The URL can be used to link to this page

Home My WebLink About02-0460 PETITION FOR PROBATE and GRANT OF LETTERS ,;J./... ();.. 'I&,() Estate of Fay c. Willis also known as Faye E. Willis No. To: Register of Wills for the Deceased. County of Cllmherl ::lnd in the Social Security No. 204-03-8141 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 rix in the last will of the above decedent, dated August 24 and codicil(s) dated named 1998 (state relevant circumstances, e.g. renunciation, death of executor, etc.) County, Pennsylvania, with PA Decendent, then 85 years of age, died May 4th M 106 N. Market Street, Mechanicsburg, PA 17055 Except as follows. decedent did not marry. was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: None , 2002 $20,000.00 $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) pre"ented herewith and the grant of letters testamentary theron. (testamentary; administration c.La.; administration d.h.n.c.t.a.) ~ <It 11 u c .. -0 ~ ._ <It <It~ ..... Cl<::" C -00 c';: ~.= ~.. ~c.. ..... ~o cu c 00 i:ii (C)fJ^,-I'-I/ t., CtxY02ZA { ~ ~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } S8 COUNTY OF Ctnnberland /7-&'~,-/~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and, tr,uly administer t~.ye" s,lJte according to law. n / 1 /.-1 ~ 0) . Swern to or affirmi-Otrtnd subscribed \~<., \...AJ "C c- '~ before me this d Yo _of ~ ~ u~ ~ s: ~ ~ No. 21-2002-460 Estate of Fay C. Willis, a/k/a Faye E. Willis DECREE OF PROBATE AND GRANT OF LETTERS , Deceased AND NOW May 13th 2002 . 'd' f h . . _, m const eratlon 0 t e petItIOn on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Augllst 24th. 1998 described therein be admitted to probate and filed of record as the last will of Fay C.Willis, a/k/a Faye E. Willis and Letters Testamentary are hereby granted to Sally J. Cocozz a FEES Probate, Letters, Etc. ......... $ 60 .00 Short Certificates(5) . . . . . . . . .. $ 15.00 Renunciation .., J.1'>' . . . . . . . .. $ 5 . 00 x-Pages (3) $ 9.00 JCP TOTAL _ $ 5.00 Filed May. .l3th,. .2002 . . . . . . .$. . ~4 !99. . ATTORNEY (Sup. Ct. 1.0. No.) ADDRESS PHONE -(Ii:J , _.~;.) 7 I (i l (. 1I -' }.\f!.j 20. MAILED LEITERS TO ATI'OFNEY ON MAY 13th, 2002 LAST lULL AND TESTAIIEN'r OF FAY C. HILLIS :l/~O;;'- ~,tJ I, FAY C. ',lILLIS, of the Borough of Hechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last \1i11 and Testament, hereby revoking and making void any and all prior 'Hills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give and bequeath fifty (SC%) per cent. of my estate, of whatsoever nature and wheresoever the same may be situate, to my daughter, SALLY L. COCOZZA, absoll1tely and unconditionally. 3. I give and bequeath the remaining fifty (50%) per cent. of my estate, of vlhatsoever nature and wheresoever the same may be situate, to my three (3) grandsons, to wit, SCOTT }1ACHEHER, SIIAHN NACm~HER and STEPEHN liACHEliIER, share and share alike, per stirpes. -1- 4. For the purpose or racilitating the settlement and distribution of my estate, I authorize and empower my Executors, hereinafter named, or any substitute personal representative or my estate, to sell any and all real estate which I may own at the time of my decease, as 'Hell as my personal property, at either public or private sale or sales. LASTLY, I nominate, constitute and appoint my daughter, SALLY L. COCOZZA and her husband, DONALD P. COCOZZA, Co-Executors of this my Last \'Till and Testament, and direct that they be excused from postIng bond or other security for the faithful performance of their duties in any jurisdiction. IN HITNESS \'JHEREOP, I have hereunto set my hand and seal this ~r_ day of August, A. D., 1998. ~ 1 Ct W_~. Fay c. Vallis (SEAL) -2- SignedJ sealed, published and declared by the above named, FAY C. WILLIS, as and for her Last Will and TestamentJ in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testatrix, in her presence and in the presence of each other. ~~ = L~/ d. 11-~ -3- COMMONWEALTH OF PENNSYLVANIA ) 55. COUNTY OF CUMBERLAND 1, FAY C. vlILLIS , the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and FAY C. \'iILLIS day of August affirmed to and acknowledged , the testat rix , A. D. , 1998. ::f-a.M C ), · . ~{)Fay' C.~'i~ /J1-~ C ~ . 1- Notary Public before me by"'J"'..... , this :J '(/ 55. H~t~ial Sr~tr.rv Publi~ Marilyn ~. W'l\i?m~umb8rland County MecnaniCsb~r9.Bri'~xpires NOli. 6. 2001 My CommlsslO -. -~ .ta'ie'S 'a Msociall'JO 0, NI. .. Memoer. Pei1n~yNarl\ . COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STAUFFER and SUSAN A. HcCOY , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testatrix, FAY C. \-lIL..LI S , sign and exe- cute the instrument as :.i1:tK/her Last Will and Testament; that the said testatrix, FAY C. HILLIS , executed it as lxJlm'her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatriX , signed the Will as witnesses; and that to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and nnder no constrah'turess or undue influence. LI _~~_~ d. Sworn and !Juf~ibed to before . me this u- .} ~ day of V August 1998. /'t{~ cz. W~ 1 Notarial Seal PubliC Mal1lyn E. WIlliams. '::rt'ana county Mechan;Csb':lrg'IOBnOf~~~es Nov. 6. 2001 My commtSS I.... I , A oclatlon ot NOla"" Member, Pennsylvania 58 -4- RENUNCIATION 21-2002-0460 In Re Estate of Fay C. Willis deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Donald P. Cocoz7.a of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to Sally L. Cocozza WITNESS hand this day of May ,~2002 . 100 Wesley Road Ocean City, NJ (Address) c__ (Signature) ;"./ ;::5 (Address) ... r .... -- '............ (Signature) (Address) NDER RULE 5.6 a Name of Decedent: Will No. Admin. No. To the Register: Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date U/(f4 / R' A t!JrJ ~ J Signature Name ~/ Address _Counsel for personal representative 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 COCOZZA SALLY L 100 WESLEY ROAD OCEAN CITY, NJ 08226 ---.~--- fold ESTATE INFORMATION: SSN: 204-03-8143 FILE NUMBER: 2102-0460 DECEDENT NAME: WILLIS FAY C DATE OF PAYMENT: 09/20/2002 POSTMARK DATE: 09/18/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/04/2002 NO. CD 001640 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $8,804.99 I I I I I I I I TOTAL AMOUNT PAID: $8,804.99 REMARKS: CHECK# ? SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS J>' . .. ..~ .~ .../ : d "e ", "-':1-. .' 1II ~ l,,'~ ~l'Ioa ~ Ph.1SCkEXl6-OO'/ REV-1500 OFFICIAL USE ONLY I COMMONWEALTH OF / "/-6.;k- 1';;;- { PENNSYLVANIA , DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 RESIDENT DECEDENT 2 1 - 0 2 0 4 6 0 HARRISBURG. PA 17128-0601 -- -- -UJABER--- COU<TY COO< T.... DecEDENTS NM'E (lAST, FRST, AND MIDDlE 1Nf1W.) SCCw. SECURITY NUI>t3fR I- Z ESTATE OF FAY C. WILLIS 204-03-8143 W 0A'lE OF DEATH (f,f,\.Do. YEAR) 0A'lE OF BIRTH (f,f,\.00- YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 05-04-02 03-16-17 REGISTER OF WILLS 0 W (IF -..cABlE) SURIIMNG SPOUSE'S NM'E (lAST. FIRST AND MVDLE INf1W.) SCC:AL SECURITY NUt.'llER C N/A w !Xl 1. OIigina Return 0 2 Sup~emenIliI Ret"" o 3. Rern<irder Retlm (dill rJ death ihJr 10 12-1:1..82) ,.., ",$</) o 4. Urrited EsIae 0 4a. Future li1erest Cornpronise (date of dtathall8l' 12-12..al1 o 5. Fedeaj Estate Tax Retlm Reqlired ",0:'" wg;'" !Xl 6. DecedorI Died TesIale (IIt\ad1 00171 of O\!l) 0 0ecederI Mairl<ined a U~ng Trust {AllKh"", oIT",,! ---18. Tlia NUI1'ber cI sa. Oepait Boxes Ia:9 7. "'a.<D ~ o 9. Utigllioo Proceeds RecEived 010. SpcusaIPovertyCredit(dat.cAduthbetwwil2-31.91an:11.'-95) 011. BeclioototaxurderSee.9113(A)_..o) I- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAl TAX INFORMATION SHOULD BE DIRECTED TO: z NM1E COMPLETE Ml\lLlNG ADDRESS w c SALLY L. COCOZZA 100 WESLEY ROAD z 0 a. FIRM NM'E (' """"'bioi OCEAN CITY, NJ 08226-4464 </) w 0: 'lELEPHDNE NUMBER 0: 0 '" 609-398-4849 1. RealEstatelSchedueA) 11) OFFICIAL USE ONLY 2 Stocks;nj Bor<ls (Schedue BI 12) 43,503.19 1 Closely Held Corporatioo. Par1nersI'ip 01 Sd..Proprietorslip (3) 4. f.b1gages & NcIes RecEivable (Schedue 0) (4) 5. Cash, BalK Deposits & Msa;llaneous _ Prcpeo1y (5) 25,565.66 .. Z (Schedue E) Q 6. J<intly o.,ned Property (Schedue F) (6) !;( o Separae Billing Requested ..J 7. rler-'-1vos TrMSlers & r.tsa;llaneous Non-Probale Property (7) 128,090.36 ::l t: (ScI1edueGOIL) c.. 8. Total ~ A...ts (Iaa Ures 1 . 7) (6) 197,159.21 c( 0 9. Fure'a E>penses & AdlTiristr.live Cools (Schedue H) (9) 1,132.71 W c::: 10. 0elXs cI Oecederl, f.b1gage Ua;lities, & Uens (Schedue Q (10) 360.00 11. Total Deductions (tcIaI Ures 9 & 10) (11) 1,492.71 12 Net Value of Estate (Une BlTinusUne II} (12) 195,666.50 13. Cha1!al:leaxl Go.oemmenta BequestslSec9113Trustsft<wtichlllelecliontotaxhasrdbeer1 (13) rrade (Schedue J) 14. Net Value Subject to Tax (Une 12lTinus Une 13) (14) 195,666.50 SEE INSTRUCTIONS FOR APPUCABLE RA'lES Z 15. An'OJI1 clUne 14talOll;e a1he5l'OlJSOltax 0 !;( rale. OIlra1sfers wOOer See. 9116 (aX1.2) X.O_ (15) I- 16. AmolrtclUne14talOll;eatlinealr.ie 195,666.50 X.O 45 (16) 8,804.99 ::l c.. 17. Amou1t cI Une 14 talOll;e a siblirg rale X .12 (17) ::2: 0 18. Amou1t cI Une 14 taxatlle at alilatera rate X .15 (lB) 0 ~ 19. Tax Due (19) 8,804.99 20. 0 I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < sn= PA42021F.1 Decedent's Complete Address: STRE!T 106 NORTH MARKET ST. C~MECHANICSBURG I STATE PA I ZIP 17055-3339 Tax Payments and Credits: ,. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Plior Payments C. Discount (1) 8,804.99 3. Interest/Penalty if applicable D. Inleresl E. Penalty Totai Credits (A + B + C) (2) TotallnteresUPenaJty (0 + E) (3) 4. If Line 2 is 9reater Illan Line 1 + Line 3, enler the difference. This is the OVERPAYMENT. Check box on Page lUne 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter Ille difference. This is Ihe TAX DUE. (5) 0,00 8,804.99 A. Enter lhe interest on Ille tax due. (SA) B. Enter Ille total of line 5 + SA. This is Ille BALANCE DUE, (56) Make Check Payable to: REGISTER OF WILLS, AGENT 8,804',99 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No [ZI [ZI [ZI [ZI [ZI !XI contains a bene1iciBl)' designation? ..................................... . . " .. . . . . . . . . . ... 0 [ZI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN: Urder penilties ri P<fillY, I <ledare Il1at I haw OlllIIirod llis rellll1, irduding ~ng sehedlJes iI1d slaIllIllElIU, iI1d to tte best ri"'l knowledge iI1d belief, ~ is tn.e. CXlIled iI1d CXlI1'ol<1.. Dedarlllioo ri ciI'or thai tte petSOnai represeIilii.. is based 00 all irlamaioo ri INti'" preparer has "'I knowI SIGNATURE ERSO RESPONS L OR FILING RETURN Uut~ z.. DATE 9-9-02 ADDRESS RADNOR TAX SERVICES, 336 KING OF PRUSSIA ROAD, RADNOR, PA 19087 For dates ofdealll on or after July 1, 1994 and before January " 1995, the tax rate imposed on Ille net value oftransfern to or for Ille use ofllle survivin9 spouse is 3% (72 P.S. !l9116 (a) (1.1) ~)]. For dates of deatl1 on or after JanuBl)' " 1995, Ille tax rate imposed on the net value of transfers to or forllle use o!the survivin9 spouse is 0% [72 P.S. !l9116 (a) (1.1) (ii)]. The statute does not examot a lransfer to a survivin9 spouse lTom tax, and the statutory requirements ilr disclosure 01 assets and filin9 a tax retum are still applicable even il Ille survivin9 spouse is the only beneficiBl)'. For dates 01 death on or after July 1, 2000: The tax rate imposed on Ille net value of transfers from a deceased child twenty-one years of age or youn9er at death to or for the use of a natural parent, an adoptive parent, or a stepparenl of the child is 0% (72 P.S. !l9116(a)(1.2)1. The tax rale imposed on Ihe net vaJue of transfers to or forllle use ofllle decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !i9116(1.2) (72 P.S. !l9116(a)(1)]: The tax rate imposed on the net value of transfers to or for Ille use o!the decedent's siblings is 12% [72 P.S. !i9116(a)(1.3)]. A siblin9 is defined, under Section 9102, as an individual who has at leasl one parent In common wilh lhe decedent, whether by blood or adoption. SIFPA42021F,2 'I REV.1502 EX + (1..g7}(1) ~THOFPENNSYl\O\H1A INHERITANCE TAX RETURN RESIOENT OECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER FAY C. WILLIS 21-02-0460 All real property owned solely or as . ten.nt in common must be reported .t f.i, market value. Far market v.jue is defined as tIv! price at wtich property WOOd be exx:Imged between a v.;lIing buyer..-d a v.;lIing seller. ....tIv!t being compelled to bo..y ex sell. both h:Mng reasonable klv:JMedge ri tIv! relev.rt fa:ls. Real property which is joinUy-owned with right of survivorship must be disdosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STFPA42021F.3 ~ , REV-1503 EX'" (1-97)(1) J SCHEDULE B STOCKS & BONDS ~TItOfPENNSYl.\i\H1A INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 All property jolnUy-owned with the right of sUril.OBhip must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. u.S. SAVINGS BONDS-SEE SAFE DEPOSIT BOX INVENTORY VALUE AT DATE OF DEATH 43,503.19 TOTAL (Also eoter OIl line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STFPA42021F.4 43,503.19 . \ REV-1504 EX. (1-97) (I) ) SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP COMMOIMEAl.TH Of PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 Sd1edLJe C-1 er C-2(h:ludirg all Sl.WOI1irg irtarmalion) """ be aIla:hed fer _ dosell'"held ccrporaIioo'patrershp interest ri Ire decederl, _ than a sde-proprietorshp. See inslrudions for Ire suppOl1irg i_on to be _eel for sde-proprietorshps. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STFPA42021F.5 -- \ REV-1505ex-l>{1-97)(l) , j SCHEDULE C.1 ~THOFPENNSYl\l\HlA CLOSELY.HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER FAY C. WILLIS 21-02-0460 1. Name of CoIporation State of Incorporation Address Date of Incorpolalion Cily State Zip Code Total Number of Shareholders 2. Federa! Empioyer 1.0. Number Business Reporting Year 3. Type of Business ProductlSOIVice 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK VOOng I Non-VOOng SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENTS STOCK Common $ Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? DYes DNo If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? Dyes DNo If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? DYes DNo If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one yew; prior to death or within two years if the date of death was prior to 12.31-82? DYes DNo If yes, DTransfer DSale Number of Shares TransfereeorPu~haser Consideration $ Date Al1ach a sepaale sheEt fa llIditicm tr.rlsfers ardIa sales 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? DYes DNo If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? Dyes DNo If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? Dyes DNo If yes, provide a breakdown of distributions receved by the estate, including dates and amounts receved. 12. Did the corporation have an interest in other corporations or parinerships? DYes DNo If yes, report the necessary infonmation on a separate sheet. inciuding a Schedule C-l or C-2 for each interest. THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calcuiations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federa! Corporate Income Tax returns (Fonm 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addressles and estimated lair mar1<et value/so If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their reiationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid_ G. Any other infonmation retating to the valuation of the decedent's stock. STfPA42021F.6 REV-1SOSEX +(1-97) (I) 1 C(M,t()N\\I;All11 OF PENNSYlWIA INHERITANCE TAX RETURH RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 1. Name of Partnersl1ip Address City 2. Federal Employ... 1.0. Number 3. Type of Business Oate Business Commenced Business Reporting Year State Zip Code ProducUSeNice 4. Decedent was a 0 General 0 Limited partn.... If decedent was a limited partn..., provide initial investment $ 5. PERCENT OF PERCENT OF BAlANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnersl1ip indebted to the decedent? DYes DNa If yes, provide amount of indebtedness $ 8. Was th....life insurance peyable to the partnership upon the death of the decedent? DYes 0 No If yes, Cash Surrend... Value $ Net proceeds payable $ Own... of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of dealh was prior to 12-31-a2? DYes DNa If yes, 0 Transfer 0 Sale Percenlage transfenedlsold Transfu<eeorPu~haser AlIach a sep;nie s/'eet for additiona tnr1sfers ardIor saes. Consideration $ Date 10. Was th.... a written partnersl1ip agreement in ellect at the time of the decedent's death? DYes 0 No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? 0 Yes 0 No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnersl1ip dissoived or liquidated aft... the decedent's death? DYes DNa If yes, provide a breakdown of distributions received by the estate, inciudmg dates and amounts received. 13. Was the decedent related to any of the partners? 0 Yes 0 No If yes, explain 14. Did the partnership have an interestin oth... corporations or partnerships? 0 Yes 0 No If yes, report the necessary infonnation on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax relums (Fonn 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing Ihe complete address/es and estimated fair marl<et value/s. If real estate appraisals have been secured, attach copies. D. Any oth... infonnation relating to the valuation of the decedent's partnership interest. STFPA42021F.7 ...... , REV.fS07EX+(1.97)(1) ca.v.tOHWEAl.Tll Of PENNSYlWIA INHERITANCe TAX RETURN RESIDENT DECBlENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 All property joindy-owned with the right of survivonhip must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) I (If more space is needed, insert additional sIleets of the same size) STFPA42021F.a , REV.1508 EX + (1.97) (I) ~lllOf PENNSYlWIA INHERJW<CE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 n::h.d.the proceeds" litigaioo;rd the dal.the proceeds __ received bytl'e esta.. All property joindy~ed wilh 111. right of survivolShip must be disclosed on Sdledul. F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ALLFIRST BANK CHECKING ACCT #0090648404 19,082.53 ACCRUED INTEREST .26 2 FURNITURE & PERSONAL ITEMS - SEE ATTACHED LIST 1,107.00 3 PNCBANK CHECKING ACCT #50-7008-9111 5,375.87 STFPA42021F.9 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 25,565.66 REV-l509 EX + (1-97)(1) ~THOFPENNSYl\O\H1A INHERITANCE TAX RET1JRN RESIDENT DECEDENT SCHEDULE F JOINTLY.QWNED PROPERTY ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 If an asset was made joint within one year of the decedenfs date of death. it musl be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME ADDRESS RElATIONSHIP TO DECEDENT A. B. c. JOINTLY-OWNED PROPERTY: UETTER DATE DESCRIPTION OF PROPERTY %OF Il'.TE OF DEATH ITEM FOR JOINT MADE In::idefll'1'leoffi'Qn:jalinslitWonwdbriaccxllnn.rrilerorsimJaridel1it)inglUTtler. Il'.TE OF DEATH DECO'S \l\LUEOf NUMBER TENANT JOINT "-deedforilirit1-heldrealeslale. \l\LUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) SlFPA42021F.l0 REV.1510 EX to (1-97) (I) ~THOfPEJjNSYlJ.(l.NIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 Ths sc:I-.dlJe rrusI beCOf1'llllOed.m filed "the..-.-Io rnfd qL.eSlioos l1ttough4 on the '.......side dtheREV-l500 COVER SHEET is yes. DESCRIPTION Of PROPERTY %Of fTEM !M:tlLE 1l-E No\UE OF M TlWf5fEREE. n-eJR flE.A"TIONSHP TO lJECE!ENT ~ TIE nt.TE DATE OF DEATH DECO'S EXCWSKlN TAJC.6&.E VALUE NUMBER Of TR.OHSFER. ATTACHACOPY Of T1-E ceo FOR REAL ESTATE. VALUE Of ASSET INTEREST ~F~CABLf) 1. GLENBROOK LIFE AND ANNUITY CO. ANNUITY-CONTRACT #GA0678611 67,755.07 100 67,755.07 2 MONUMENTAL LIFE INSURANCE CO. ANNUITY-CONTRACT #010SP731489 60,335.29 100 60,335.29 TOTAL (Also 8I1teron line 7. Recapitulation) S 128 090.36 (If more space is needed, insert additional sheets of the same size) STt=PA42021F.11 . REV.1511 ex + (1-97) (I) ~lliOfPENNSnli\H'" INNERlTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FUNERAL EXPENSES 191.00 B. ADMINISTRATIVE COSTS: 1. Persona Represerlalve's Comrrissions Name r:J Persona RepreserIaIw(s) Soda Security Nun'ller(s)/EJ.l Ntlrberr:JPersona Represerlalw(s) Street Address City SIal. Zip Yel>(s) Convrissioo pad: 2. Altomey Fees 94.00 3. FlIl'ily ElalmpIioo: (I decedent's o1dress is nr:J u.. same as damafs, atach eJCpianaioo) Clairnart Slreel Pddress City SIal. Zip Relliionsl'ip r:J Clairnart to Oecedenl 4. Probal. Fees 5. Ac:c:cuiat'sFees 500.00 6. Tax Return Prepa-er's Fees 7. WILLIAM ROWE-APPRAISAL 85.00 8 THE PATRIOT NEWS-LEGAL ADVERTISING 191. 56 9 THE SENTINEL-LEGAL ADVERTISING 71.15 TOTAL (Also enter on line 9, Recapitulation) $ L 132 . 71 (If more space IS needed, insert additional sheets of the same size) STFPA42021F.12 . REV-1512 EX to (1-97)(1) ca.tMON\\fAlTH Of PENNSYl\I\H1A INHERITANCE TAX RETURN RE~OENT DECEDENT SCHEDULEr DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 Include u,,",imbursed modical _. ITEM NUMBER DESCRIPTION AMOUNT 360.00 1. ERNEST OBER-MAY RENT TOTAL (Aiso enter on line 10, Recapituiation) $ (If more space is needed, insert additional sheets of the same size) 360.00 STFPA42021F.13 . REV.1513 EX + (9-00) CClMMClIMEALTli OF PENNSYl\I\H1A INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FAY C. WILLIS FILE NUMBER 21-02-0460 RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS pnclude outlight spousal distributions, and transfers under Sec. 9116 (a) (1.2)1 SALLY L. COCOZZA 1. 100 WESLEY ROAD OCEAN CITY, NJ 08226-4464 DAUGHTER 2 SCOTT D. MACHEMER 149 HIDDENWOOD DRIVE HARRISBURG, PA 17110 GRANDSON 3 SHAWN MACHEMER 408 MEADOW DRIVE CAMP HILL, PA 17011 GRANDSON 4 STEPHEN MACHEMER 4615 CLEARVIEW DRIVE CAMP HILL, PA 17011 GRANDSON AMOUNT OR SHARE OF ESTATE 50% 16.666% 16.666% 16.667% 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S (If more space is needed, inseri additional sheets of the same size) STFPM2021F.l. . REV.'51"EX+{l.97)(~ . . SCHEDULE K LIFE ESTATE, ANNUITY COIofMONWf.<LTH OF PENNSYl_ & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT OECEDENT (Check Box 4 on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER FAY C. WILLIS 21-02-0460 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will o Intervivos Deed oITrust o Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE OUreor OTerm olYear.l OUreor OTerm olYeaIS o Lire or OTermofYeaIS o Lire or 0 Term 01 YeaIS 1. Value of fund from which life estate is payable $ 2. Actuarial factor per appropriate table Interest table rate - 031/2% 06% 010'10 OVariable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) $ ANNUITY INTEREST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE o Ure or OTerm olYeaIS o Lire or OTerm olYear.l oureor OTerm olYeaIS o ure or 0 Tenn 01 YeaIS 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout- OWeek~ (52) o B~weekly (26) o Monthly (12) o Quarterly (4) o Sem~annually (2) OAnnuaUy (1) o Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate 031/2% 06% 010% o Variable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity .If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 X Line 6) + Line 3 $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax retum. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (II more space is needed, insert additional sheets 01 the same size) ST'FPA42021F.15 . REV-1647 EX + (9-00) SCHEDULE M FUTURE INTEREST COMPROMISE ~THOFPEN/jSYl\I\N1A INHERITANCE TAX RETURH RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FilE NUMBER FAY C. WILLIS 21-02-0460 This schedule is appropriate only for estates of decedents dy ing after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in pcssession and enjoyment cannot be established with certainly. Indicate below the type of instrument which created the future interest and attach a copy to the tax retum. o Will o Trust o Other I. BenefICiaries DATE OF BIRTH AGE TO NAME OF BENERCIARY RELATIONSHIP NEAREST BIRTHDAY 1. 2. 3. 4. 5. 11 For decedents dying on or after July 1, 1994, if a suNiving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedenrs death. check the appropriate block and attach a copy of the document in which the suNiving spouse exercises such withdrawal right 0 Unlimited right of withdrawal 0 Limited right of withdrawal III Expianation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . .. . . . . . ........ . . . . .. . . . . .... . . . . . . . . . . ....... ... $ 2. Value of Une 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Une 13 of Cover Sheet) ........... $ 3. Value of Une 1 passing to spouse at appropriate tax rate Check One 06%, 03%, 00% ......................... $ (also include as part of total shown on Une 15 of Cover Sheet) 4. Value of Une 1 taxable at lineal rate Check One 06%, 04.5% ............................ ..... $ (also include as part of total shown on Une 16 of Cover Sheet) 5. Value of Une 1 Taxable at sibling rate (12%) (also include as part of total shown on Une 17 of Cover Sheet) ........... $ 6. Value of Une 1 Taxable at collateral rate (15%) (also include as part of total shown on Une 18 of Cover Sheet) ........... $ 7. Total value of Future Interest (sum of Unes 2 thru 6 must ecual Une 1) . . . . . . . . . . . ..................... $ (If more space is needed. insert additional sheets of the same size) STFPA42021F.16 . REV-1649 EX + (1-97) (I) COt.tMOlfflEALTH Of PENNSYL""'" INHElllTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER FAY C. WILLIS 21-02-0460 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) 01 the Inheritance & Estate Tax Act. lIthe election applies to more than one trust or similar arrangement, a separate fonr must be filed for each trust. This electior applies to the Trust (melital, residual A, B, By-pass. Unified Credit, etc.). II a trust or similar anangement meets the requirements 01 Section 9113 (A). and: a. The trust or similar anangement is listed OIl Schedule 0, and b. The value of the trust or similar anangement is entered in whole or in part as an asset on Schedule 0, then the t/'lKlsferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election 0Il1y as to a fractiOll of the trust or similar anangement. The numerator of this fractior is equal to the amount of the trust or similar anangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar amr1gement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. CIE.SmIPllON VALLE Part A Total $ PART B: Enter the description and value of aU interests included in Part A for which the Section 9113 (A) election to tax is being made. l6CRP11ON IO'U.E Part B Total $ (If more space is needed, insert additiora! sheets of the same size) STFPA042021F.17 ~@ rr1 MONUMENTAL LIFE lJ:IJ INSURANCE COMPANY Monumental Life: Insurance Company Home Office: BaltUnoreJ Maryland Administrative Office: 4333 Edgewood Road NE PO Box 3183 Cedar Rapids. Iowa 52406-3183 June 28, 2002 Sally Cocozza 100 Wesley Road Ocean City NJ 08226 RE: Annuity Number OlOSP731489 Dear Sally Cocozza: We have received notification, Fay Willis, annuitant of listed non-qualified tax deferred annuity is deceased. wishes to extend sincere condolences for your loss. the above Our office Our records indicate the following annuity information: Annuitant: Owner: Primary Beneficiaries: Fay Willis Fay Willis Sally L Cocozza 52% Scott D Macherner 16% Shawn D Machemer 16% Stephen D Machemer 16% 10/25/2000 $60,888.99 $6,388.99 $60,335.29 Annuity Policy Date: Full Value as of 6/28/2002: Taxable Portion: cull Value as of 05/04/2002: The attached document reflects the options available to the primary beneficiaries listed above. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. The attached document contains general tax information based on Monumental Life Insurance Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish LO consult a tax advisor. :lJi.2S12,J"~2 :S:3'~ .r..:..:.~:.r..::; ;:4996 ? '>;:..; :; ';:.. Glenbrnok Life and Annuily Company P.O Box 942/2 Pa/aNne, IL 60094-4212 GLENBROOK LIFE A Member ,f AlLsr./lte Financi4l GrrJ1l.,' JuJy 25, 2002 Sally Cocozza Via fa.,<'# 609-398-2233 Re: Contract Number: Fay C. Willis GA0678611 Dear MJS Cocozza.: We have been requested to complete lnternal Revenue Service (IRS) Form 712 with regard toO the referenced contract. The purpose of Form 712 is to provide an estate or donor witJl. the value of a life insurance contract or with its proceeds as of cert:ajn date (usually the owner's date of death or date oftraDsfer of the contract). TIle contract referenced was an annuity contract, which is not reportable on IRS form 7 J 2. TIle foHowing information is provided regarding the value of the annuity and OdlCT data as oftbe date specified: Date of Death: 05-04-2002 Annuity Value as of Date of Death: $ 67,755.07 Cost J.lasl 3: $ 66,276.18 Named Ben.efi.ciary: Sally Cexozza, Scott Machemer, Shawn Machemer & Stephen Maehemer The actual amount paid may differ due to M3rkct Value Adjustments and/or any applicable Surrender Charges. If you have any questions, or need further assistance, please contact us at 1-877-499-6418. n0 Isola Balderas Life and Annuity Claims Overnight Address: 300 Nortb Milwaukee Avenue, Vernon Hills, II. 60061 Toll Frre FRX: J -866-635-4523 To: Sally L. Cocozza 100 Wesley Road Ocean City, NJ 08226 From: William G. Rowe, Appraiser 211 Old Stone House Rd. Carlisle, P A 17013 Re: Estate of Fay C. Willis 106 N. Market Street Mechanicsburg, PA 17055 Date: June 6, 2002 LINDEN HALL ANTIQUES 211 OLD STONE HOUSE ROAD CARLISLE, PA 17013 717-249-1978 HALL Bamboo shelf Oak chest (cut down) Misc. household Crib Vacuum LIVING ROOM Blanket chest Wall hangings Brass umbrella holder Upholstered chair Upholstered chair Sofa Lamps Lamp stands T.V. Pine chest Brown jug Kerosene lamp DINING ROOM Dining room set Martha Washington sewing stand Misc. costume jewelry Chest of drawers Knick knacks 2 plank seat chairs Mahogany chair Set dishes, Japan Min. lamp Cups/saucers Misc. housewares Clock KITCHEN Refrigerator Willis Appraisal $10.00 $20.00 $10.00 $10.00 $30.00 $100.00 $2.00 $10.00 $10.00 $10.00 $20.00 $20.00 $10.00 $35.00 $20.00 $25.00 $15.00 $250.00 $20.00 $15.00 $20.00 $10.00 $30.00 $5.00 $25.00 $25.00 $10.00 $10.00 $2.00 $35.00 1 61612002 " Freezer Misc. k~chen items Small appliances Desk Microwave stand Small T.V. Flatware Crock $30.00 $10.00 $15.00 $10.00 $10.00 $5.00 $10.00 $5.00 BEDROOM Old TV. - no value Bed/dresser Dresser Sewing machine Kerosene lamp 2 pc. waterfall set Cedar chest Lamp Stand Book shelf Books $0.00 $60.00 $25.00 $2.00 $10.00 $30.00 $50.00 $1.00 $5.00 $10.00 $5.00 TOTAL $1,107.00 -..Jid f?-<p.- William G. Rowe Copy to: James E. Reid 2109 Market Street Camp Hill, PA 17011 Willis Appraisal 2 6/6/2002 !) allftrst June 13,2002 Allfirst FinJndal Ceucer !'\.,-\. po. Bo'.\. 9()Q Milisboro. Dl: : 'N6~ Sally L. Cocozza, Administrator Estate of Fay C. Willis 100 Wesley Road Ocean City, NJ 08226 RE: Estate of Fay C. Willis Date of Death: May 4, 2002 Social Security Number: 204-03-8143 Dear Ms. Willis: In response to your request, please be advised of the following accounts the above. named decedent had with this bank and their balances on the date of death. I. Account Type........................... Relationship w/lnt. Checking Account Account Number....................... 0090648404 Ownership (Names of)................ Fay C. Willis with Scott D. Machemer POA Opening Date........................... 08128/64 Balance on Date of Death...........$ 19,082.53 Accrued Interest....................... 0.26 Total. ...... ...............................$ 19,082.79 2. Account Type........................... Certificate of Deposit! 3 MOS Account Number....................... 87008100561923 Ownership (Names of)................ Fay C. Willis with Margaret W. George POA Opening Date........................... 02/09/95 Closed 6/12/01 Balance on Date of Death...........$ 00.00 SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS . (1) Cosh: Report 10101 only. .{2\ Stock", li.t in dOlail r:<ery common or preferred cenificcle, warrant or Olher rights found in box. Slocks are 10 be designaHld by name of compony. eenilicale number. dote of Clrtine,".. nQIM in which..ox!: is registered. ; and nulllber of .hore. OIld dou of Slock.. . (31 Obligations of U. S. Ga'ftmmenl: Number of items: dOle of issue. faC!! volue. na;...s in which ;"gi$18nld crnd type of o_enbip. i.e.. j<>intly held. payable an d8C1th. 8IC. (41 acne!., Designate by nome, am""nt. seriol number, or alher designation. IBearer Bonds) (5) Bank and SovinllC and La<u. P~sboolcs: SI<:II. nome 01 deposiror. number of boo.. taS! dole appearing in boolc, nome of bonk and bronch. cmd balon... 16) Jewelry, Coin., Stamp" Monuccriprs, c:l1:: list and,describto ". fully o. possi.ble. (7) Dc:ecI., Mortgage., CUrTCnt Ins...._ Policies or ~ ""idc:nus of indebtedness: liSI and d85Cribe as Ivlly a. pcmible. 18) All othe, co",...t.. . lTfM NO. ITEM DlSaJvnOl" . llnYc . ; .... TOTAL P. 02 SAFE DEPOSIT BOX INVENTORY . I STRUCTIONS . (1) c-h: Report Iotal only. .(2) Stack" List in dOloil every Gemmon or proferred co11;r.""o. warranl or other righlS found in box. Slocks ore to be d=agnated by nome of company, (er1ifi(Qfe numbor, dote of c-ertific.ot&, flome in which ItoCIc' i$ registered.. ; ond nU!llb.r of sharos ond.dOll of <lock. . . (3) Obligations of U. S. GOllemRlenl: Number 01 ilion\$; dOle of issue. fo"", voluo. nomes in which "9islo~ O1ld type of awne"hip. i.... jointly held. payoble on dealh. OfC. (4) Bond.: Designale by nome. amount. serio/ numbor. or other d""gnolion. [Ileorer Ilonds) (5) Bank and Savings ond lean Panboolcs: Slore no... of doposi/or. numbor of bo<lk. lasr dolo appearing in book. name of bank and bronch. and bolonce. (6) Jewelry, Coins, Stamps, Man"",riplS. .,fe: Lis! and,describe OS fully os possible. (7) Deed., Mortgogu, C"...nllns"ron<e Polio..: or ot....r eviduc.. of indeb"'.!n...: lisl ond d...cribo os fully os o=;b\". (8) AU oth.r c.on"'nl.. ITEM ,"0. rrfM CBa/PIlO'" _ I f I I I. I' " " " /- (' I' /. /, /. <-.....-. 11' ~ _ .. ". M~ ., NOTE: Attach odd.tlinft4"t1 .,...... "'* ".. ~L~._"." '"it .a.'P~P1l:1 , bOClJlor(f",:j O"'d~","fTQ'orll"'jI;J o E:lotc R.cp~lIlat,...C' 0 Joiftj 0_." oj 1o.f. d<t1)Q:';" t,Oilto TOTAL P.02 SAFE DEPOSIT BOX INVENTORY . INSTRUCTIONS . (1 J Caah: Report !alal only. .(2) St"d.., list in delo~ ~ery "'mmon or prelerr.d ,e"ilia,lo, worronl or olher righls laund in box. Slocks ore 10 be designated by nOllle of company, certificole numbor, dote of "'I'\ificote, name in which stacie is registered. t and number of shor.s and. clan 01 <lock. (3) Oblillcnians of U. S. Ga""mmen.; Number of irems; dale of i>sue, foa; value, names in which "'SiSI.re<l O1ld type of ownership. i.... iO;n1ly held. payable on dealh, OlC. (4) Bond.: Designate by name, OIllOunl, serial number, or olher designation. (Beorer Bonds) (5) Banlr. and Savings ond loon Pa..boalcs: SIal. nome of deposiror, number of book.. las, dolO appearing in bool nome << bonk and bronch, and bolana. (6) Jew.>lry, Coins, Stamps, MonuscriplS, ,,~: Lis! and,describe ,,, fully os po..ibie. (7J Oeeds, MortgagC&, Curront InsurCll\<:e Polia... Or othet evidences of indebt..dno..: list and deseribe os fylly 0' po>>ibl.. (S) AU ather cont..nt.. 1m.. oEsarp.f10t< @. 5:J.OO L9./I'2213(,;,,;). E. SO. D ~ L-?/I r%''7 74<./ ~ 6000'- L 'iI/ ff717/~ 50 oj L ~;N 9L/1f 57<{r=. I CE~IFY UNDER PENALTY OF PERJURY THAT THE A80VE RECORD IS PERSON RECEIVING COpy OF COR EeT AND COMPltTE TO lHE Bf3T OF MY KNOWI..EIX;E ANO lI<UEF. SAFI! OEPO IT llOX INVEN10R't, S lJJl:t SIvHATUI \ \ " II ~!; /'i NOTE: Affac.h additinftft "~"... t'" ~L_ __ . . ., / ( {:rc.:'o I ..J TOTAL P.02 SAFE DEPOSIT BOX INVENTORY , 'INSTRUCTIONS , (1) c....h: Report ""or only. . .(2) Slae!<., List in de'oil fNety <:omman or preferr.d cel1m",r., worran' or other riQhl~ found in box. Sloa. or. 10 be designol<!d by nom. al company, certificor. number, do'" of c,,,"ili,,,'e, nome in ..,l>Icl> .'ock i. regis"'",d, t and number of ~I>ot.. ond,cla,", of "ock. , (3) Obligations of U. S. Govemm"nl: Number af i~m1; dale of is.sue, face value, nome. in ..,hich registered ""d type of awnersllip. i.... ioinl1y held, poyoble On death, "'c. (4) Bond.: Cesignate by name, amount, serial numbet, ar other de.igno,jon. (Beare, Bond.) (5) Bonk ond Scsving. csnd loon Penbooks: Stote n"me of depo.iror, number of book. 1011 dolO appearing in book,. neme of bonk ond branch, ond bolon",. (6) Jewelry, Coin., Stamp" Monuscripl$, "fe: List a..d,describe Q' I,ully CI1 po>>ible. (7) Oe.d., ",.,<tgag"', Cunen' Insur(U\ce Policies Or other evidence. of indebtodMu: list and describe a. fully os possible. (8) AU other con,,"t.. II /I II I' " il 1/ 11 1/ Ii II II II <('0 It ((/ /I fJ- II 1? I II '6l/ /I S It l" II i' ITEM OE'SalI'TIOt' ... $O,DO 'DO . .J1.OO 60. Q() 0tJ .00 aD. Do 5D. D (j 6D.co r9>5. 0 lJ ~6. DO 0l5,o u "tc. Jo." MtlATE I. , )(OC\ltorjrrl_] O.A.~.,~tTQlotfuj,o;J o E;toh: RJ:Pf'CCI"lIO'lIVC: 0 JOi"f o....-n.., 01 1Q.f. d<to<l:.i.1 tlo:r. JP/..'~ .... ".. ..L._.. . . ., TOTAL P.02 SAfE DEPOSIT BOX INVENTORY . INSTRUCTIONS . (1) Caah: Report IoIor only. .(2) Stodr.., ti., in detoa f:Very COmmon or preferr.d certificat., worronl or other riglllS found in bolt. Slow or. to be designated by nom" of company, certificalo number, dote of c:ertificolo, OOme in wbicb .Iock i. registered, ; and nulnber of snores and.daSl of sIeck. , (3) Obligations of U. S. Govemment: Num~r of itilms; date of j>>".., f<lee voluo, name. in which rvsi.tered ""d Iypo of ownonnip, i.... iointly hold. payable on death, ole. (4) Bonds: Designale by name, amount, ,erial numbor, or other designation. (Seorer Sonds) [S) Bank and SaYings and loon Po..boob: SlQIO nOm6 of depositor. number of book. los, dOh> appearing in book. name of bQnk and brandl, and balonCII. (6) J.......,lry, Coins, Stamp., Monu...,;p", efe: list and,.describe ,.. fully o. pOSlible. (7) De.ds. M",rtgog.., CurronllnsutCUlce Policies or other cvic/ence. of indebhtdno..: list and describe a. fully as pO$Sible. (8) AU othor c.onlent.. ITEM rrrM OE5C1IPTIO~ NO. 6600 00 It C;)5. 00 .. ..-- II 016. oD "e- II J5.oo II .0 1\ .00 \1 .00 II 50.00 II __.jjtJ,D0 \J 00 \1 0.00 II D.DO II 5tJ.o 1\ II O.DO II aD.DO II 0.00 II bO. uO II .StJ ,()O tl &.00 II . -,~ ---- to~___.__ . '1lIN" ITllt ~~~/J~ ~ _ NOTE: Attach cu:idi.t..n",,1 1 n ... ,. 1 H ..L. ~ __ . . ~" ~IClrt'WlJ "'4~"~ITGlorrfrl.r;.J I E:lOh:: RCp~I'lI"'I"'C 0 loi,,' o-n.O' o( ~I. d.90~' l;,()" I TOTAL P.02 SAFE DEPOSIT BOX INVENTORY . ',INSTRUCTIONS . (1) ea.h: Report !<lIal only. . .(2) Slock., list in dete~ nery <:ammon e" prolerTed c.rtificete, warrenl or other righlS found in box. SlOW arc 10 be designated by neme of compony, cet1ilicale numbor, dole 01 certificate, name in which stoele: i. registe",d, t and n~rnb.r of shore. ond.clo"" of stock. . (3) Obligatien. of u. S. Government: Number of items: dale 01 issue, fate volue, nomes in which ,"gistered end Iyp.. of own.rship, i.... ioinlly held. poyoble on d.ath, ...c. {4l Bonds: Designate by nome, emounl, seriel numb.r. or oth.r designelion. (Beerer Bondsl (S) Blink and Savings and Loa" Panbooks: Stele na_ of dopo.itor. number of baole. loS! daro appeering in boole. neme of benk and branch. end belen... (6\ Je....,lry, 'Clins, Stomps, Menuscripts. etc: list and, describe as lully os possible. (7) Deed., Mortgages, CurranllnsurGl\<<: Policies or other evidenc.. 01 ind.b....dn....: list ond desaibe os fully o. p.,..ible. (8) All oth..r conte..l.. ITtM NO. ITEM De;CI'I'f'ON il ..--.. II II \1 JI II ,. ~~~~~~""'"---~"" ._.~--- '.IL2ILLf))l1<7n TOTRL P.02 SAFE DEPOSIT BOX INVENTORY . INSTRUCTIONS . (1) Caah: Repel1lalal only. . (2) SIaa., Lis! in derail f:Very <omman or preferred ce";;,,,,,re, warrant or other righlS fcund in box. Slods ore to be d..igner.d by nome of company, cer!;;,cole numbor, dote of ~"ir,cato, nomO in which slade is registered, ; and number of shares and.cla.. <>f SIe<:X. . {3\ Obligatians of U. S. Govemmen1: Number of i,;,,,,,: dote of i..ue, foa: value, names in which resislered <md type of ownership. i.e., joinl)y held, payable on dealh, ",c. (4) Bond., Designare by name, omeunl, .eriol number, or other desisnolion. (Becrer Bonds) (S)llank and Savings and J.gan Pa..booles: StolO ll(\1n6 of depositor, numbor of book. 10s1 daro opp<loring in book,. name of bank and branch, and balanOJ. (6) Jeltrtlry. Cains. Stamps. Monuscripts, efe: lis! and,d..scribe Q' fully a. possible. (7) Deed.. Mortgages, Cumn! InsurQl\<<: Policies or other evidences 01 indebtordneu: lisr "ne! desaibe os fully os possible. (8) All alh,,, cantorn!s. IT~ NO. If EM OE'SClUI'TIOI' I=Tc~dOO}. t ( Il hurt' II 00 OO,O() OO.DD 100 DO d...s I CfJl1IFY UMlER PENALTY OF PERJURY TIIAT THE ABOVE RECORa J. PERSON RECEIVING COpy OF CORRECT AND COMPL(TE 10 THE BEST OF MY KNOWUPGf AND BEUEF. SAFE DEPO IT BOX ,NVl:NTOlll':' · .. .>Q<ATU' ./2~ -" ~ 'N'N_i-NL'.' Aza~... r:;;;L(iQ~~, c"tc A,.p~PitI.r x OE.ll.~,nQ('tt(IJ'.1 A.~n~b'clilorl"i$.) I Oe:'lOll: Rep!"C:.cI'lICf1I"''' 0 )0;'" 0_.' 0/.),01. d.po:il b.:JA .J ""." - . ." .L - -- . . .. TOTAL P. 132 ./ . LAs'r 'dILL MID TESTJ\!lmrr OF FAY C. HILLIS I, F'J\Y C. 'dILLIS, of the Dorough of lIechanicsbure;, County of Cumberlnnd and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void illl] Dnd all prior Wills by me at any time heretofore made. 1. I direct the pa;y111ent of all illY just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give and bequeath fifty (50;(,) per cent. of my estate, of whatsoever nature and Hheresoever the same may be situate,- . , to my daughter, SJ\LLY L. COCOZZA, absolutely and unconditionally. 3. I give and bequeath the remaining fif'ty (50%) per cent. of' my estate, of t.rhatsoever nature and wheresoever the same may be situate, to my three (3) grandsons, to wit, SCOTT HJ\CHEHER, SILI\.VlN HJ\CHEHEfl and S'!:'EPEIIN llACIIEHER, share and share alike, per stirpes. . !~ . For the pnrpose of: f:acilitating the settlement and distribution of my estate, I authorize and ePlpoHer my Executors, hereinaf:ter named, or any substitute personal representative of my estate, to sell any ond all real estate Hhich I may mm at the time of my decease, as vlell as my personal property, at either public or private sole or sales. LIlS'fLY, I nominate, constitute and appoint my daughter, SliLLY L. COCOZZA and bel' husband, DONALD P. COCOZZI\., Co-Executors of: tbis my Last Hill and Testament, and direct that they be excused f:rom posting bond or other security f:OI' the f:aithf:ul per1'ormance 01' their duties in any jurisdiction. IN \HTNESS IlHEREOF, I this ~ r day of August, -..,.- have hereunto set my hand and seal A. D., 1998. I ~ c, , WL~~. Willis (SEAL) Fay C. . '" Signed, sealed, published and declared by the above named, FAY C. HILLIS, as and for her Last Hill and Testament, in the presence of us, Vlho have subscribed our names hereto as uitnesses, at the request of said testatrix, in her presence and in the presence of each other. o ~ . / L,/ IZ ~/'- Q 71~ - -3- . .. . CONMONWEALTlI OF PENNSYLVANIA ) S5. COUNTY OF CUNBERLANIJ I, FAY C. HILLI S , the testat rix whuse name is signed to the attached or foregoing instrument, having been duly qnallfled according to law, do hereby acknowledge that I signed and executed the Instrument as my Last WLll and Testament; that I sIgned It wil.lIngly; and that 1 sIgned it as my free and volun- tary act and deed, for the purposes thereln contained. SWQ rn arIll _ FAY C. IHLL;IS day of AU>1:ust affirmed to and ackllowleuged before , the tesbit rix , thJs , ii-:-u. , 1998. ~ C ) t . . -{jFay' C.Ly,li~ /J{~r/J- ["" [~i~- me by r-.. :J'/' Notary Public 55. ,",Olarial Seal publi.: ,"'r,jamS tla,r."" \y M~r~y" Ef 'f~'}~~< 6l1mbe(13;~d ~oor~ Meon."~ 9, ",pire. Nov, &. M'f Co~m\S5Ion -----":'-:"ta:;c'; _ _ 'j\f\.II::it.'Ci,),ti'Jll(),Nl' MtI"llMf. pl':lm~NC'tf\, ' cmlHONWEALTII OF PENNSYLVANIA ) COUNTY OF tUMBERLANIJ ) We. the unuersigned, J. ROBE!1T STAUFFER and SUSAN A. HeCOY , the witnesses whose names are sIgned to the attached or foregoing lnstrument, being duly qualified according to law, depose and say that we were present and saw the testat:rix_, Pf\.Y C. HILT,IS ' sIgn and exe- cute the instrument as :!lXX/her Last WIl.I. and Testament; that the said testatrix, FAY C. l-IILLIS , executed it as t:c.bmher free nlHj volunt::try net [or the [llJrpOSe5 therein expressed; that each of us, in the hearing and sight of the testatrix , signed the Will as wHnesses; and that to the hest of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sounu mimI, anu under no constr~int211ress or undue influence. L, 6'f.fibed to before~ day of 1998. Sworn and !u me thIs c;.J- AUgust ,1.4 .-' // ' ( (-;{fi.....-.. .\.... c;. (v;..{l---, Holanal Seal PublIC M'~'yn f.. YlIni..m~. =~EII1d CoUnlY Moc\1.nic.oUIll, Bnor~~':es Nov, &. 2001 M COMl11lSStO V" Y ,Ia"on .t Ho~rit. Mtlmber, pennsylvania ASSUC ;805 Rf-V.9IS.! This is to cerrify that the information here given is correctly copied from an original certificate of death duly filed with me as Lota! Jtl.<;ti;trar. The original certificate will be forwarded to the State Vital Records Office for permanent fiiling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 8390941 No. l~~~ ~'7 Local Registrar 11(1 7. ddO d- , Date Hl(l$.I44~..1191 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) S1lllt!1'll1___ SEX SOCIAl. SECIJlIIIT't NOWBER IW l. Female 1. 204 03 8143 .. IIfITttPtACE(CIr..... PVoCE:OFOE.ltH(C:/'cIc........... _...............""__1 sw.orFo-_~ HOSI'I1'Al: OTHER Bendersville, ~O ~O ::::::00 k ........._l 106 North Market Street rYP€./PIIINT '" 'EIlMANENT IlILACKIHK z ~ :i o , " , ~ 1J.'llrlllwJ E Willis uraAlD.llrr CUllE0#9IATIt __ - I_o.y._. Cumberland Penns;ylv::mi~ "'''''"' Mechanicsburg .....SllECEDeNTEVEIlIH US.AAMEDFOfICES7 _D HeXJ """""',- '- r--.",$+I " It_"" May 4, 2002 ~lO IoIoI.fWtIU.SWus...._ ---.-' -- V'hIite ~"""""'''''"''' lll_.__<-....j 171l.0-.__.. 106 North Market Street Camp Hill, Pennsylvania 17011 Reuben C. Crum Sally L. Cocozza ,a '" - M.' Cumberland -"'1 lu.il ::':""ao:::'':::", YOTHER'SNMIE,....-.................. .. Lottie A. Beamer -"'- ~_...O """" ....- ... 1NFOflMNfT'8MAltMGACIOfIIU8\SWMl. .-. 1.l)C.n)H.~s...lJp May 7, 2002 UCENBE NUW8EA _. _oI...~.__"'IM___...._ ~.....r..l - "'" CUllEPAONOlJNCEO ,......,.0.,-1 Hay 4, 2002 24.. 9:25 P. W Z1."",,"~ ~...-........."'..........-._____c.......___o/..._..C*doc"'~......_"'__. UII....,,__....__ H ertensive Cardiovascular Disease OlIl!TO(ORASACOIdEO\JENCEOF): . OUIiTOlOfIlASACONSEOOENa:OF'l: OIAlOlOlIASACCiHSEOIJEtUOF): . .....-....... ........."""'" "'''"'''' """"""',.... ""''''....... .... Do,_ )t o o CouIol.....t>oo...._ Conolite Crematory IWlIE A/CIAODAUI CW'MCIUTY Schae~town,Pa. 17088 ...... ....... l_.o.w..-. _. . -~ .....~ HoD _. ..."'" I==- 1-.....- MItT.:OIMr~_ctInIr~"'_."" -.....-.;.....-.....-.......-.. IDDM -"'....... IHJUFlYRWORK1 DeSCfIBEIt:MINJUAYOCCUAIlED. "''''"~ - o o O ~OIFlK.UIY'Al-.-'-''''''''''''~ --- - ..... D HoD -. - ...................... YH 0 Ho)il ..... 0 NIl 0 n.. __ UIlT..-.eJI/OIoocI<"...,C01el 'CUTlN1MQ~jPIIy.-.~_"'__"""~'I\MIlfOI'OUf'C*I__~""";13J 1Io__.....,~.___1O...~a)_____......... ............... ......................... --- a. .'110 aItIClNOAHOCEllTIf'Y_I'HY8lQfM~_~_.....~.._oI_1 ,...._..""...........__"''''''-._._....__..........1__..._.... 'WEDICALUAMlNeRICOfIONIA O"ItIII......or.I........Ilon~....~....lIqIopInIoII.__llCCIUt'Ml.tltHlllIM..w.._,.....__IGIM---c.I_ -...........................,..............................,...,..................,.....,.........,..,....... 31.. . Coroner o,ql SlGNEDI_. 0001._1 o J1C~ I. May 6. 2002 IWlIEAI'IOADOAESSOf' PERSOHWI<<)C\JMP\ETEDCAuSE OF OERH C--Z7)TI'P"OIP.... Michael L. Norris. Coroner IWI 6375 Basehore Road. Suite 11 1"\ llI. Hechanicsburg. Pa. 17050 CUllEFLEOr......o.,.~ M. ~ , . ~ ... STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, MARY C. LEWIS Register for the Probate of Wills and Granting Letters of Administration &c. in and for said County of CUMBERLAND do hereby certify that on the 13th day of May A.D., Two Thousand and Two, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of WILLIS FAY C (LA~l, tLK~l, MLUULbi a/k/a WILLIS FAYE E in said county, deceased, to , late of MECHANICSBURG BOROUGH COCOZZA SALLY L (LA~l', I"LK~l, rvHUULb) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 13th day of May A.D., Two Thousand and Two. File No. PA File No. Date of Death S.S. # 2002-00460 21-02-0460 5/04/2002 204-03-8143 c.~ Register NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL \/7-~..2 - /.;:v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX SALLY L COCOZZA 100 WESLEY RD OCEAN CITY DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-13-2003 WILLIS 05-04-2002 21 02-0460 CUMBERLAND 101 - REY-15~7 EX AFP (81-83) FAY C Allount Rellitted NJ 08226-0318 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, fA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =l5"4-j-ix--AFP--coY--o3Y-NOYiCE-oF-YtiHER-iTAifci-YAX-APPRA-isEifENT~--ALrowANci-ifR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WILLIS FAY C FILE NO. 21 02-0460 ACN 101 DATE 01-13-~003 , TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: lS. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 195,666.50 X 045 = 8,804.99 .00 X 12 = .00 .00 X 15 = .00 (19)= 8,804.99 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (S) (6) (7) .00 43.503.19 .00 .00 25,565.66 .00 128.090.36 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 1,132.71 360.00 (11) (12) (13) (14) NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 197,159.21 1.492 11 195.666.50 .00 195,666.50 TAX CREDITS: ~ ..-... l+l AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-18-2002 CDOO1640 .00 8,804.99 TOTAL TAX CREDIT 8,804.99 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 4/07/2005 COCOZZA SALLY L 100 WESLEY ROAD OCEAN CITY, NJ 08226 RE: Estate of WILLIS FAY C File Number: 2002-00460 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.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: 5/04/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge J .0"" . . . . e : Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 N~ofD,_' IfrJ {', Lv~ D"" ofDoolli, '111l "I;;),'. ~ Estate No.: ,~() ~ 00 c.; (p_ 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: I. State ~ether administration of the estate is complete: Yes)Ll No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did ~ersonal representative file a final account with the Court? Yes)Ll No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the person~resentative state an account informally to the parties in interest? Yes p No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date:~()I.;L06C cr'l I b 0 LtJ .~,t) ~. Q (}.4.J- Address 609 098VA L/? Telephone No. Capacity: ~ersonal Representative ,0 ~ounsel for personal representative vf