=.-.JD ~~ /04 ,L;-<.
~He;rlng,~t~e I'
HUD-1\3.$i)1U;$"....Ha43052
L. SETTLEMENT CHARGES
,OTAL COMMISSION Based on Price $ 115,000.00-;';;;- 6.0000 % 6,900.00 PAID FROM PAID FROM
Division of Commission line 700 as Follows: BORROWER"S SEllER"S
11 Ii 3,475.00 10 George L Ebener & Associates FUNDS AT fUNDS AT
102. Ii 3,425.00 to The Homestead Group SEITLEMENT SETTLEMENT
703. Commission Paid at SelUemenl 6,900.00
704 to
800. ITEMS PAYABLE IN CONNECTION WITH lOAN
801. loan Orl inallon Fee % to
802. Loan Discount % to
803. Appraisal Fee to Ridge Marketing Appraisals 30000
804. Credit Report to MeR 17.00
805. Flood Certification Fee to The Washington Savings Bank 22.00
806. MortOane Ins. -,:,r;rc Fee to
807. Assumption Fee to
806.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901 InlereslFrom 11122/04 to 12101104 @ $ 1B.710000/day I 9 days %) 168.39
902. Mort a e Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 "" to Erie Insurance POC $31O.00b
904.
905 VA Funding Fee to $3750lfinanced $45/Cash 3,795.00
1000. RESERVES DEPOSITED WITH lENDER
1001. Hazard Insurance 3.000 months $ 25.83 "' month 77.49
1002. Mort a e Insurance months $ "' month
1003. School Taxes 6.000 months $ 94.54 "' month 567.24
1004 Coun fTownshi 10.000 months $ 40.59ner month 405.90
1005 Assessments months @ $ pe, month
1006. months $ e, month
1007. months , month
1008. A re;:;BteAdlUstment months $ e, month -394.88
1100. TITLE CHARGES
1101. Sell1ementor Closin Fee to
1102. Abstract or Tille Search to Tn-Coun AbstractSvcs. 117.00
1103 Tllle Examination to
11 04. Clos~ Protection letter to First American Tille Ins. Co. 35.00
1105. Document Pre arallon to BradleVl.. Griffie, Es uire 45.00
1106. Nola Fees to Cash 12.00
1107 Atlorney'sFees \0 Keefer, Wood, Allen & Rahal, llP 666.00
includes above item numbers:
1106 Title Insurance to Tn-Count AbstractfA ent for First American 404.75
includes above item numbers:
1109. Lender's Coverage $ 119,000.00
1110. OWner's Coverage $ 115,000.00
1111. Endorsements (300, 100,6.1) to Tri-County AbstractfAgent for First American 150.00
1112. Approved Atty. Fees to Bradley L. Griffie, Esquire 549.00
1113
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 39.50; Mortgage $ 64.50; Releases $ 104.00
1202. Ci /Coun Tax/Starn s: Deed . Mort .e 1,150.00
1203. State TaxlStam s: Revenue Slam , ; Mort a e 1150.00
1204. Powers of AlIorne 2 to Cumberland Count Recorder of Deeds 34.00
1205
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surve \0
1302 Pest Ins ection to
1303. Final Water/Sewer Readin to Borou hofCarlisle #00568A 32.36
1304. Home Ins action to AnSCom an Inc. 285.00
1305
1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Sec::Uon K 7,797.69 8,794.36
8Y$lgn~pagelorlh..slatamflllllhesognalonesaoknowledQe"'~plorecompleteda>pyolpage2~rlhiSIwCP8\19SlSlamAl
~ :c--:-,: " 'D)
,~
L Agent//'
Certified to be a true OOPY
{MOYEA/MOVEA/5}
-'
r
\.
r
.
REVOCABLE TRUST AGREEMENT
OF JELSIE C. LaROCCA
ON THIS, the ~c\ day of O~r
, 2000, JELSIE C.
LaROCCA, of the Borough of Carlisle, Cumberland County, Pennsylvania by her
Attorney-in-fact James N. LaRocca (the "Settlor"), by this Agreement and desiring to
establish a Trust, hereby assigns to JELSIE C. LaROCCA, JAMES N. LaROCCA, of
Cumberland County, Pennsylvania, ROSALIND L. FOLKERS, of Wichita Falls, Texas,
and ANNE L. HERRING, of Bensalem, Pennsylvania, as Co-Trustees (collectively
referred to in the singular, neuter gender as the "Trustee"), the property described on
Schedule A attached hereto, to be held, together with such additional property as may
be transferred or bequeathed hereto by the Settlor or any other person, upon the
following terms of trust:
WITNESSETH:
ARTICLE I
Descriction of Procertv Transferred. The Settlor has paid over, assigned,
granted, conveyed, transferred and delivered, and by this Agreement does hereby pay
over, assign, grant, convey, transfer and deliver unto the Trustee the real and personal
property described on Schedule A, which is annexed hereto and made a part hereto.
Any other property that may be received or which has been received by the Trustee
hereunder, as invested and reinvested (hereinafter referred to as the "Trust Estate"),
shall be held, administered and distributed by the Trustee as hereinafter set forth.
r-
r
ARTICLE II
Provisions for Settlor Durinq Lifetime. The Trustee shall hold, manage, invest
and reinvest the Trust Estate (if any requires such management and investment) and
shall collect the income, if any, therefrom and shall dispose of the net income and
principal as follows:
A. During the lifetime of the Settlor, the Trustee shall pay to or apply for the
benefit of the Settlor who is then living, all the net income from this Trust.
B. During the lifetime of the Settlor, the Trustee may pay to or apply for the
benefit of the Settlor who is then living, such sums from the principal of this Trust as the
Trustee in its sole discretion shall deem necessary or advisable from time to time for
the medical care, comfortable maintenance and welfare of the Settlor, taking into
consideration to the extent the Trustee deems advisable, any other income or
resources of the Settlor known to the Trustee. In exercising this discretion the Trustee
is advised to be generous in making distribution to the Settlor, even if such distributions
have the effect of significantly reducing or even eliminating the funds available for the
remainder beneficiaries.
ARTICLE 1\1
Settlor's Riqht to Amend. Chanqe or Revoke the Trust Aareement. The Settlor
may, by signed instrument delivered to the Trustee during the Settlor's life: (1) withdraw
property from this Trust in any amount and at any time upon giving reasonable notice in
writing to the Trustee; (2) add other property to the Trust; (3) change the beneficiaries,
their respective shares and the plan of distribution; (4) amend this Trust Agreement in
-2-
,~
r
any other respect; and (5) revoke this Trust in its entirety or any provisions therein;
provided, however, the duties or responsibilities of the Trustee shall not be enlarged
without the Trustee's consent nor without satisfactory adjustment of the Trustee's
compensation.
ARTICLE IV
Discretionarv Provisions for Trustee to Deal with Settlor's Estate and Make
Pavment of Debts and Taxes. After the death of the Settlor, the Trustee shall, upon the
request of said Settlor's Personal Representative, pay all or any part of such deceased
Settlor's funeral expenses, legally enforceable claims against the Settlor or the Settlor's
estate, reasonable expenses of administration of the Settlor's estate, any allowances by
court order to those dependent upon the Settlor, any estate, inheritance, succession,
death or similar taxes payable by reason of the Settlor's death, together with any
interest thereon or other additions thereto, without reimbursement from the Settlor's
Personal Representative, from any beneficiary of insurance upon the Settlor's life, or
from any other person; provided, however, that no estate, inheritance, succession,
death, or similar taxes payable by reason of death of the Settlor shall be apportioned to
or borne by any share or property passing to any charitable beneficiary. Except for
amounts passing to charitable beneficiaries upon death of the Settlor, all such
payments, except of interest, shall be charged generally against the principal of the
Trust Estate includeable in such deceased Settlor's estate for federal estate tax
purposes and any interest so paid shall be charged generally against the income
thereof. The Trustee may make such payments directly or may pay over the amounts
- 3-
,-
(
thereof to the Personal Representative of such deceased Settlor's estate. Written
statements by the Personal Representative of such sums due and payable by the
estate shall be sufficient evidence of their amount and propriety for the protection of the
Trustee and the Trustee shall be under no duty to see the application of any such
payment.
ARTICLE V
Distribution Uoon Death of Settlor. Upon the death of the Settlor, the Trustee
shall distribute the then remaining principal and undistributed income of the Trust
Estate in equal shares, per stirpes, among the then-surviving issue of the Settlor.
ARTICLE VI
Trustee's Powers. In addition to the powers hereinbefore provided and those
given by law, the Trustee, and any additional or successor Trustee, without any order of
court and in its sole discretion, may:
A. Hold and retain the property now and hereafter comprising a part of the
Trust Estate, for such length of time as in its sole discretion it may deem wise, or sell
any part thereof, without liability of any kind by reason of such retention or sale and
invest and reinvest, alter, vary and change investment from time to time, in such
manner and in such property, real, personal, or otherwise, including any common or
diversified trust funds and proprietary or other mutual investment funds maintained by
any bank or trust company or an holding company or affiliated thereof, including the
stock of any such bank or trust company or affiliate thereof, as the Trustee may deem
- 4-
r
prudent, without being confined to what are known as legal investments under the laws
of any state or jurisdiction;
B. Repair, alter, improve or lease, for any period of time (even for more than
five (5) years) any property and give options for leases;
C. Make distributions hereunder either in cash or in kind or partly in each,
and cause any share to be composed of property differently in kind from any other
shares, without regard to the basis of such property;
D. Purchase investments at a premium;
E. Vote in person, or by proxy, all stocks or other securities held;
F. Exercise any rights or warrants to subscribe for stocks or bonds or other
allotments received by reason of securities held, or sell them for such prices as it may
deem best;
G. Deposit, surrender or exchange stocks or pay any assessments in
connection with any reorganization or merger or similar proceedings as it may deem
best;
H. Exercise any option, right, or privilege granted in any insurance policy;
I. Sell any real or personal property at public or private sale to any person or
entity, or give options therefore for cash or credit, without liability on the part of the
purchaser to see to the application of the purchase money; provided, however, that no
sale hereunder shall be made at a price less than that which the Trustee acting in good
faith shall consider to represent adequate and full consideration;
- 5-
r
J. Borrow money from any source, including from the Trustee, mortgage or
pledge any property and purchase assets from a Settlor's estate at fair market value
and loan money to any person or entity or to either said estate; provided, however, that
appropriate interest and collateral shall be required for such loans;
K. After the death of the Settlor, to merge any trust created hereunder with
any other trust or trusts created by the Settlor under will or trust, if the terms of such
trust are then substantially similar and held for the primary benefit of the same person;
L. Compromise claims;
M. Register securities in the name of a nominee in such manner that title
shall pass by delivery;
N. Employ attorneys, investment counsel, accountants and agents in
connection with the discharge of its duties, and determine and pay to them reasonable
compensation;
O. Pool the assets of all trusts created hereunder or any of them for
investment purposes, allocating to each trust an undivided interest in all of the assets
so held;
P. Add to the principal of any trust created hereunder any property received
from any person by Deed, Will or in any other manner;
Q. In the exercise of its discretion with respect to the use of principal for any
beneficiary, the Trustee may take into account other property and income available to
such beneficiary; in doing so, the Trustee may conclusively rely on written
representations made to it by such beneficiary, and the judgment of the Trustee as to
- 6-
r
the amount of principal so used and the extent to which other resources are considered
shall be conclusive as to all parties in interest;
R. Exercise all power, authority and discretion given by the Trust Agreement
after termination of any trust created herein until the same is fully distributed; and
S. Accept property or not, in the Trustee's sole discretion, by bequest or
lifetime transfer from any person, estate or trust, subject to the payment of, or liability
for, state and/or federal gift, estate, transfer, succession. inheritance or other death
taxes, including any interest or penalties thereon, and sign any required consent or
acknowledgment or liability for such taxes and/or lien against such property.
ARTICLE VII
ContinuinQ Trust Protection for Minor Beneficiarv. If any share hereu:1der
becomes distributable to a beneficiary who has not attained the age of twenty-five (25)
years, then such share(s) shall immediately vest in such beneficiary, but
notwithstanding the provisions herein, the Trustee shall retain possession of such share
in trust for such beneficiary until such beneficiary attains the age of twenty-five(25)
years, using so much of the net income an<.l principal of such share as the Trustee
deems necessary to provide for the proper medical care, education, support and
maintenance in reasonable comfort of such beneficiary, taking into consideration to the
extent the Trustee deems advisable any other income or resources of such beneficiary
or his or her parents known to the Trustee. Any income not so paid or applied shall be
accumulated and added to principal. Such beneficiary's share shall be paid over and
distributed to such beneficiary upon attaining the age of twenty-five (25) years, or if he
- 7-
r
or she shall sooner die, to his or her executors or administrators. The Trustee shall
have with respect to each share so retained all the powers and discretion had with
respect to this Agreement generally.
ARTICLE VIII
Trustee Succession. Removal. Votina Riahts. Fees and Limitation on Powers.
The Trustee shall be subject to the following:
A. Trustee Incaoacitv or Death. Upon the disability (as certified by a
physician), death or resignation of Jelsie C. LaRocca, James N. LaRocca, Rosalind L.
Folkers, and/or Anne L. Herring, as a Co-Trustee, the remaining Co-Trustees shall
continue to serve in such capacity, provided that two Co-Trustees shall serve at all
times.
B. Successor Trustee. If there shall ever be less than two Co-Trustees, the
Successor or Substitute Trustee shall be some attorney or bank or trust company with
trust powers, which Successor or Substitute Trustee shall be designated in a written
instrument filed with the court having jurisdiction over this Trust Agreement and signed
by the Settlor, or if unable to act, then by the remaining Co-Trustee, if any, otherwise by
Robert R. Church, Esq., or by the law firm with which he is associated, or was last
associated. Any Co-Trustee may at any time appoint an attorney or qualified bank or
trust company as a Successor or Substitute Co-Trustee...
C. Trustee Removal. The Settlor may, at any time, remove any then-serving
Co-Trustee; provided, however, that the Settlor shall immediately thereafter designate
- 8-
r
an attorney or a qualified bank or trust company as a Successor or Substitute Co-Trustee.
D. Trustee Desianation. Designations hereunder shall be written and shall
be effective when accepted in a writing signed by the designee and delivered to the
then-serving Trustee. Removals hereunder shall be effective when contained in a
writing signed by the person holding such power, and delivered to the Trustee being
removed.
E. Trustee Resianation. Any Trustee acting hereunder may resign at any
time without court approval, to become effective upon delivery to each adult beneficiary
to whom the Trustee is then directed or authorized to pay income, or a written
instrument signed by the resigning Trustee.
F. Trustee Fees. For its services as Trustee, the Trustee (except for the
Settlor, acting in his capacity as Trustee) shall be entitled to receive reasonable
compensation, as well as reimbursement for reasonable expenses incurred.
G. Bond. Trustee and its successors and substitutes shall serve without
bond in any jurisdiction in which called upon to act.
ARTICLE IX
Governina Law and Situs. This Trust Agreement and the trusts created hereby
shall have situs in Cumberland County, Pennsylvania, and this Trust Agreement shall
be construed, regulated and governed by and in accordance with the laws of the
Commonwealth of Pennsylvania.
-9-
r
ARTICLE X
Definition of "Trustee." Whenever the word "Trustee" or any modifying or
substitute pronoun therefor is used in this Trust, such words and respective pronoun
shall include both the singular and the plural, the masculine, feminine and neuter
gender thereof, and shall apply equally to the Trustee named herein and to any
successor or substitute Trustees acting hereunder, and such successor or substitute
Trustees shall have all the rights, powers and duties, authority and responsibility
conferred upon the Trustee originally named herein.
ARTICLE XI
Acceotance bv the Trustee. The Trustee acknowledged receipt of the property
described on Schedule A attached hereto, accepts the Trust hereby created, and
covenants that the Trustee will faithfully discharge all of the duties and responsibilities
of the office under this Trusteeship.
[INTENTIONALLY LEFT BLANK]
- 10 -
r
IN WITNESS WHEREOF, the Settlor and the Trustee have executed this Trust
Agreement on the day and year first above written.
W]TNES~
~~~fA1~~:' (SEAL)
by her Attorney-in-fact, James N.
LaRocca
P-
,,;," .
<:::' ,I' .'
~
~
~
'-
~,'-f.'o.,4. (SEAL)
SIE C. La ccK. Co-Trustee
by her Attorney-in-fact, James N.
LaRocca
~?- ~~. - (SEAL)
ES N. La OCCA, Co-Trustee
~t . L c;(. ~ (SEAL)
ROSALIND L. FOL1<ERS, Co-Trustee
~
r
(SEAL)
Trustee
- 11 -
r
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
(2Lu"x.b if ~
SS.
On this, the J ^-..d day of 0 C---h:, b..L.'\...- , 2000, before me, the
undersigned officer, personally appeared James N. LaRocca, known to me or
satisfactorily proven to be the person whose name is subscribed as attorney-in-fact for
Jelsie C. LaRocca, and acknowledged that he executed the same as the act of her
principal for the purposes contained therein.
IN WITNESS WHEREOF, I hereunder set my hand and official seal.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF L u. r,J'J if Lo-w
On this, the ~ day of () c..:+-o ~'-
~LL~
Nota Public
NOTARIAL SEAL
CYNTHIA J. RULE, Notary Public
Camp Hi>> Boro.. Cumberland County
Mv Commission Expires Jan. 24. 2004
SS.
, 2000, before me, the
undersigned officer, personally appeared James N. LaRocca, known to me or
satisfactorily proven to be the person whose name is subscribed as attorney-in-fact for
Jelsie C. LaRocca, and acknowledged that he executed the same as the act of her
principal for the purposes contained therein.
IN WITNESS WHEREOF, I hereunder set my hand and official seal.
N~~crL(_,-
NOTARIAL SEAl,
CYNTHIA J. RULE, No\l\ry Public
Camp Hi>> Boro.. Cumberland County
- 12 - Mv Commiss~~. Expires Jan. 24. 2004
,-
r
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~_r~}JU ~
SS.
On this, the .;1.0
day of
o~~
, 2000, before me, the
undersigned officer, personally appeared JAMES N. LaROCCA, Co-Trustee, known to
me, (or satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged that he executed the same for the purposes therein
contained.
iN 'NITNESS WHEREOF, I hereunder set my hand and official seal.
~U
Nota Public
NOTARIAL SEAL I
CYNTHIA J. RULE, Notary Public I
Camp HiM Boro.. Cumber'.and County
M Commission Expires Jan. 24. 2004 ;
COfvlMONWEALTH OF PENNSYLVANIA
COUNTY OF Q~Ef~
SS.
On this, the ~
day of
()~~
, 2000, before me, the
undersigned officer, personally appeared ROSALIND L. FOLKERS, Co-Trustee, known
to me, (or satisfactorily proven) to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, I hereunder set my hand and official seal.
~GoLL-
Nota Public v
NOTARIAL SEAL
C~pNmIAB J. RULE, Notary Public I
M" ~ro., Cumberland County
y Commls~~pires Jan. N 2004 I
- 13-
c
COMMONWEALTH OF PENNSYLVANIA
COUNTYOF ~ ~
On this, the J.ui day of Ddo ~
55.
, 2000, before me, the
undersigned officer, personally appeared ANNE L. HERRING, Co-Trustee, known
to me, (or satisfactorily proven) to be the person whose name is subscribed to the
within instrument, and acknowledged that she executed the same for the purposes
therein contained.
IN WITNESS WHEREOF, I hereunder set my hand and official seal.
~u,
Nota I Public
NOTARIAL SE.A~
CYNTHIA J. RULE. Notary Public
9amp Hill Bora.. Cumberland County
Mv Commission Expires Jan. 24. 2004
- 14 -
r
SCHEDULE A
OF THE REVOCABLE TRUST AGREEMENT
OF JELSIE C. LaROCCA UNDER AGREEMENT
Dated OC:f-oIo..u d ,2000
Asset Descriotion
Aooroximate Market Value
Personal Prooertv
1.
None
Real Prooertv
1.
$ 75,000
Residence known as
809 North College Street
Carlisle, PA 17013, located
in the Borough of Carlisle,
Cumberland County, Pennsylvania
(Copy of the Deed is attached)
TOTAL - Personal and Real Estate:
i 75,000
nf..-.(D
,If.
,
. A1~')O
~ J,+u
(.
,
Parcel Number 06-19-1643-212
This Deed,
MADE THE~ day of (j cfu~L in the year of our Lord Two thousand (2000).
. <">
BETWEEN = ~ ""
c:::J .::.... __~ :-'1
_I'.
e=> ....... 0 ~::
Jelsie C. LaRocca, by her attorney-in-fact, James N. LaRocca, ~ntog g ~:;
" ...
U1 ~ g :.;
and 0: ::..:.: :- ~
-0 C') C j-.l
Jelsie C. LaRocca, widow, James N. LaRocca, a married man, Rosalind L. Folkers, a marrlal g ~ ;C,
woman, and Anne L. Herring, a married woman, as Co-Trustees of THE REVOCABLE ~S"E <2~ ;c;
OF JELSIE C. LaROCCA under Trust Agreement with Jelsie C. LaRocca, James N. LaRoesa, -< C ~~
Rosalind L. Folkers, and Anne L. Herring, as Co-Trustees, of even date herewith, -.J ~ (J)
Grante?
WlTNESSETH. that in consideration of One Dollar ($1.00) and familial love and affection in hand paid.
the receipt whereof is hereby aclcnowledged. the said grantor does hereby grant and convey to the said grantee, her
heirs, successors, and assigns.
ALL that certain piece or parcel of land, situate in the Borough of Carlisle, Cumberland
County, Pennsylvania, bounded and described as follows, to wit:
BEGINNING on the West by North College Street; on the North by land formerly of the
Carlisle Land and Improvement Company; on the East by a 16 foot wide alley; and on the South
by land now or formerly of Sarah A. Mountz; having a frontage on North College Street of 50
feet and extending at that width 210 feet to the alley in the rear; being Lots Nos. 9 and 10 of
Block 23 of the Plan of Lots of the Carlisle Land and Improvement Company, as recorded in the
Office of the Records of Deeds in and for Cumberland County in Misc. Book No. II, page 572;
atld being improved with a frame bungalow and garage (said garage is no longer in existence);
and being known as No. 809 North College Street.
ANTI BEING the same premises which Merle E. Ankabrandt and Maxine A. Ankabrandt,
his wife, of the Borough of Carlisle, by their Deed, dated March 12, 1958, and recorded in the
Office of the Recorder of Deeds in and for Cumberland, Pennsylvania, in Deed Book "H",
Colume 18, page 435, granted and conveyed unto James A. LaRocca and Jelsie C. LaRocca, his
wife.
AND the said James A. LaRocca died on April 5, 1991, thereby vesting sole ownership in
his wife, J elsie C. LaRocca, by operation of law as the sole surviving tenant by the entireties.
AND Jelsie C. LaRocca by Power of Attorney dated August 1, 2000 and recorded, in the
236 ... 4'31:)
~'
r-
Office of the Recorded of Deed in and for Cumberland County, in Miscellaneous Book
Page , appointed James N. LaRocca, her Attorney-in-Fact, with authority under said Power of
Attorney, to grant and convey this real estate.
This is a transfer from mother to mother and her children, and is, therefore, exempt from
realty transfer tax.
AND the said grantor hereby covenants and agrees that she will warrant specially the property hereby
conveyed.
IN WITNESS WHEREOF, said grantor has hereunto set her hand and seal the day and year first above
written.
Signed., Sealed., and Delivered
~
~ ~~ /?~.,4 (SEAL)
Ie C. LaRoc by her Attomey-
in-Fact, James N. LaRocca
-
Witness
State of Pennsylvania )
) ss,
County of Cumberland )
On this. the ~ day of ed-o ~ .2000, before me, the undersigned
officer, personally appeared James N. LaRocca, known to me or satisfactorily providen to be the person whose
name is subscribed as attorney-in-fact for Jelsie C. LaRocca, and acknowledged that he executed the same as the
act of her principal for the purposes contained therein.
IN WITNESS WHEREOF. I hereunto set my hand and official seal.
. ::f#it t~. '* U
~"-';Jfo";'~:'" - '
. , ,', ,-, '. '''~~
...~~\~~~~t~~;~~"~' NOTARIAl. SEAL
. z:iii..' .~:. ~..~~~~'-: ~. ;;
_.~ ..>.,.~ '.. ". ~'::f.', = E Notary Public
~~'fjJj}.iiJ.;i:l$~/'~" C~v:;;~,IM!.Ib~mberland Co~
~i~::"~ ~.:;,>'->:f ~> MvCommission Expires Jan. 24,
-0... t ," .. ?:\\.... .iI'. .
;:~<;.,';t:/j::~~r;~:~'}' ~
(SEAL)
I, Stefanie A. Morrison. do hereby certify that the precise residence and complete post office address of the within
named grantee is .::10<. La...." ~"...+-l.<>--c. I CA_{ '*' \ \ . q>A \ "\~\ \ .
A"om'Y~
(':'U-j'."( l)~.n (;',Sc
U v.. ""..,v
. "~(""
'100
COMl"ONWEALTII OF PEN/lSYLV ANIA J
) ss.
Co- of J
",CORDED 0' ,'" ~ '0' of ~A.D.lOOO'" ". .""",,"
oJll'" of""'" CO~"'" ~ .",:::;;t" ,Yo'. ~p,g. ~
Gi '" ~,,, my''''''' 0'" ". ,"" of ,he ~id oJll"" "" """
above written.
,
~
-cw
~
~
(
~
~~
.,...-1 ~
~~
81~
, Recorder.
~;:;''i(i;';t'' /J'JJJ ~
,;j.?w~''--5.ii~ ... .//~ .'
,,~_.'i?ff!'#f!f~'~ .~"",'I.,t...
.._ ~~4V" ~ ,?,"O'_ > "'''''. .:....'t...
:'W ::Jo:~(!' .' -, ,'; ", ,,-~~,,,;",,"I 'Ct,
''r.-~",,;,-,,,,,~:'M,.'S:;,,~;;r!f
~~~~fiff~~~1<~',;.~~;"~I'~~'
"1~(~" . ,...,:ifjg~t'.'I'.~""" .
:~1~li~; '''' 230 ,;,", 401
'-::i.O-"'::A:~' -
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WHITLEY BRIDGET M, ESQ
PO BOX 11963
HARRISBURG, PA 17108-1963
_n_nn fold
ESTATE INFORMATION: SSN: 171-03-4869
FILE NUMBER: 2105-0168
DECEDENT NAME: LAROCCA JELSIE C
DATE OF PAYMENT: 02/18/2005
POSTMARK DATE: 02/16/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 09/16/2004
NO. CD 004967
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,016.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$3,016.00
REMARKS:
CHECK# 2029
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS