HomeMy WebLinkAbout02-0488
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of John R. Roland
also known as John R. Rolands
No.
To:
,11-01.- t1tf1
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. 160- 6 6-5 3 9 7
The petition of the undersigned respectfully represents that:
Your petitioner(s), who isAiK: 18 years of age or older, app] 1es
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h lS last family or principal residence at 4 Courtney Drive, Shippensburq 13 <:r~o.) 1\
(list street, number and municipality)
Decendent, then 31 years of age, died June 27, 2001 ,:ll!l'::
at Chambersburq Hospital, Chambersburq, Pennsylvania
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ 0 . 00
(If not domiciled in Pa.) Personal property in Pennsylvania $ 0 . 00
(If not domiciled in Pa.) Personal property in County $ 0 . 00
Value of real estate in Pennsylvania $ 128 , 000 . 00
situated as follows: lying and being situate in the Borough of
Shippensburg. Cumberland County. Pennsylvania and havinq a
street address of 4 Courtney Drive. Shippensburg. PA 17257
Petitioner_ after a proper search h<l.S.- ascertained that decedent left no will and was survived by
the following spouse~it~and heirs:
Name Relationship Residence
Abbv P. Roland Spouse Shippensburq, PA
Shawn Roland Son Unknown
Jena Roland - Dauqhter Unknown
THEREFORE, petitioner(x) respectfully request(s) the grant of letters of administration III the
appropriate form to the undersigned.
I? ~::.1~f:I
~~ .
~g 4 Courtney Dr1ve
~:E Shippensburq, PA 17257
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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The petitioner(x) 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(x) and that as personal
representative(x) of the above decedent petitioner(x) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed f I&t I. /l.~
before me this 17th day of Abby F. Roland ;.:"
M~ 2002 7~' mJ ::c '
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MARY . LEWIS / - Register
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No.
21-2002-488
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Estate of John R. Roland, a/k/a John R.
Rolands
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW May 17th ,200 2 ~8_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Abby F. Roland
is/Xlle entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Abby F. Roland
in the estate of John R. Roland. a/k/a John R. Rolands
~"~'w~pt~
MARY C. LEWIS ~
FEES
Letters of Administration
Short Certificates(3 ) . . . . . . . . . .
Renunciation ................
JCP
$ 235.00
$ 9.00
$
$ 5.00
TOTAL _ $ 249.00
Filed .... ~~'(. p.~J:1. . . .~99~fg,X~_.
Robert C. Schollaert #10196
ATTORNEY (Sup. Ct. J.D. No.)
82 West Queen Street
Chambersburg. FA 17201
ADDRESS
717/264-5194
PHONE
CALL EXECUTRIX WHEN LETTERS ARE IXNE
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
John R. Roland, a/k/a John R. Rolands
Date of Death:
06/27/2001
Will No.
2002-00488
Admin. No.
21-02-0488
To the Register:
I certify that notice of (beneficial interest) 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 June 6, 2002
Name
Address
Abby P. Roland, 138 Beacon Drive, Harrisburg, PA 17112
Shawn Roland, 740 Walnut Drive South, Mansfield, OH 44904
.
Jena Roland, 740 Walnut Drive South, Mansfield, OH 44904
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except no exceptions
)~ - .y' cP?
June 26, 2002
Register Of Wills:
This is a Claim on Estate of John Roland #2407797
On June 2, 2000 I loaned John Roland Five thousand nine hundred sixty six dollars and forty-six cents,
($5,966.46). This check was paid to American General Financial Group, as payment in full for loan
#13525781 in the name of John Roland.
On October 12,2000 I loaned John Roland Three thousand dollars, ($3000.00), for a total of Eight thousand
nine hundred sixty six dollars and forty-six cents. ($8,966.46). We had an oral agreement that repayment of
these loans would begin approximately a year after settlement on his new home. There were no structured
payments set up and this was a zero interest loan.
The only payment received was Thirteen Hundred and sixty dollars ($1360.00) on May 27, 2002, leaving a
balance of Seven thousand six hundred six dollars and forty-six cents. ($7,606.46).
Sincerely,
1Li&~~~'"
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OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
/?-6~-/S
REV -1500 EX ... (6-00)
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FILE NUMBER
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT,280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Roland John R.
DATE OF DEATH (MM-DO-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
160-66-5397
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
21-02-0488
NUMBER
DATE OF BIRTH (MM-DD- YEAR)
REGISTER OF WILLS
SOCIAL SECURJTY NUMBER
07 10/1969
LAST,FIRS ,ANDMfDOLEINITIAL
Roland, Abb P.
X 1. Original Return
4. limited Estate
6. Decedent Died Testate
o
3 date of death
. Remainder Return prior to 12:-13-82)
5. federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
2.
4a.
7.
Supplemental Return
Future Interest CompromJse(date of death after 12-12-82)
Decedent Maintained a Li...lng Trust
(Attach copy of Will)
o 9. litigation Proceeds Received
(Attach copy of Trust)
010. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113{A)
(date of death between 12-31-91 and 1-1-95) (AttaCh Sch OJ
THIS SECTtoH MUST BE COMPLETED; ALL CORRESPONDENCE & ClltlFIDIiNTIAL TAX INFOflMA liON SHOULD BE DIRECTED lO) '. .
NAME COMPLETE MAiliNG ADDRESS
Robert C. Schollaert
fIRM NAME(lf Applicable)
Black and Davison
TELE~HONE NUMBER
82 \lest Queen
Chambers burg ,
Street
PA 17201
R
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C
A
P
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A
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,. Real Eslale (Schedule A) (1) 125,000.00
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation, Partnership or (3) None
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule oj (4) None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) None
(Schedule E)
6. Jointly Owned Property (Schedule F) (6) None
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 27,238.82
10. Debts of Decedent. Mortgage Liabilnies, & Liens (Schedule!) (10) 107,168.39
11. Total Deductions (total Lines 9 & 10) (11)
12. Net Value of Estate (Line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/See 9113 Trusts for wrnch an election to tax has not been (13)
made (Schedule J)
14. Net Value Subjeello Tax (Line 12 minus Line 13) (14)
(9,407.21)
OfFICIAL USE ONLY
125,000.00
134,407.21
(9,407.21)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
0.00 X .0 0 (15)
0.00 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
0.00
0.00
0.00
0.00
0.00
RllFUND OF AN llWl:llPAVIilENT .
ALL QUl;$ffi;\'N$l:lliftEvEiI$E $illS AND TQ RECHECK MATH < <'
~:::.t,;::l ?'H:'f';,:;~i];i~t;t
Copyright (c) 2000 form software only T he Lackner Group, Inc.
Form REV-1500 EX (Re.... 6.00)
. &. .~
Decedent's Complete Address:
STREET ADDRESS
4 Courtney Drive
CITY I STATE I ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + B + C) (2)
0.00
3. fnterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
S. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line S + SA This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0,00
0,00
0,00
0.00
0,00
:ijJWW1Jj])ii
i:imm':'j:"]jJ;ij:..li:,::..;:mj.:::11l;WWWWij]jjIJIIWIJJIJiliiWiiliJiliJlliiiliillllllimmi!i!liiii!:llli!!!iiii!!!i!!ilil:il:I::iii:mmmmmmmmmmm:mlimil::::::::ml:ii:.i:;'::i:!!;.:mmmmmml..1..mmm...l.
mm.mmmmmim:'mmm.m:.:.!!.!mi:..i.::.:::'!!:.';!:..;UH'iU
PLEASE ANSWER THE FOLLOWING GUESTiONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
,. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ~ ;x:
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 fife of either payments, benefits or care? .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . 0 [KJ
3. Did decedent own an "jn trust for" or payable upon death bank account or security at his
or her death? 0 [!J
4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property
which contains a beneficiary designation? 0 [!)
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perJury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It Is true.
correct ana complete. Declaration of preparer other than the personal representatl...e Is based on all Information of which preparer has any knowledge.
SIGNATUR OF PERf 0 EqP vNSWttPIBLE FOR FlUNG RETURN Abby P. Roland
138 Beacon Drive
- --Ha~;'-i~b;'-':-~- -pi" - --1711"2 - -- - -- - -- - -- - -- - -- - -- --.
PREPARER OTHER THAN REPRESENTATIVE Black and Davison
_ _ _8.~ _ !I-,:~!_ _qt:~!'_~ _ ~~_:r:~~~... _ _ _. _ _... _. _. _ _..,.. _ _.
Charnbersbur ,PA 17201
DATE
~.~2"O;;L,
DATE
~-~'b. -0;<'
For dates of death 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.5. 9116 (aJ (1.1) Iil).
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) {in]. The statute does not exempt a 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 of death on or after July 1. 2000:
The tax 'ate 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"1.. (72 P.S. 9116 (a) (1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. 9116{1.2)
[72 P.S. 9116(aXll).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. 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 (e) 2000 farm software only The Lackner Group, (nc.
Form REV-1500 EX (Re.... 6-(0)
"
REV-1502 EX + (1-97)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE r/VI. RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John R. Roland SS# 160-66-5397 06/27/2001 21-02-0488
All real property owned solely or as a tenant in common must be reported at fair market Yalue. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledae of the relevant facts. Real property which is jointly-owned with riaht of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
DESCRIPTION
NUMBER OF DEATH
1 Real estate lying and being situate in the Borough of 125,000.00
Shippensburg, Cumberland County, Pennsylvania and having a street
address of 4 Courtney Drive, Shippensburg, PA - sale price
TOTAL (Also enter on line 1. Recapitulation) $ 125,000.00
(If more space is needed, insert additional sheets of the same size)
Copyrlght(c) 1996 form softwar~only CPSystems, Inc. Form REV... 1502 EX (Rev. 1-97)
.~ .r.
REV.1511 EX. (1.97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
John R. Roland
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
55!1 160-66-5397
06/27/2001
FILE NUMBER
21-02-0488
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES,
Lanterman and Allen Funeral Home, Inc.
2,405.00
funeral expense
2
The Train Restaurant - funeral luncheon
135.00
1.
ADMINISTRATIVE COSTS,
Personal Representative's Commissions
Name of Personal Representative(s) Abby P. Roland
Social Security Number(s) / EIN Number 01 Personal Representative(s)
Street Address 138 Beacon Dr i ve
City Harrisburg State PA Zip 17112
5,850.00
Year(s} Commission Paid:
2002
2.
3.
Attorney's Fees Black and Davison
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Abby P. Roland
Street Address 4 Courtney Dr i ve
City Shippensburg State PA Zip 17257
Relationship of Claimant to Decedent Spouse
1,093.75
3,500.00
4.
Register of Wills
249.00
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Accubanc - real estate document fee
300.00
2
Afterlife - cleaning (decedent died at home as a result of
self-inflicted gun shot wound)
750.00
3
reimbursement for travel expense advanced
24.82
Black and Davison
4
75.00
Black and Davison
preparation of deed
5
11.70
Black and Davison
overnight mail fee
6
75.00
Cumberland Law Journal - legal notice
Total of Continuation Schedule(s)
12,769.55
TOTAL (Also enter on line 9, Recapitulation) $ 27,238.82
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form $oftwareonly CPSystems, Inc. Form REV-1511 EX (Rev. 1.97)
.~ ,
Estate of: John R. Roland
Soc See #: 160-66-5397
Date of Death: 06/27/2001
Item
fI
Continuation of Schedule H-B7
(Other Administrative Costs)
Description
Amount
7
Cumberland County Register of Wills
filing fee
10.00
8
Cumberland County Recorder of Deeds
piece
recording satisfaction
14.00
9
Cumberland County Recorder of Deeds - real estate transfer tax
1,250.00
10
ERA-NRT, Inc. - real estate transaction fee
100.00
11
ERNA-NRT, Inc. - commission on sale of real estate
7,239.00
12
Lereta Corporation Tax Service - real estate tax service fee
77 .00
13
Notary fee
3.00
14
Seller contribution to closing costs
3,973.00
15
The Sentinel - legal notice
103.55
12,769.55
. ,
REV.1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John R. Roland
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
55!! 160-66-5397
06/27/2001
FILE NUMBER
21-02-0488
Include unreimbursed medical expenses.
ITEM
NUMBER
1
NCM Mortgage #006256-6
DESCRIPTION
mortgage payoff
AMOUNT
97,746.13
2
NCM Mortgage #006256-6
April 2002
mortgage payments July 2001 through
9,360.00
3
Tiger Direct and PES Magazine - balance due on account
62.26
TOTAL (Also enteron line 10. Recapitulation) S 107,168.39
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
.. ,
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John R. Roland
SSIf 160-66-5397
06/27/2001
FILE NUMBER
21.02-0488
RELA r10NSHIP TO DECEDENT AMOUN I OR SHARE
Do Not List Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
t. TAXABLE DISTRIBUTIONS flnclude Qutrlghtspousal distributions, and
transfers under Sec. 91 16(a}(1.2)]
1
Spouse
Abby P. Roland
138 Beacon Drive
Harrisburg, PA 17112
2
Son
Shawn Roland
740 Walnut Drive South
Mansfield, OH 44904
3
Daughter
Jena Roland
740 Walnut Drive South
Mansfield, OH 44904
1/2 share of
residuary
estate
1/4 share of
res iduary
estate
1/4 share of
res iduary
estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS.
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Q. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Copyrlght(c) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev, 9-00)
A. Settlement Statement
U.S. Department of HOU8IngA.,.
and Urban Development ,.....~
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OMB No. 2502-0265
B.
2.0 FmHA
3.0 Conv. Unins.File Number
RAGNO
loan Number
00822547
Mortgage Insurance Case Number
441-6906234 703
4.
I. SETTLEMENT DATE: May 21. 2002
J. SUMMARY OF BORROWER'S TRANSACTION
100..GBOSS.AMOUNT'DUE FflQM.BORFlOWER;':"
K. SUMMARY OF SELLER'S TRANSACTION
OO,'.GROSSAMOUNTDiJEroSELt;ER:
lOr. t'onll'tCI: sal.lI. "PJltt.
'. 125., 000".0.:0.: ~,":'~.,il.<i.:"'''l>'l'.:.. .
'.: 125,000,0:0
ADJUSTMENTS FOR ITEMS PAID BY SEt;LER IN ADVANCE:
: .ort...... .
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE:
~~Of;.,:~itYltcQ:~h: t~":.;.: ,."
107. County taxu
.:. :::"tOe:,.A......millri1S: .
171.36
409.
120,27
109.
<,"~O'+.'
111.
"'11~:
Sch.
120.27
.
. ..
.. ... ..J...... ....
. .:.",". " <.,,,.:,.,
411.
.....:.:.<:.,....: ":.;"::.hi.:">',.::'
120. GROSS AMOUNT DUE FROM BORROWER:
200: AMOUNTS PAID.BY OR IN....BEHAlF OF'BORROWER:
131,699.90
420. GROSS AMOUNT DUE TO SELLER:
....: 500..: 'SEDUCTlONS: lNAMOUNT DUE TO SELLER:
125,291.63
201. DeposIt or earnest money
~2,; ~ti:el~A1 amcu'nl -i:li ..n~ 'l/ia~t"l. . .' .'
9,419,62
97,746.13
205.
208., .
207.
20&.. "">,." .
"'..
210. City/town laxelll
"2:'1:t..:county (a)(ell
212, AU&lIIIIImttnts
510. City/town taxel
,:...$,,";;-\t>>M:J;~~".,::: : :.
512. "lIellllmentl
to
'::::.to: .'
to
. tJ~:L.'.
,,"-
:, :.,:~,.s:~/ ,.:.:'
. . . .
. ':',:,< (:',:.,:.':$ia('),','"
21f1.
. ..tio,
220. TOTAL PAID BY/FOR
BORROWER:
300';::' 'ASf\: 'AT.'. am.. .
~ n:4Ue fr ler r HIl@
301. less amount 'aldb Ifor bOrrower Oine.22.0l.
303. CASH (0FROM) ( 0 TO) BORROWER:
, '. '.'51g,,:,,',"
TOTAL REDUCTIONS
IN AMOUNT DUE SELLER:
'eOQ:i:.D.ASfhAT..SEn'lieMeNT'TIi:IIF . ''5ELI.ERi:' : : . '. '..
131,699.90 O. Gr 55 mount du to eller 11n 420 125,291.63
]28992: 00 602. less redutt'ns In arot. due sel1ermne 520 1:16 138..75
2,707.90 603. CASH ( @TO) (D FROM) SELLER: 9,152.88
116,138.75
HUD-1 (3-86) - RESPA, HB 4305.2
PAGE 1
,
H~~1. .rR~V. 3/88)
LiL'..'"
700. TOTAL SALES/BROKER'S COMMISSION
. .SETTLEMENT>CHARGES/."....
OMS No. 2502.0265
BASED ON PRICE
.120,650.00 @6.000... 7,239.00
PAID FROM
BORROWER'S
FUNDS
AT
SETTLEMENT
PAID FROM
SELLER'S
FUNDS
AT
SETTLEMENT
7.'23';,.0.
DIVISION OF COMMISSION (LINE 7(0) AS FOLLOWS:
7" '7 23 ..; 00' .... .... .RA.NRT ...lnc,; .
702. to
. .. ...
70 ":"ci:i:m:mll"lon: ~ki :at. '''lItttement... ..
704.
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN:
1I0"i.: &o,,",oifmlllt).;,:.:t:"e:'" ::M;:'
80. oan discount %
...0' .:.:. . 'tll.l~al :te:.'100,'.' . :Jonri::A'UsMrmari:"::,' "'.
!0.4 edit re ort 10: SMR Info 1
.: ,.'.~ ...... "fetlcid'..
. '325.00
10.00
... .
.. ..... ..... .....
..... ......
eoe Mort a . Insurance a
~.. :n", lie .
... Corrrnitment Fee. AccuBanc
. . p' .;' fe . . 'A n
., Flood Cert. Fee - FAFDS Inc.
,"'; . ,Tax"Serv ce Fee" 'Lereta. Cor ratiOO lax. $er;.'
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE:
'il01>tnt"ers.t, itom . .5. 2:1;-, :.Q.:;:r. .:.::~ti ::" '. :':6: :;. '1;:=-".0=2:.::' ........: 23,: >:78i ": ," ....da..: .'
IIcatlon tee to
0' ..
".:,.
. 261..8 ."
902. Mort a II InII ranee remlum or m s. to
go:t..l'tatud "l"n'll'Vttnee.... ~emi\t~: ~ar"" . .: ...: ':.:' :,? .1:':':=: .::" ri:;::'lD::- ::.. ::At6r.d..: .
90'4. Flood in'llurance remlum for rs. to
......, .'.MIf/PMI.Pr.eIlL ..
1QOO. RESERVES DEPOSITED WITH LENDER:
60:~;'.f1i:iia.td .IMutanc4f'. '. :'. "'3:: . >:.:.::.: :mQ":ntn"'@'::$: :. :.:" . ".
:25$'/{)OP'~'O';.c.. "
1 ~.
0" .,' ."taXI':.'
months@ $
. :.:.,: ~.:. .-.;;:jjrjth.::$ '$:'.. .:'"
4 months @ $
:"':'nii:liittjs::.:@',*.'
monlhs@ ..
:.2 :: .:: ~ ":::",brjih~":@ :.$ :'.:
monlhs @ $
screw 'Ad ustment .
.. "2l';2-5',p.i.,...i>lh""...
per month
:.',. : : ::. \::::':'p,,('~.ht~.:'. .' .... '.
23.75 p.r month
'.. . .:: .:('::.::P.~.)#~Uf :': ,.... :
.. 63
10'0'2. Mort a e Inlurance
10'0'4. Count ro eri ta)(1II
1 0111"...& m~li:ts
laae Fl od lnlurance
I 07;,'" h l'1 x' .
10'0'8.
'.. A r ate.countln
1100. TITLE CHARGES:
psr month
:.P.f~~.t>lIjti:::.::::.:'" .
per month
'10'1. Ssttlemlnt or clalln lee to
',O'Z: Ab.,rl6t ':ar Inl... diatetf 10 "
110'3. Tille examln.atlon to'
'~:04.:.rW. .lti~ltra' ....;,:..'tjirii:htr:to: .
1105. Oocumenl re aratlan to
J: .O~.: NOUf .lees.::to: :.
'10'7. Attorney'l leel 10
Black and Davison
75.00
'3.00
111 'w et~'.
1111.
l1t~. '.'
1113.
'F e..
Cls .Ser.Let.Fee - RCS A ent for FNTIC
l201~:1\='co~din :Ilt..:.. :':'
120'2. cn count ta lIam 'II:
1203. :si..'I. fa nam ::: :
12'4. Record; n
12O:S~ :.:'
1300. ADDITIONAL SETTLEMENT CHARGES:
1200. GOVERNMENT RECORDING AND TRANSFER CHARGE
. .'0..." '.. '.2S';${P'.""i;{' . .....".
'1 25 .00 . Mo, . ,
"ri..~:' ..j{'2S0';O'O """'""6>;'..,'
Fee - Mt . Satisfaction Piece
'3950
.:::.... .:,,:.... :.'
.. ........
:.'A:Relell.tii:i..:
Oeed
1
. 65< 00
250.00
1 250.00
14.00
l30t:::Stlf\t-l 'io. .
130'2 Pest In'll ection to' Ke stone Termite & P
.~. Tra . tl fiFe. RA~N n
, '4. Fi na 1 Sewer B; 11 - CFJMA
iF; i'm. r f
I .. Overn; ht Mall Fee. Black
" .,.,'. ". :,R ;mb. 'f'r' A v .or:!>r'
Control Serv; s
2 .00
',:0 '.'0'0' ,.
10.00
44.94
EMENT
6,408.27
9,419.62
I hl"e car.tully reviewed thl HUO-l Setulmlnl Stallment and '0 the bl.t of m)' knowledg. and bln." It I, . true and accurate Itlllmlnt 01 all recllpt. and dllburumenta mad.
on my account by me I thl., nuctlon, I furlher C.-Illy thai I have r.celved .a copy of thl HUD-1 Sattlemlnl Sllt'mllll.
Est. John R. ROland. Rolands
/ / SeUer or
Oate: 5 21 02 Agent:
Oale:
5/21/02
Barrower:
Borrower:
Oale:
Sellar or
Agent:
Oale:
The HUo..1 Settllment Stat.ment which I haye preparad II .. trUI and accurat. account 01 thla tranucllon. I h..... cauud or wIU cau.. the lund. to be dlaburud in accordance
wilhthlluatemlnl. ~
Dot" S,"l,m,,' _g"" r ~ / //1 DOl" 5/21/02
Ro~rt . SC~llae~~
WARNING: It I, a crime to knowingly make lain atalementl 10 the United St.atn on thll ar any ather '11lmllar form, Penallles upon convlctlan can Include .a fm, and Imprison.
mint. For detail. sn: Title 18 U.S. Code Secllan 10'0'1 and S.ctlon 10'10'.
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'v BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
'11
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-07-2002
ROLAND
06-27-2001
21 02-0488
CUMBERLAND
101
ROBERT C SCHOLLAERT
BLACK & DAVISON
82 W QUEEN ST
CHAMBERSBURG PA 17201
*'
REY-1547 EX AFP (DI-02)
JOHN
R
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=is4-j-Eif-AFP--foFo2Y-Ncii"-icE--OF-YNHERYrAtfcrTAinrpPRA-isEifENT~--AL.i-OWAifcE-O-R------------ -- - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ROLAND JOHN R FILE NO. 21 02-0488 ACN 101 DATE 10-07-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks end Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgeges/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
125,000.00
.00
.00
.00
.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. 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)
llO)
27,238.82
107.168.39
Ill)
ll2)
(13)
(14)
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. 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
NOTE: To insure proper
credit to your account~
subllit the upper portion
of this forll with your
tax paYllent.
125,000.00
134.4D771
9,407.21-
.00
9,407.21-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
TAX CREDITS:
,"........, .+, AHoUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .OD
INTEREST AND PEN. .00
TOTAL DUE .00
. DO X DO =
. DO X 045 =
.00x 12 =
. DO X 15 =
(19)=
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF ~S FoRH FOR INSTRUCTIONS.)
Cv
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
John R. Roland, a/k/a John R. Rolands
Date of Death:
06/27/2001
Will No.
2002-00488
Admin. No.
21-02-0488
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? Yes No X
b. The separate Orphans' Cuurt No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No X
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 10/10/02 17 /) ~~
hi~al2e
Robert C. Schollaert
Name (Please type or print)
82 West Queen Street
Chambersburg. PA 17201
Address
(717) 264-5194
Tel. No.
Capacity:
Personal Representative
X
Counsel for personal
representative
(MAH:rmf/AM3)