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Home My WebLink About02-0466 KERWIN & KERWIN ATTORNEYS AT LAW 4245 ROUTE 209 ELIZABETHVILLE, P A 17023 GOVERNORS' ROW 27 NORTH FRONT STREET HARRISBURG, PA 17101 PATRICK E. KERWIN (1913-1987) (717)362-3215 (717) 896-9089 FAX (717) 362-4459 E-mail: kkl@epix.net (717) 238-4765 FAX (717) 238-8455 GREGORY M. KERWIN - GMK@Kerwinlawfirm.com TERRENCE J. KERWIN - KK@Kerwinlawfirm.com JOSEPH D. KERWIN - JDK@Kerwinlawfirm.com HOLLY McCLURE KERWIN - KK@Kerwinlawfirm.com Please Reply To: . ELIZABETHVILLE OFFICE a HARRISBURG OFFICE November 1, 2002 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Mary J. Houser Date of Death: 05/03/2002 File No. 2002 - 00466 Dear Sir or Madam: Please find enclosed herewith an Inheritance Tax Return and Inventory with respect to the above- captioned estate for filing in your office. Also enclosed is a check in the amount of $25.00 for the filing fee and a check in the amount of $710.74 representing the balance due. Would you kindly time stamp the enclosed file copies and return them to me in the enclosed stamped, self-addressed envelope? As always, thank you for your help. GMK:bmk Enclosures ~~-~~~~~----~/~~~~~---~~~~~~-~~~~~~-~~~ z ~ _ 0 ~3;a>t- ""tIlo"- W....J"'<S: ~~So. o1SlIlai ~a:.:=: Zc:: ... -'O'!1% i~~~ ~ \f1 \il (fl P g ,.... ,M Cf) ~ <'"' P <'"' '614c1-, r.n ?~ ~ 6 .-:l<:-,P"'" p'g~"'" ':3''6 \il 4. \>' ",I'M opP ~~~~ \>lg~'t?, ~ \~ P 'j .....I:CIO .~ 0~04. ~0.....0 II'-'~"_Jl'-'I VI VVI1I0 VI vUIIIUC;IIOIIU \,.,UUIILY, ,tllll::JYIVdllld Estate of MARY J. HOUSER INVENTORY No. (;2!" ();;;. - I..Jb? also known as Date of Death 05/03/2002 , Deceased Social Security No. 174-20-5630 THOMAS H. SNYDER Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: GREGORY M. KERWIN Personal Representative: . 7&')7"~~ f-J ~ ~;7~I--(/) THOMAS H. SNYDER 1.0. No.: 21222 Address: 4245 ROUTE 209 ElIZABETHVILLE, PA 17023 Telephone: 717-362.3215 Dated /0/11/0 J- I I Description Value 1. $ 79,000.00 2. 4,198.76 3. 33,957.15 4. 17,466.66 5. 505.14 6. 258.30 7. 1,900.00 8. 214.50 9. 686.73 10. 100.00 11. 165.60 1. 28 Series HH United States Savings Bonds, face amount 2. Savings Account #3083365962043 at First Union National Bank 3. Checking Account #00443.4632-8 at Allfirst Bank, Harrisburg, PA 4. Savin9s Account at Allfirst National Bank 5. Messiah village, relund 6. Lutheran Brotherhood, monthly payment 7. Penn Treaty network American Insurance Company, long term care payment 8. Penn Treaty Network American Insurance Company, refund premium 9. Auction of Personal Property 10. Refund on apartment 11. PA BlueCross/BlueShield, refund Total: $ 138,452.84 (Attach Additional Sheets if necessary) NOTE: The Memorandum of rea! estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Fo,mRW.7 (Dauphin County Rev, 9/921 E '''B/VI KIPI{QBA TEII-!OUSER.M, INV KERWIN & KERWIN ATTORNEYS AT LAW 4245 ROUTE 209 ELlZABETHVILLE, PENNSYLVANIA 17023 GOVERNORS'ROW 27 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17101 (7I 7) 362-3215 (7I 7) 896-9089 FAX (7I 7) 362-4459 E,mail kkl@epix.net (717) 238-4765 FAX (7I 7) 238-8455 Please Reply To: . ELlZABETHVILLE OFFICE o HARRISBURG OFFICE July 29, 2002 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Mary J. Houser Date of Death: 05/03/2002 File No. 2002 - 00466 Dear Sir or Madam: 237 UNION STREET MILLERSBURG, PA 17061 (717) 362-3215 549 MAIN STREET LYKENS, PA 17048 (717) 453-7422 PATRICKE. KERWIN (1913-1987) GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN HOLLY McCLURE KERWIN Please find enclosed herewith a check payable to the Register of Wills, Agent in the amount of $4,500.00 representing a payment on the Inheritance Tax on the above-captioned estate. Would you kindly prepare a receipt for the payment and return it to me in the enclosed, stamped, self-addressed envelope? As always, thank you for your help. GMK:bmk Enclosures COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX111-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KERWIN GREGORY M ESQUIRE 4245 ROUTE 209 ELlZABETHVlllE, PA 17023 __nnn fold ESTATE INFORMATION: SSN: 174-20-5630 FILE NUMBER: 2102-0466 DECEDENT NAME: HOUSER MARY J DATE OF PAYMENT: 11/04/2002 POSTMARK DATE: 11/01/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/03/2002 NO. CD 001809 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $710.74 I I I I I I I I TOTAL AMOUNT PAID: $710.74 REMARKS: THOMAS H SNYDER C/O GREGORY M KERWIN ESQUIRE CHECK#1009 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS MARY C, lEWIS REGISTER OF WillS --~~,,~--_//-/~~////~ " ,\))\q! i q l \\\\\ ," ~ ~ .~ ~ ~ U 7'~~ '2-"~"" (Z......"" ~';:J~0. .....Oc/lo .... U ,,' r-- ~ ,..,.... \J-< @. 'G -<!. o ..r. 0 p... ~d~~ ';J:ll-'":!~(j) t-';J:lI-M,.." ~e;';:J"'" O,?<O~ \)J,';:Ju..r. ~u""u ~ 'b '" ~\ ~ M 0 <;; .( ~ ~ ~ ~ tf)~ if) ~ ~ \;( "" 'b~ '" ~:l ,...- ~~ ~~ ?t:. ~~ ~~ ~N \;( ~a - - - -:::. -;::; - - - -;::; - t'-l \Sl t." 11' 1'".' \"t) -I- (':, .... \Sl r'. ..... /'/- 63-~- ~ 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 'I DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN GREGORY M KERWIN 4245 ROUTE 209 ELIZABETHVILLE 12-02-2002 HOUSER 05-03-2002 21 02-0466 CUMBERLAND 101 *' REY-15"7 EXAFP (Dl-02) MARY PA 17023 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV:is'4j-ix--AFP--roFii2rNoYici--oF-YNHiifiTAifcri''Ax-XP'PRXisiMENT:--ALToWANCi-oi------------ - ---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOUSER MARY FILE NO. 21 02-0466 ACN 101 DATE 12-02-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTUR~ INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) ~. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Trensfers (Schedule G) 8. Total Assets ll) (2) (3) (~) (5) (6) (7) .00 79,000.00 .00 .00 59,452.84 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) l~. Net Value of Estate Subject to Tax (9) 1l0) 12,732.53 4.663.01 (11) 112) 113) ll~) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 138,452.84 17 .395 54 121,057.30 .00 121,057.30 NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line l~ at Spousal rate 16. Allount of Line l~ taxable at Lineal/Class A rate 17. Allount of Line l~ at Sibling rate 18. Allount of Line l~ taxable at Collateral/Class B rate 19. Principal Tax Due IlS) .00 X 00 = .00 116) 121,057.30 X 045 = 5,447.58 117J .00 X 12 = .00 118) .00 X 15 = .00 119)= 5,447.58 TAY CREDITS: nu """ I tI T+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-29-2002 CDOO1459 236.84 4,500.00 11-04-2002 CDOO1809 .00 710.74 TOTAL TAX CREDIT 5,447.58 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 MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-UD7EX AFP CUI-02l 't DATE ESTATE OF DATE OF DEATH FILE NUMBER i_\ COUNTY ACN 12-09-2002 HOUSER 05-03-2002 21 02-0466 CUMBERLAND 101 MARY GREGORY M KERWIN 4245 ROUTE 209 ELIZABETHVILLE Allount Rellitted PA 171123 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forB with your tax paYBent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6'irj-ix-AFP-('oFii2r-----...--fNHERITANCrYAX--STAyE:MENY-OF'-AC-COl,itfy--.-..------------------ --- ESTATE OF HOUSER MARY FILE NO.21 02-0466 ACN 101 DATE 12-09-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-02-2002 PRINCIPAL TAX DUE:_ 5,447.58 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-29-2002 CDOO1459 236.84 4,500.00 11-01-2002 CDOO1809 .00 710.74 TOTAL TAX CREDIT 5,447.58 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J \, /6 ~c23o - Y' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-UD7EX IFP (o1-D3> ROGER S REIST SHIRK ETAL PO BOX 1552 LANCASTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 HOSTETTER 04-21-2001 21 01-0466 CUMBERLAND 501 ROBERT R Allount Rellitted PA 17608 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=i6ifj-iif-AFP--[oFiiir-----...-i;,ii.fiRiYANCrYAX--SyjrfEMENY-OF'-AC-COlitff--.-i.---------------- -- --- ESTATE OF HOSTETTER ROBERT R FILE NO. 21 01-0466 ACN 501 DATE 01-21-2003 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-10-2002 PRINCIPAL TAX DUE: 685.82 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-04-2002 CDOO1812 .00 685.82 12-20-2002 CDOO1976 2.92- 2.92 TOTAL TAX CREDIT 685.82 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 " IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J ~. o~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARY J. HOUSER Date of Death: 07/30/97 Estate No.: 2002 - 00466 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes _X_ No 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.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? No _X_. Yes b. The separate Orphans' Court No. (if any) for the personal representatives' account is : c. Did the personal representative state an account informally to the parties in interest? Yes _X _ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dot" April 23, 2003 ,0 0 ~, Signature / GREGORY M. KERWIN, ESQUIRE 4245 ROUTE 209 ELIZABETHVILLE, PA 17023-9765 (717) 362-3215 Capacity: _ Personal Representative _X_Counsel for personal representative RW-27 E:\BMK\EST A TES\Houser .Mary .612. wpd 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 KERWIN GREGORY M 4245 ROUTE 209 ELlZABETHVlllE, PA 17023 -------- fold ESTATE INFORMATION: SSN: 174-20-5630 FILE NUMBER: 2102-0466 DECEDENT NAME: HOUSER MARY J DATE OF PAYMENT: 07/30/2002 POSTMARK DATE: 07/29/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/03/2002 NO. CD 001459 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,500.00 I I I I I I I I TOTAL AMOUNT PAID: $4,500.00 REMARKS: CHECK#1004 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS PETITION FOR PROBATE and GRANT OF LETTERS Estate of fI1A t<V X Hat/51; R.. No. .2/-0.2 -V"~ also known as I To: Register of Wills for the Deceased. County of Cumberland in the Social Security No. ; 7 r - ;2 eJ- 6"'~J 0 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of agl; or older an the execut or in the last will of the above decedent, dated eX/tV ;) (, and codicil(s) dated 1./ {J 1../ E I named ,19~ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) h er County, Pennsylvania, with Cam Hill PA /70/ Decendent, then 86 years of age, died fI1 ~V..:? ,~ ~60;). at fI1 E ~ S J A ~ 1/ IL. Lllc:;€. D fl 'pEl? 11 L E. P -rwf) ,{'(../M b'Er<t../1/V'tJ (' 1l; Except as follows, decedent diu not marry, was not divorced and did n6t 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: f/ D II//;; Ffl 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 Pennsylvani~ E situated as follows: /v O!J /1~O,j() $ $ $ $ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. I ~~ (I~/- :!l-;;, flr~) ~~ " - <>:1! -00 \::': clj': ~" ~o.. ,,~ 30 ;; " .. <Ii II, f.) MI! 5 f-I, ,r Iv Y ~ E 12.- ~ q :J I e Ii 1. rlJ ,/v'/ /) 1< , 'A f11 (J HI L( 4, /7{) II OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ') ss COUNTY OF OnnhPrlrmn J 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 w~nd truly administer the estate according to law. Sworn to or affirmed and subscribed t~ Ii ~ ~~ ~ before me this 13th d<lY.8f OQ May ~~ ~ s:: ~ ~ /1-I.P3-5 No. 21-2002-446 Estate of ;Vl ~ fl... V ::T. Hou Sf l<- I , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Mav 14th l~ 200,2in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated MAY 26th, 1983 described therein be admitted to probate and filed of record as the last will of MARY J. HOUSER TESTAMENTARY THCMAS H. SNYDER and Letters are hereby granted to FEES $ 235.00 $ 12.00 $ $6.0U TOTAL _ $ 5.00 Filed. .May.14."th,. 2002.... .$258.00.. Probate, Letters, Etc. ......... Short Certificates('t) . . . . . . . . . . Renunciation ................ x-Pages (2) JCP ATTORNEY (Sup. Ct. 1.0. No.) 4245 ROUTE 209, ELIZABETHVILLE, PA 17023 ADDRESS (717) 362-3215 PHONE "Lll:\~) ".") 90: ? J t l ,W!.) ZOo MAILED LETTERS 'ill ATTORNEY ON 5-15-2002 " n~ ':I''' "T:.\ "(, This is to certify that the information hete given is cortectly copied ftom an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office fot permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~L~R~ fee for this certificate. $2.00 p 8206650 MAY 0 7 2002 Date ~v 2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT ihsl. Middle. La5Il so $TATE FilE MJMllEA SOCIAL SECURITY NUMBER I. Mary AGE (la$l BlI'lrldlYI J. Houser UNDER 1 YEAR UNDER 1 DJI:t Montn. Oa.,. tbQ MIrM.II_ ." .. female .. 174 20 y~ DATE Of' &tRT" .,Monltl,Oav...... February 1, e. 1916 CJTY. BORO. TWP OF DEATH PLACE Of' OEAlHiCN!ck or>I'f I)('e '" "'SlIut:l.ot~ on Qltler '>>081 HOSPITAL: Berrysburg, PA ,....,....0 , ... FACILITY NAME (II nolll'l~NUlIQO. g've g'ee! and number, BIRTHPlACE IC"" iIf'ld StiI"Offcr~CounIlVI s. 86 COUNTY OF DEATH ;::",,10 ... Cumberland DECEDENT'S USUAL OCCUM1ON (~':on~_:OC::::~~ Clerk Upper Allen Twp. Ie. tel. KINOOf' BUSlNESS/tNDUSTRV white MARITAL STATUS. Marliad N._~iM:l.W~. 0N0r,*, iSpel::lly) widowed SUfMVING SPOUSE III....... ~... malOIlf1 NfmI) ... 119 November Drive ,~ Camp Hill,PA 17011 F.lJHER'S NAME tF~st, M~, last) ... Hubert Stine INFORMANT.S NAME: (TyplIIPlinll '00. Thomas H. Sn der METHOD OF DiSPOSITION eun.lC!D CI.fllWlic:lnO ~"omSlalaD OIh.-'(Sp<<:IIy\ ,... Cumberland 17_.00 :.,~.:::'" WOTHER'S NAUE IF_51. Mod(je, ~Sur~1 ... Beulah Shoo INfORMANT'S MAIl.INGADORESS ISlrMl. Cit.,.ITown, &.N. ZipCodll) 1931 Chatham Drive, Camp Hill, PA 17011 PlACE OF DiSPOSITION. NarnI oC c.m.t.y, C"malOlV LOCRlON. CitylTown. St.... Z"1p ec:... orOl'-'PIK. Rolling Green Memorial Park Lower Allen Twp., PA 17011 2te. 2td. NAMEAHDADOAeSSOf'FAaLITY Parthemore FH & CS, rue. ~.P.O. Box 431 New Cumberland PA 17070-0431 LICENSE NUMBER ORE ~NfD (MoNh.o." ""1 Camp Hill ,- 340 L 311. 23cl. Y*.S CASE REFERRED TO MEDICAl EXAMINERICORONER? ",,0 NoL"O H. I Apptozimal. I~~n I 0fIMl and dMth PART II: OIhersignil\canl~conriIutinglo~,buI IlOIr"'*iIlgintMundIrtying~giWninPARTI .....EDlATE CAUH {fsnal d_Ofcone;lilion '~IIIOMltlJ_ s.qu.ntiaIIylilllconditionl i1~,INdIngIO~ ~.E,,*~WO CAUSI (00MaM Of ,nlU'Y m.illlllialed.....-u 'esulllngIllOMltllLAST DUE 10 (OR AS A CONSEOUENCE on , WAS AN AU10PSV PERFORMED? . WERE AUTOPSY FINDINGS A\WLABlE PRIOR 10 COMPLETWJN OF CAUSE Of'DEAI'H? MANNER OF DEATH DATE Of INJURY (Mcwln,Oay,,*,lII) T1MEOFlNJ RY tl'tJURV /IJ YIIOAK1 DESCRIBE HOW IHJURY OCCURREO "" 0 NofXJ _0 NoD Nalural ~ AccllMnt 0 ....... 0 Hameidlo o o o _ 0 NoD PandinglllYNlig-.lion Could noli bltdalarmooed 2". 21b. 29, canaFlER CCtl<<:k oniy ~I .CERTIfYING PHYSICIAN Cf'hyw:""nceflllylOQ cavM 01 dealt>.....8I' JnOlhIll Ol'lVSIC'lIIl has pronOlmced dealh and compllille<ll1ern 23) To'" bul 01 my Itnow~, d..th occurNd dl.-ID IN cau..(s) and manMf a. ..aiM. , .PFtONOUNCING ANDCERTlFY1NGPHYSIC......jf'hVSC...... boItl ;lIOIlOI.IOC"'9 Olilal/'l.wd c....,.V"'9IO cause 01 deillt>l To Ih. U-I 01 my Itnowl.og.., d.ath OCCUff" allN 1imaI, dale,.nd pIK.. and du. to I~ c;IU"lalancl mannar 1I11 1I1aled" 'MEDtCAL EXAMINER/CORONER On the bul. or .lamln.tlon and/or investigation. in my opinion, d.athoc:curr.d at the lime, dal., and place, and due to the UUM(S)and mann.f..st.ted....................... ....,...,.,."....,...... ..........,..,,",.....,.,......,.,.,...,.,....... 't. REGISlRAR'S SIGNATURE AND NUMBER o " ~/?C~,t>..~~ I~/I~//I ". ::" FIlEO';:h:% ~ , , 21-2002-446 LAST WILL AND TESTAMENT OF MARY J. HOUSER I, MARY J. HOUSER, of East Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I bequeath all of my tangible personal property to my children, Thomas H. Snyder and Gloria M. Myers. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate as follows: A. I bequeath the sum of $5,000.00 or 10% of my estate, whichever is less, to each of my grandchildren, Michael Snyder, Vicki Myers and Jeffrey Myers, who are living at the time of my death. B. I devise and bequeath the remainder of the residue ARNOLD,SUKE&BAYLEY of my estate unto my children, Thomas H. Snyder and Gloria H. ATTORNEYS AT LAW CAMP H'LL.P~I<N"YLVA""" '~QII }l! &1 L 11-~~ (' 0 . Page 1 Myers, or their issue per stirpes. IV - I appoint my son, Thomas H. Snyder, as Executor AANOLD, SL~x~%E & BAYLEY ATTORNEYS AT EAW CAMP H~i~,Pvxr srivnwu i>o~~ of this my Last Will and Testament. Should my said son fail to qualify or cease to act as such, then I appoint my daughter, Gloria ~~. Myers, to act in this capacity. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal 7`~7 ,,~ on this, the ~;,~Cc day of ~~,//~',,~, 1983. ~f ~~ ,~ ~L'Z'~- ~ ~;...~.~._~c,-C.~ ( SEAL) '~ Mary J~ user t Signed, sealed, published and declared by Mary J. Houser, the Testatrix therein named, on this and one (1) other sheet of paper as and for her Last Will and Testament in our presence, who, in her presence, at her request and in the presence of each other, have hereunto subscribed our names as attesting witnesses. .~~ .. N ,~ F i .._... Name ~Y s/.~V ~YIJ / V .J _~~._X r~ .' A~J Address " ,~ '~. Address Page 2 COM*10NWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUP'IBERLAND ) WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Wi11 and that she signed willingly (or willingly directed another to sign for her) and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by the testatrix, and su~cribed and swo to before me by bo~ wit- nesses, this ,Z~ day of 19 3 otary Public ARNOLD~ SLIHE Bc BAYLEY ATTORNEYS AT LAW ('..wv N~i~..Pe v. e~i ..u ~roi~ - Thelma S. McCauslin, Notary Public My Commission Expires July 1, 1964 Camp Hilf, PA Cumberland County G~ z~~ ' ~~.~ ~t T tatrix Name of Decedent: Mary J. Houser Date of Death: May 3, 2002 No. 2002 - 00466 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 28, 2002: Name: Address: Thomas H. Snyder 1931 Chatham Drive Camp Hill, PA 17011 Gloria M. Myers 109 South 17th Street Camp Hill, PA 17001 Michael Snyder c/o Thomas H. Snyder 1931 Chatham Drive Camp Hill, PA 17022 Vicki Myers 109 South 17th Street Camp Hill, PA 17001 Jeffrey Myers 91 Beacon Drive Harrisburg, PA if ~ 12 1 Notice has now been given to all persons entitled there ~ ~ er Rule 5.6 , except: NONE Date: 05/28/00 ~ Signature: ~ w ~~ V~ Name: .Kerwin Address: 2 5 Route 209 Elizabethville, PA 17023 Telephone: (717) 362-3215 Capacity: Personal Representative X Counsel for Personal Representative D: \DOCUME -1\BMK\ESTATES\HOUSER-M. CER ., AEV-1500 EX.. (6-00) .... ~ OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I -; - &:<3' ':J FILE. N,IJMBER ~ OJ... D E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 260601 HARRISBURG, PA 1712.8-0601 DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) Houser Mar J DATE OF DEATH (MM-DD-YEAR) COUNTY CODE SOCIAL SECURITY NUMBEA 174-20-5630 THIS RETURN MUST BE FLED IN 0lA.JCA. YEAR 1-./1:",(, NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER X 1. Original Retuffi Z. Supplemental Return 3. Remainder Retum (d!3 po CAPB 4. Limited Es1ate 4a. w~r~~~[e2} Compromise (date of death after 12-12- 2) 5. Federal EslaJe Tax Return HpRL X 6. Decedent Died Testale 7. geqededt Maintained a Living Trus1 0 8. EplO Tolal Number 01 Sale Depo CRAC (Attach copy 01 Will) $Rt&Dka<<lpy of Trust) KOTK 09. Litigation Proceeds ReceivedD 10. 0 ES Spousal Poverty Credit 11. Election to tax under Sec. 9 C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N 0~1"j<)1!U02 02 01/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~~<ieathbet>Mlef112-31-91 anti '-'-95) (Attach Sch 0) THIS SECTION MUST BECbMPL1:Ii:.It'Al1eo"'~ESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAIliNG ADDRESS Gre or M. Kerwin, Es uire FIRM N,t.,ME (It Applicable) Kerwin &: Kerwin TELEPHONE NUMBER 4245 Route 209 E1izabethvi11e, PA 17048 R E C A P I T U L A T I o N 1 62-3215 1 Real Estate (Schedule A) ZStocks and Bonds (Schedule B) 3CJosely Held Corporation, Partnership or Sole-Proprietorship 4Mortgages & Notes Receivable (Schedule D) 5Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6Jointly Owned Property (Schedule F) Deparate Billing Requested 7Jnter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8Jolal Gross Assets (total Lines 1-7) 9Funeral Expenses & Administrative Costs (Schedule H) HDebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 1fTotal Deductions (total Lines 9 & 10) 13l1et Value of Estate (Line 8 minus Line 11) 13::haritable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 141et Value Sub.eet to Tax (Line 12 minus Line 13) (1) (2) (3) None 79,000.00 None (4) (5) None 59,452.84 (6) None (7) None (9) (10) 12,732.53 4,663.01 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 1 5O.mount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16C1.mount of Line 14 taxable at lineal rate 17Arrount of Line 14 taxable at sibling rate 18Otmount of Line 14 taxable at collateral rate 191'ax Due .0 0 .0 45 121,057.30 x X X X .12 .15 OFFICiAl USE QNL Y (8) 138,452.84 (11) 17,395.54 (12) 121,057.30 (13) (14) 121,057.30 (15) (16) (17) (18) (t9) 0.00 5,447.58 0.00 0.00 5,447.58 Copyright (c) 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev_ 6-00) Hyers, or their issue per stirpes. IV - I appoint my son, Thomas H. Snyder, as Executor of this my Last Will and Testament. Should my said son fail to qualify or cease to act as such, then I appoint my daughter, Gloria M. Myers, to act in this capacity. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I , ~-) I. tid f thls, the Cy~ ay 0 have hereunto set my hand and seal fJ:? 11/ , 1983. on ;1'?t/t? J" )~~-'L.-/ (SEAL) Mary J user Signed, sealed, published and declared by Mary J. Houser, the Testatrix therein named, on this and one (1) other sheet of paper as and for her Last Will and Testament in our presence, who, in her presence, at her request and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ;::.) (J L_~/Wt Addres /1-t)JJ; If. )f /'(" --"~,~ C -,;"'--z-z:7 d-<::'i/ Address:? / ;7 ( --://'-. ARNOLD, SURE & BAYLEY ATTORNEYS AT LAW CAMP H'LL,P!':"""YLVANlA '70ll Page 2 ~ ..... Decedent's Complete Address: STREET ADDRESS 119 November Drive CITY STATE1 ZIP I Camo Hill PA 17011 Tax Payments and Credits: Uax Due (Page 1 Line 19) 2Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,447.58 4,500.00 236.84 Total Credits (A + B + C) (Z) 4,736.84 3JnteresVPenalty if applicable D. Interest E. Penally 0.00 Totallnlerest/Penally (D + E) (3) 4Jf Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line ZO to request a refund (4) SJf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (s) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT :1:.:::[::.:.[.1[::::.:[[:1:;[:[:.,:,'1:::::;::),.,::1]'I:.:"'::::!:::!!:!!!!!!:!!!!!!:!::I!I!!I::::::::::::::::::::.::::::::::::::::::::::::::::::::i::II!li!:!:!11:!:!:!I!!:!!I!!!I:!::!I!I:I::!:!!!: !::I:!i::!::I!illi!:i::::::::::::::,::.I!::[[i[:::)':::I!:]:'::::::!:::.:::!J::I::::_:Wl:l:i:.i,l:l::W:ll::~:iJlil::J:::!I[J.i..:':::i:::'[: PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 0.00 710.74 0.00 710.74 1 Did decedent make a transfer and: 8. 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? 21f death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . 3Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 40id decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. o o o Under pena\'ias 01 perjury, \ declare that I have examined this retum, including accompanying schedules and statements, and to lhe best of my Jl;nowledge and belief. it is tJ\Je. correct and complete. Declaration of preparer other than lhe personal representative is based on all infonnatioo of which preparer has any knowiooge. S\G~AE OF PERSOO RESPONSIBLE FOA FILING RETURN Thomas H. Snyder L~ H. -C ~2~1--~~i'i;~/'N6ilmm--~------mm TUAE OF PREPAREA OTHER 1 AN EPRESENTATlVE Kerwin & Kerwin , 4245 Route 209 ~--Eii;,~a:b;'t~h";'i].-Ie~- ~-- -- D04~8 ~ -- ~ ~ -- ~ ~~. ~ ~~ ~ ~ ~ ~ Yes No ~~ !KJ IRJ lKJ D A /1~ 'Y : A T E For dat of d ath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (aJ (1.1) (I)]. 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. 9116 (a) (1.1) (ii)]. The statute does not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates 01 death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one 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. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal bene1iciaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [7Z P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use otthe decedent's siblings is 12% f72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c\ 2000 10!11l softWal"O OI1\y The Lackner Group, Inc. Fonn REV-1500 EX (Rev. 6-00) .' CO~10NWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUHBERLAND) WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her) and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. m?t--tL1 &t', ~,~ (J T tat:rlx 11.-V.- ~i Witness Subscribed, sworn to and testatrix, and subscribed and nesses, this 2.t, l;;!) day of acknowledged before me by the swo~ before me by bo);J"! wi t- _ , 19 )'3 . /~j 1et<<~A ;Notary Public ~ ARNOLD, SU1I:B. 8: BAYLEY ATIOIlNEYS AT LAW C.....r HIl.l-.Pll....TLV....U. ,TOll . Thehna S. McCaus6n, Notary Pub6c My Commission Expires July I, 1984 Camp HiU. PA Cumberland Counly U :lIo~. REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Mary J Houser SSff 174-20-5630 05/03/2002 FILE NUMBER ITEM VALUE AT DATE DESCRIPTION UNIT VALUE NUMBER OF DEATH 1 5 - Series HH U.S. Savings Bonds 10000.00 50,000.00 2 2 - Series HH U.S. Savings Bonds 5000 10,000.00 3 17 - Series HH U.S. Savings Bonds 1000.00 17,000.00 4 4 - Series HH U.S. Savings Bonds 500.00 2,000.00 TOTAL (Also enter on line 2, Recapitulation) 79,000.00 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) Copyright (c) 19961Qrtn s.o.ftware onl'i CPS'istems. Inc. Form REV-1503 EX (Rev_ 1-97) 8 CERTIFICA TION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mary J. Houser Date of Death: May 3, 2002 No. 2002 - 00466 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 28, 2002: Name: Address: Thomas H. Snyder 1931 Chatham Drive Camp Hill, PA 17011 Gloria M. Myers 109 South 17th Street Camp Hill, PA 17001 Michael Snyder c/o Thomas H. Snyder 1931 Chatham Drive Camp Hill, PA 17022 Vicki Myers 109 South 17th Street Camp Hill, PA 17001 Jeffrey Myers 91 Beacon Drive Harrisburg, PA Date: OS/28/00."; Signature: Name: Address: . Kerwin 2 5 Route 209 . Elizabethville, P A 17023 (717) 362-3215 Notice has now been given to all persons entitled there -~ !~~ Telephone: Capacity: r. ........... Personal Representative X Counsel for Personal -- Representative ''1 P D:\DOCUME -1 \BMK\ESTATES\HOUSER-M.CER '- REV-,SD8 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETUAN RESIDENT DECEDENT ITEM NUMBER 1 10 DESCRIPTION Savings Account #3083365962043 at First Union National Bank PO Box 13327, Roanoke, VA 14040-7314 VALUE AT DATE OF DEATH 4,198.76 2 Checking Account #00443-4632-8 at A11first Bank, 213 Market Street, Harrisburg, PA 17101 33,957.15 3 Savings Account at A11firs Bank 17,466.66 4 Messiah Village, refund 505.14 5 Lutheran Brotherhood, monthly payment 258.30 6 Penn Treaty Network American Insurance Co., long term care payment - Messiah Village 1,900.00 7 Penn Treaty Network American Insurance Co., refund premium 214.50 8 Auction of Personal Property 686.73 9 Refund on apartment 100.00 PA B1ueCross/B1ueShie1d - refund 165.60 $ 59,452.84 TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyrignt (c) '996 form software only CPSystems. Inc Form REV-1S08 EX (Rev_1-97) -' .... REV.1Sl t EX + (t.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mary J Houser Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. FILE NUMBER SSjl 174-20-5630 05/03/2002 DESCRIPTION AMOUNT 1 2 UNERAL EXPENSES: Part hem ore Funeral Home, New Cumberland, PA, funeral Funeral Meal 4,880.00 150.00 1. ~DMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number oj Personal Representative(s) Street Address City Zip State Year(s} Commission Paid: 2. 3. Attorney's Fees Kerwin & Kerwin Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 6,923.00 4. Register of Wills 258.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs Vital Records, death certificates U.S. Postmaster, express mail The Patriot News, Estate Advertisement Cumberland Law Journal, Estate Advertisement Register of Wills, filing Inheritance Tax Return Reserved for closing costs 9.00 12.45 200.08 75.00 25.00 200.00 TOTAL (Also enter on line 9. Recapitulation) $ 12 ,732.53 (If more space is needed, insert additional sheets of the same size) CoPVright (c) 1996 form software or.ly CPSY$\ems, loc. Form REV-1511 EX (Rev. 1-97) .. ...... AEV-1512 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REl\.lAN RESIDENT DECEDENT ESTATE OF Mary J Houser SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS FILE NUMBER SSf! 174-20-5630 05/03/2002 Include unreimbursed medical expenses. ITEM NUMBER 1 10 11 DESCRIPTION Messiah Village, account payable for room and board AMOUNT 3,045.00 2 Internist of Central PA, account payable 190.00 3 Lower alIen EMS, account payable 366.50 4 Quest Diagonistic, account payable 170.18 5 Quantum Imaging, account payable 77.69 6 PPL Corporation, account payable 56.72 7 Penn Gi consultants, account payable 210.78 8 Kunkle Surgical Group, account payable 340.00 9 West Shore Pathology, account payable 70.00 Verizon, account payable 69.14 Ambulance Service 67.00 $ 4,663.01 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyrigh1 (c\1996 form softwa.re ool'f CPSy$\ams. Inc. Form REV-1512 EX (Re,"" ,.97) '- REV.1513 EX-+ (9-00) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Marv J Houser SS11 174-20-5630 05/03/2002 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s} OF ESTATE I. AXABLE DISTRIBUTIONS [include outright spousal dislribulions, and transfers under Sec. 9116(a)(1.2l] 1 Michael Snyder Grandson 5,000.00 c/o Thomas Snyder, 1931 Chatham Drive Camp Hill, PA 17011 2 Vicki Myers Granddaughter 5,000.00 109 South 17th Street, Camp Hill, PA 17001 3 Jeffrey Myers 91 Beacon Drive, Harrisburg, PA 17112 Grandson 5,000.00 4 Thomas H. Snyder 1931 Chatham Drive Camp Hill, PA 17011 Son 1/2 residue of estate 5 Gloria Myers 109 South 17th Street, Camp Hill, PA 17011 Daughter 1/2 residue of estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18 AS APPROPRIATE ON REV 1500 COVER SHEET II. ON.TAXABLE DISTRIBUTIONS: . SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE . CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 fol'1Tl software only Tha Lackner Group, Inc. Form REV-1513 EX (Rev 9-00) '- iii allfirst MARY J HOUSER SEE COMMENTS 119 NOVEMBER DR APT 5 CAMP Hill PA 17011.5045 1...11',..111"",.11...11,1.1.11111.1,,1.1.1....111.1...11,,1 Page , of 15 Relationship With Interest iWldry J I ;tiU~.1 Se. Commenls Activity Summary AC':'l i-~.:J m.:443.Jo32-u April 10, 2002 thru Mey 9. 2002 o d:lIfirst.com G 24.hcur Customer Service 1-800-533-4630 Number of images enclosed Annual percentage yield earned Avg. dally ledger balance Avg. daily collected balance Interest earned this statement Interest paid this statement Interest paid this year Days covered by this statement Dopo.Hs and addHlons q 0.25X $30,701.26 $29,902.72 $6.1q $6.1Q $22.36 3D $23,3Q8.19 12,mO.98 -1,Q32.02 $33,957.15 Balance on 04/09 Deposits and additions Checks Balance on 05109 Dale Description Amount 04/11 DEPOSIT $1,800.00 04/19 DEPOSIT 7,500.00 05101 ACH CREDIT 1,632.91 US TREASURY 312 CIVil SERV F 1057639 W CSF 3121736156MARY J HOUSER 20021156142369 05/01 ACH CREDIT 911.93 US TREASURY 312 CIVil SERV A 11156550 CSA 3121736156MARY J HOUSER 20021156139907 05/01 ACH CREDIT 5.00 US TR EAS U RY 300 SOC S EC 16512774007 SSA 3031036360MARY J HOUSER 20021217992424 05103 ACH CREDIT 185.00 US TREASURY 303 sac SEC 16512774007 SSA 3031036030MARY J HOUSER 20021217912161 05109 INTEREST PAID 6.1Q $12,OQO.98 000 120 0005-98317473173 050 .~ DEPOSITOR'S NAME ON PAGE ONE ALWAYS VERIFY ENTRY BEFORE LEAVING WINDOW THIS BOo!<, MUST BE PRESENTED EVERY TIME MONEY IS DEPOSITED OR WITHDRAWN DO HOl ROll OR FOLD THIS BOOK OA.T~I AMOUNT/GOOE l-~LANCE r TEllER NO. ~ A '"L.'- . ",;t .) .. ... ,t ~,~! L.,"-c. _ . I '-'1 ',.., . -'-'p ".'tt " "" !'- ~ .If 1; ~'l ' .-' , f l ~". "1:1::'0 2 3 4 5 6 7 8 9 10 11 PLEASE INFORM US OF ANY CHANGE OF ADDRESS 12 13 14 15 16 17 18 19 20 21 22 23 Dauphin Deposit Bank and Trust Company SAYINGS DEPARTMENT NOTICE-This bOok should be presented 81 rl1is bank al leasl one'! in each year so lh$\ it may be posTed. the interest enlered t",d 'he bBh"l(~e shown, In Making wiltldrawals, always present your pass-book-- we decline 10 pay unless you do. CODeS: 0 - Depo'" W - Wflhdrawal I _ Inle'"l / COMMONWEAlTH Of PENNSYLVANIA I4fPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EXI11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 001459 KERWIN GREGORY M 4245 ROUTE 209 ELlZABETHVILLE, PA 17023 ACN ASSESSMENT CONTROL NUMBER AMOUNT __~nn_ fold 101 I $4,500.00 ESTATE INFORMATION: SSN: 174-20-5630 I FILE NUMBER: 2102-0466 I DECEDENT NAME: HOUSER MARY J I DATE OF PAYMENT: 07/30/2002 I POSTMARK DATE: 07/29/2002 I COUNTY: CUMBERLAND I DATE OF DEATH: 05/03/2002 I I TOTAL AMOUNT PAID: $4,500.00 REMARKS: CHECK# 1004 INITIALS: AC SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS TAXPAYER " .... 21-2002-446 LAST WILL AND TESTAMENT OF MARY J. HOUSER I I, MARY J. HOUSER, of East Pennsboro Township, Cumberland county, Pennsylvania, declare this to be my Last will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I bequeath all of my tangible personal property to my children, Thomas H. Snyder and Gloria M. Myers. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate as follows: A. I bequeath the'sum of $5,000.00 or 10% of my estate, whichever is less, to each of my grandchildren, Michael Snyder, vicki Myers and Jeffrey Myers, who are living at the '. time of my death. B. I devise and bequeath the remainder of the residue -............, c... 1I....L_h....nL...... '..,,, ha'oCD.5u..~B.vc<Y of my estate unto my childr~n, Thomas H. Snyder and Gloria 1<1. ..rroulfY$AfUW )~10 1,~ U . Page I . ~ \lll'olOLD. SLIIUt Be B...YLEY AfTOI.l,Ity, ...fLAW ,-.__ lIu...I'~""n~...'" .",.. "' . -~~ -----. Myers, or their issue per stirpes. IV - I appoint my son, Thomas H. Snyder, as Executor of this..!llY Last will and Testament. Should my said son fail to qualify or cease to act as such, then I appoint my daughter, Gloria M. Myers, to act in this capacity. Neither of my personal representatives shall be required to post bond in this or any ~ jurisdiction. on IN WITNESS WHEREOF, I . -7 / f2d thlS, the cY~ ayof have hereunto set my hand and seal f/l /1; , 1983. ~~J~df~~ (SEAL) Signed, sealed, published and declared by Mary J. Houser, the Testatrix therein named, on this and one (1) other sheet of paper as and for her Last Will and Testamen:t' in our presence, who, in her presence, at her request ~nd in the presence of each other, have hereunto subscribed our names as attesting witnesses. {.) 7( /(, ->~~ / .) c...-.:.-~" Address . Page 2 ~ ... \ R"'OLD. SLa. &: BAYLEY AT'1UVirrIAT U... .... JI'....._ru.n............ C6~~ONWEALTH OF PENNSYLVANIA) 55. COUNTY OF CUMBERLAND) W~, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last will and that she signed willingly (or willingly directed another to sign for her) and that she executed it as her free will and voluntary aot for the purposes the.rein .' expressed, and that each of the witnesses, in the presence and .. ,~ hearing of the testatrix signed the will as witnesses and that ~ to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. M~<-1--1., ~ ()TYtat'ru {' Witness ~ Subscribed, sworn to and testatrix, and subscribed and nesses, this ..z.4>i:!?- day of acknowledged before me by the swo~ before me by bo);h wIt- ~ , 19)'3 . '. /~j ~ct/~~A " ;Notary Pubhc .. Thelm. s. McC.u,r,.. Nof.r:y Pubr" My Commiuion fxpirtJ July I, 1984 (,mp Hiff, PA (umberflnd (ounty ., ~N. Reference 10: 365050 First Union National Bank Attn: Account Verifications POBox 40028 Roanoke VA 24022-7313 June 5, 2002 KERWIN & KERWIN ATTORNEYS AT LA W 4245 ROUTE 209 ELIZABETHVILLE, PA 17023 SUBJECT: Verification! Confirmation of Account and Balance Information provided for: Customer: MARY J HOUSER (SSN# 174-20-5630) Date of Death: May 3, 2002 DeDosit Account Information Account Type Account Number Date of Death Balance Average Balance'" Date Opened Maturity Dale Interest Accrued yrD Date Rate Interest Interest Paid Closed SA VINGS 3083365962043 $4,198.76 11/1/1979 $043 $1050 LEGAL TITLE MARY J HOUSER '" Due to system limitations, we can only provide a twelve month average balance on depository accounts '" Date of death balance does not include accrued interest. ... If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. ~i([CVV1W2O ( J~/ia Sorrells Servicenter Associate June 5, 2002 (540)56J-7323 Phone Number sss; ag 001032