HomeMy WebLinkAbout02-0704PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Jess~.~ Mae Prowell
also known as Jesse Mae Prowe
Jessie M. Prowell
Deceased.
Social Security No. 2 0 3 -1 0- 2 7 4 2
lvo. Z I - ~ 2 ' ~'10~
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s~, who islare 18 years of age or older an the execut nr named
in the last will of the above decedent, dated June 1 3 ~ ~ 2 0 0 0
~~~~~X
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Cumberland
Decendent was domiciled at death in County, Pennsylvania, with
her last family or principal residence at Fourth Street, New Cumberland ~~ ~ ~? r/
(list street, number and muncipality)
D ce de t, the $ 6 ears of ag did Ju 1 y 2 9 2 0 0 2
at ~1 ~ ]4our~' tF-~r~et~, New ~'umeber an , um er an oun y, ~~
Except as follows, decedent dial not marry, was not divorced and did not have a child born or adopted
after execution of the will offered fc;r probate; was not the victim of a killing and was never adjudicated
incompetent: nosie
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 2 , 0 0 0.0 0
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) .Personal property in County $
Value of real estate in Pennsylvania $ 9 0 , 0 0 0. 0 0
situated as follows: 413 Fourth Street, New Cumberland,
Cumberland County, PA
WHEREFORE, petitioner(sj respectfully request(s) the probate of the last will a~ctx~s)
presented herewith and the grant of letters testamentary
(testamentazy; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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-Je~~re Lynn Prowell
<`-5~T3~ Avenue
Men o Par CA
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ s3
COUNTY OF _ ~•CTMRFRLAND
The petitioner( abo~~e Warned s-wear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of tte kT.owledge and belief of petitioner(s~ and that as personal represen-
tative(l~ of the above decedent petitioner( will well and_ truly administer the estate cording to law.
Sworn to or affirmed and subscribed `~-~~.~~~ ~ ~ ~
before me this 7th day of °p~
AUGUST 2002 _ x}~xx
r
MARY LEWIS egister
Jeffrey Lynn Prowell
A
~.
tip
No. 2, ~- O a - 104
Estate Of JESSTE MAE PROGJET~ A K A JESSE MAE PROWET,T,__~ D@C8AS8(~
A.K.A. JESSTE M PROWELL
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW AUGUST 7, 2002 ~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 06-13-2000
described therein be admitted to probate and filed of record as the last will of
JESSTE N1AE PROWEI~ A.K.A. JESSE MAE PROWELZ A.K.A. JESSTE M PROWFJ~ ;
and Letters TESTAMENTARY
are hereby granted to JEFFREY LYNN PROWEI~
FEES
Probate, Letters, Etc.......... $ 200.00
Short Certificates( Z) .......... $ h _ (1fl
x~~~x. extra .~ac{es . $ 12.00
~c~ $ 5.00
TOTAL $ 223.00
Filed ....8-.72002 .......................
mailed to atty 8-7-2002
Register of W ~"^^N
Richard L. Placey 07232
3b31 NA- FT'~L~S~tI'2I~No.)
Harrisburg, PA 17110-1533
<anbxESs
(717) 236-9577
PHONE
~=r ~: - -:_ ,~ '~,e ±n-ormatlon #~ere given is correctly copied from an cariginal certiticare of death duly filed with me as
L,tl„{] ZI L,I.ir~(, Iht~o ,final certificate will be forwarded. to the Stare ti'irll Records Office for permanent filing.
`~IVARPdING: It is illegal to duplicate this copy by photostat or photograph.
F~; Hof this ~~r~ifcate, 52.00
84~~327
~~~.
144 Rev. ,/91
Local Registrar ~~(~
r~UU ~ 3 2002
r~at~
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner}
NAME OF DECEDENT (f ust, M,dcke, Last) SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Month. Day. Year)
,. Jesse Mae Prowell x. Female ,. 203-10-2742 ,. July 29, 2002
AGE (Last Binnday) UNDER, YEAR UNDER , DAV GATE OF BIRTH BIRTHPLACE lGIy and PLACE OF DEATH,O~,e.:M only one - ee u,uiuaions ou ulhar vdel
Momhs Days Hours Minutes IMallh. Oay, Yearl Smle orFae,gnCwnny) HOSPITAL: OTHER.
~-I
Sept. 13, 191 Unknown Inpatwrn^ EWOutpahent ^ DOA ^ FN/orn ~ ^ Residence (~Spd rayllJ
86 Y
rs.
a. 7. e..
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.
CEDEN7 OF HISPANIC ORIOIN7 RACE -American intlian, Black, WMIe, etc.
O
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' COUNTY OF DEATH CfT BOR TWP OF DEATH FACILITY NAME dt not nulnunwr, q,~e sweet and numheil WAS
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No Y-J Yes L~ll yes, Specify DUDen, ISpyc
Cumberland New Cumberland 413 4th Street Merican.PuenoRican,el=. White
8b. M. !tl. 9. 10.
DECEDENT'S USVAL OCCUPATION KINDOF BUSINESS/INDUSTRY WAS DECEDENT EVERIN DECEDENT'S EDUCATION MARITAL STATUS-Married SURVIVING SPOUSE
groemaNen name}
01 wsa
Widowed
an and Never Married
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{Give kinoWwaF done dunr~q most U. S. ARMED FORI~,C~~7E7S? 5
^ No pLJ ElemeraarylSecorMary College Divorced ISpaLdYl
of working tile; do rat use letrcad) Ye
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`°'9'2 (I4°`5" Widowed
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Home
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DECEDENT'S MAILING ADDRESS (Stteea, CnyrTuwn, Stale, Zip Cude1 DECEDENT'S
decetlentlwedm ,wp.
pA Did 77uL~ Yec
413 Fourth Street .
ACTUAL ,7a. Slate
RESIDENCE decedem
PA 17070
New Cumberland (See mS!(UCianS live In a
arntrlyrsay, Cumberland ,.wnshm? y ND decedentn~ed New Cumberland
ci
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16. ry
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`) wnNn actual kmns of
17D. Count ,7d.
FATHER'S NAME iFCSI. Middle. Lase MOTHER'S NAME (Fusl, MWdb. Marttyn Suniemel
„_ Unknown ,s, Unknown
'
S MAILING ADDRESS {SUeet GtylTuwn Stale T~41Cafe)
INFORMANT'S NAME (Typy+Pnnll INFORMANT
CA 94025
Menlo Park
573 6th Avenue
,
,
Jeffre L. Prowell ,,
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bment DATE OF DISPOSITION PLACE OF DISPOSITIONName of Cemetery, Gematory LOCATION ~CnyfTOwn, State, Zip Code ,
N
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METHOD OF DISPOSIT
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DDnation^ 01her(spetatri ^ august 5, 2002 tolling Green Mem,r? Parkx~dCamp Hill, PA 17011
21a. 2 b. 1c.
' SIG U OF FUNERAL E ICE LICENS E ERSON ACTING SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY
F0 012342-L done&MurrayFH408 3rd St New Cumberland7,
32b,
.
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e items 23ec oMy when cenirying Tot krawledgn, death occured at the time, dale end place stated. LICENSE NUMBER DATE SIGNED
' fish fie not available al lirM d tleelh to IS Iur Itle) (Month, Uay. Year)
i
, cerDry cause of deem.
23a. x3h. x3c.
AD (MOnRI, CMy. Year) WAS CASE REFER
DATE PRONOUNCED DE
' Items 24-xe must be complelrM Dy TIME GF DEATH A rX RED SO MEDIC LEXAMINER/CORONER7
^
,
n
person who poraunces death. p J ll y 2 7, 2 ~~ 2 xg
y
8:00 P Yes No
M. xs.
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27. PART I: Eller the diseases, inlunes or compnca,ans whin causetl lne death. Oo not solar the mode of dying, such as cartliac or respnatory arrest, shock or hash taiWre. ~ Appro>;Imate
i imervat between PART 11: Other signdicant coraftwns connibubng to death, but
not resulting in the un0erlyin9 cause given m PART I.
Lis, only one cause on each hoe.
~ onset and death
IMMEDIATE CAUSE IF~nal
diseases<abltwn Occlusive Coronary Artery Disease
i
COPD
resulang u, death)-- a.
OUE TO (OR AS A CONSEQUENCE Off: ~
I
Saglwntialy het condaans D.
0 any, leading to Immediate DUE TO IOR AS A CONSEQUENCE OF): ~
cause. Enter UNDERLYING
CAUSE (Disease a uNury c.
teal inmates events DUE TO (GR AS A CONSEQUENCE OF): ~
resunmg in deaihl LAST t
d. _ _ _ ___ '_ __ _-
_ ~
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURX AT WORK? DESCRIBE t10W INJURY OCCURRED.
PERFORMED? AVAILABLE PRIOR TD (MOnlh. Uay. Yval)
COMPLETION OF CAUSE ~
^ Yes L
; NoU
OF DEATH? Homaide
NaNraf .
r ,
Accident ^ PerMinglnvesugalion U
30a.
30bi _ M.
70c.
Sod. _
Yas ^ No ~ Yes ^ No ^ __
PLACE OF INJURY -At name, farm, sireel factory, ultw~e LOCATION ISV eel. Cny/luwn, Stale)
SUicidB ^ Could no, De determined ^ buik,mg, etc. l'~t'eL~lY1
2M. xeD. xe. I
CERTIFIER IChack cxrty ore) SICiNATUHE -E I
'CERTIFYING PHY9IGAN lVhyscun cyirdymg cause ul deagr why„ ananer pfry,wiyu has tua wuncec5 ileum anu com(xeled Item 1J)
L
1 C O r One T
.
To the best of mY knawNdge, deain occurted due w me aaues(s) and msnror sa etaced .....................................................
LIC SE NUMBEfi DATE SIGNED jMUMir Day. yeai)
'PRONOUNCING AND CERTIFYING PNYSICIAN(Pnysroian bum unn~arncing dydlh ano ceroly,ng to raos+td deyih)
~ ~ 31G 31tl August 1, 2002
To Ina bast of mY knowledge, seam occurred n the time, Nts, and pWCe, and due to tM cause(s) end manner as sated ...................... _ .. ______-~_ _- ----
NAME AND ADDRESS OF PEHSDN WHO COMPLETED CAUSE OF DEATH
otnrn zn Typa or PrlM Michael L. Norris, Coroner
'MEDICAL EXAMINERlCORONER
In my oplmon, death occurred at the time, sat., and place, arW dd. m the teasels) a~ -
on Ina Wale of eseminatbn and/or Imsetlgatfon
63 7 5 Ba s ehor a Road , Suite 1
,
mennac as eta,ed ......................................................................... ........ ~ Mechanicsburg, Pa. 17050
tta. 3x.
REGISTRAR'S SIGNATURE AND NUMBER ~r _ -- ,,.y ~q ~ ~ 2 DATE FILED InMu{nlJt~ De , Yuur)
3.
LAST WILL AND TESTAMENT
OF
JESSIE MAE PROWELL
21-02-704
I, JESSIE MAE PROWELL, of New Cumberland, Commonwealth of Pennsylvania,
do hereby make, publish and declare this to be my Last Will and Testament, revoking any and
all previous Wills and Codicils, and hereby will and dispose of all the property which I own at
my death in the following manner:
I.
I nominate, constitute and appoint my son, JEFFREY LYNN PROWELL, as
the Executor of this my Last Will and Testament. Should he be unwilling or unable to serve
for any reason, then I nominate, constitute and appoint my grandson, ZACHARIAH
ROBERT PROWELL, as successor Executor of this my Last Will and Testament.
II.
I direct that all my just debts and funeral expenses be paid out of my estate as soon as
practicable after my death.
1
III.
I give, devise and bequeath all my household goods and personal effects to my son,
JEFFREY LYNN PROWELL.
IV.
All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, I give, devise and bequeath to my son JEFFREY LYNN PROWELL.
V.
Should my son, JEFFREY LYNN PROWELL, predecease me, or survive me by a
period of less than thirty (30) days, my entire estate shall go to my grandson, ZACHARIAH
ROBERT PROWELL.
VI.
All gifts of any kind herein made shall be delivered directly to the beneficiaries free
from their control, debts, contracts and engagements, and such gifts shall not be subject to the
assignment or anticipation or pledge by them, or to execution, attachment, or any other
process for the enforcement of judgments or claims of any sort against them.
VII.
All inheritance, estate, succession or transfer taxes, whether State, Federal or
otherwise, or any other tax in the nature thereof, which may be payable by reason of my
death, shall not be apportioned but shall be paid, together with any interest or penalties, out of
the principal of my residuary estate as if such taxes were administration expenses. I further
authorize my Executor to prepay taxes on future and remainder interests if deemed advisable.
VIII.
My Executor, his successor, or any other fiduciary named, constituted or appointed in
this my Will or during the administration of my estate, shall be excused from posting bond in
all jurisdictions regardless of any law or rule of court to the contrary.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ , ~~` day of
~.,~ , 2000, to this My Last Will and Testament.
~Z ~ i~~ ~ (SEAL)
SIE MAE PROWELL
3
Signed, sealed, published and declared by the above-named JESSIE MAE PROWELL,
as and for said person's Will in the presence of us and each of us, who, at said person's
request, in said person's presence and in the presence of each other, have hereunto subscribed
our names as witnesses thereto the day and year last above written.
~ G-~Q ~a, I, , `P~..
Address
Address
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, JESSIE MAE PROWELL,~.~~~~~,.~c,.x,\~~ and
,~~~ ~L . ~..~ \~~a\ ~ ~1 ,the Maker of this Will and the witnesses, respectively, whose
names are signed to the foregoing instrument, being duly qualified according to law, do depose
and say that we were present and saw the Maker sign and execute the instrument as her Last
Will and Testament; that she signed willingly and that she executed it as her free and voluntary
act for the purposes therein expressed; that each of us in the hearing and sight of the Maker
signed the Will as witnesses; and that to the best of our knowledge the Maker was at that time
eighteen {18) or more years of age, of sound mind, and under no constraint or undue
influence.
~~~
~ ~_
Cam. % _~,-~cr-~-~~
l~ SSIE MAE PROWELL
4
SUBSCRIBED, sworn to and acknowledged before me by JESSIE MAE PROWELL, the
aker, and sub(~ribed and sworn to before me by ~~'C~~-~ ~~~ ~-~~,~ _, and
~~ C ~e_.~~~ l'c..a1~~i ,witnesses, this '~ day of ~-~-,~r~'t , 2044•
Notary Public
~Seai j Notarial seat ary _
(`,pttSt3l~C ~4. Mar~i~~a iar-~1 tAUti4y
Na{rp4e P••
My Commssioia Expi;as Aprit ., 2G~2
Membes, i'ennsylvania F,ssc~+a.ion d Neta+ias
fE\t-1!il11i1iX(8-OOl
. ~ONWEALTH OF
PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
v/
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
/J., 79~ I
FILE NUMBER
~~-~ ~X-LL~
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DECEDENTS NAME (lAST, FIRST, AND MIDDlE INITIAl)
~ROWELL, Jessie Mae
DATE Of DEATH (MM-OO-YEAR) DATE Of alRlH (MM.DD-YEAR)
07/29/2002 09/13/1915
(IF APPl1Cl\llLE) SURVIVING SPOUSE'S NAME (lAST. FIRST. AND MIDDLE INITIAl)
n/a
1Xl'. 0rI!Ji!la1 ReJum
o 4. UIritod EsIaIe
IX] 6. Decedent Died TestlIe (Allod> _dWl)
o 9. UIigatioo Proceeds_
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SOCIAL SECURITY NUMBER
203 - 10
2742
llflS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. SUWlemenIal ReJum
040. Future _ Compronise l"'d_""~lU2)
07. DecedentMainlalned aLMngTrusI__d'MIJ
o 10. SpoosaI Poverty Cred'Il: (ilaI8 ofdBelh IlItWeIn 12-31-91811d 1-1-i5)
o 3. Remaind<<Re\um lll*cf..... plior>> 12-1).82)
o 5. F_ Estate Tax ReJum RequIrad
-.l 8. Total Number of Safe DeposIt Boxes
o 11. EJection to tax under Sec. 9113(A)_Sd>0)
NAMnichard L. Place
FIRM NAME 11_)
'Placey & Wright
TELEPHONE NUMBER
(717 236-9577
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,. Real Estate (ScI1edule A)
2. Stocks and Bonds (ScheWle a)
3. Closely Held CoIporalion, Par1neIship or SoIe-ProprielOlship
4. MoI1gages & Noles Receivable (ScI1edule D)
5. Cash, Bank Deposils & Miscellaneous Personal Property
(SdJedule E)
6. Joinlly Owned Property (_e F)
o Separate ailing RequeSted
7. Inler-Vivos Transfers & Miscellaneous Non-Probate Property
(SdJedule G IV L)
8. Total Gross Assets (total Lifles 1-7)
9. FunOfll! Expenses & Administrative COSts (Schedule H)
10. Debts 01 Decedent, Mortgage Uabmlies, & Uens (SdJedule Q
1,. Total Deduct/OIlS (inial Lifles 9 & 10)
12. Net Value of Estate (Une 8 minus Une 11)
13. Charila~e and Governmental BequeslslSec 9113 Trusts fo, which an election to tax has not been
made (ScI1edule J)
14. Net Value Subject to Tax (Une 12 minus Una 13)
COMPlETE MAILING ADDRESS
3631 North Front street
Harrisburg, PA 17110-1533
(1) -86,000.00 OFFICIAL USE ONLY
(2) 1,384.90
(3) . .00
(4) .00
(5) 37,003.54
(6) 11,937.87
(7) 15,000.00
(8) 151,326.31
(9) 21,772.00
(10) 725.94
128,828.37
(11) 22,497.94
(12) 128,828.37
(13) .00
(14) 128,828.37
x.O_ (15) .00
x.O 45 (16) 5,797.28
x .12 (17) .00
x .15 (18) .00
(19) 5.797.28
SEE INSTRUCTlONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amoont of Une 14 taxable allhe spoosal tax
rate, IV bonst... under Sec. 9116 (a)(1.2)
19. Tax Due
CHECK HERE iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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16. Amount of Line 14 taxable atlinea11ale
17. Amount of line 14 taxable at sibUng rate
18. Amount of Line 14 taxable at collateral rate
20. [!I
Decedent's Complete Address:
I~~
CITY 413 :ourth street
New Cumberland
I STATE PI'.
I ZIP 17070
I
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. CredilslPaymenls
A. Spousal POverty Credn
B. Priof Paymenls
C. Discount
(1)
5,797.28
5,950.00
313.15
Total Credi1s(A+ B+C)
(2)
6,263.15
3. InterestlPenally Wapplicable
D. Interest
E. Penally
TotallnterestlPenally ( 0 + E ) (3)
4. If line 2 is greater than line 1 + line 3, enter 1he difference. This is the OVERPAYMENT.
Checl< box on Page 1 Une 20 to request a refund (4)
.00
465.87
5. ~ line 1 + line 3 is greater than line 2, enter the difference. This is 1he TAX DUE.
A. Enter 1he interest on the tax due.
(5)
(SA)
B. Enter 1he total of line 5 + SA This is the BAlANCE DUE. (5B)
. Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWERTHE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain 1he usa or income of the property transfenred;.......................................................................................... 0 IU
b. retain 1he right to designate who shall use the property transfenred or i1s inoome; ............................................ 0 KJ
c. retain a reversionary interest; or.......................................................................................................................... 0 (J
d. receNe the promise for life of either paymenls, benefits or care? ...................................................................... 0 KJ
2. ~ death occunred after December 12, 1982, did decedent transler properly within one year of dealh
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which
contains a benefioiary designation? ........................................................................................................................ iKJ
U__ofpeojuly.'_""_examlnod""__""""""",,ng_and_"'.andtoUlebeslofmyillowledgeandbekl,<<"fnle,cooectand_
~of__"""'__"".based",a1>dormal1onofwhld1p18p1ll8rhasanyknowlodge.
SIGNATURE OF ESPONSIBlE FOR filING RETIJRN
::----:;; ~~~-
~D~ effr y Lynn Pro~ 11,
c/o Placey & Wright 363
SIGNATURE OF P~PARER 0 NTA
?
street, Harrisburg, PI'. 17110-1533
DATE
~DRESS
For dates of death on Of after July I, 1994 and before January 1, 1995, 1he tax rate i the net value of transfers to or for the usa of 1he surviving spouse is 3%
[72 PS. ~116 (a) (1.1) (i)).
For dales of death on or after January 1, 1995, the tax rate imposed on 1he net value of transfers to or for 1he use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (iQ).
The statute does not exemol a transfer to a slllViving spouse from tax, and 1he statutory requJrements for dlsdosure of assets and filing a tax retum are stiI applicable even n
1he surviving spouse is 1he only beneficiary.
For dates of dealh on or after July I, 2000:
The tax rate imposed on the net value of transfers from a deoeased child twenty.ooe years of age or younger at death to or for the use of a natural paren~ an adoplive parent,
or a stepparent of the child is 0% [72 PS, ~9116(aX1.2)].
The tax rate Imposed on 1he net value of lranslers to or for the use of the decadenfs ineal benefioiaries is 4.5%. except as noted in 72 P.S. ~9116(12) [72 P.S. ~9116(aXl)J.
The tax rale imposed on 1he net value of translers to or for 1he use of 1he decedenfs siblings is 12% [72 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 1he deceden~ whether by blood Of adoption.
REV-485 EX+ (1.921
,.
SAFE DEPOSIT BOX
INVENTORY
COMMONWEAlTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
INNUlTANCI TAX DIVISION
DEPT. 2IlO601
HAlRIS8UaG, PA. \n2e-G601 Plea.. Print or Typ.
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
21 02-0704 203-10-2742
DECEDENT'S NAME (LAST. FIRST. MIDDLE) DATE OF DEATH
Prowell, Jessie Mae July 29, 2002
ADDRESS OF DECEDENT (STREET) (CITY)
413 Fourth street New Cumberland
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(N"'Wichard L. Placey, Attorney for Estate
ISTATE)
PA
IllPCODE)
17070
(STREET ADDRESS) ICITY)
3631 N. Front street Harrisburg PA
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
G. (NAME) (RELATIONSHIp)
Richard L. Placey, Attorney for Estate
,
ISTATE) (ZIP CODE)
17110-1533
(STREET ADDRESS) (CIT!) (STATE) (ZIP CODE)
3631 N. Front street Harrisburg PA 17110-1533
b. (NAME) (RELATIONSHIp)
Jeffrey L. Prowell Son
(STREET ADDRESS) (CIT!) ISTAlE) IZIP CODE)
573 6th Avenue Menlo Park CA 94025
,. (NAME) {RE\.A.TIOHSHIp)
(STREET ADDRESS) (CIT!) (STATE) IZIPCODE)
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX 15 LOCATED
(NAME)
PNC Bank
(STREET ADDRESS)
331 Bridge Street
. NAME OF PERSON MAKING LAST ENTRY
Jeffre L. Prowell
DATE OF CONTRACT TO RENT BOX NUMBER OF BOX
01/11/1977 15B
NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
G. (NAME)
Jessie Prowell (Decedent)
(STREET ADDRESS) tSTRHT ADDRESS)
413 Fourth Street
(CIT!) ISTATE) (ZIP CODE) ICIT!)
New Cumberland PA 17070
NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY
tsTAlE) (ZIP CODE)
17070
(STATE)
(ZIP CODE)
Richard L. Placey, Esquire, Attorney for Estate
WAS A WILL IN THE BOX? DYES llINO 1/ y.., o. Do" 01 will.
b. NGme Gnd Gddr... of perJOllaJ representotlve, if rlam.cI In the will
(NAME)
Will was removed at August 1, 2002 entry. Previous entry was
(STREET ADDRESS) (CITY) ISTATE)
January 11, 2002 by decedent.
c. Nome orld add,.... of affomey, if any
(NAME)
IZIPCODE)
{STREET ADDRESS}
fCIT!)
(STATE)
(ZIPCODEI
Page ----1-~ of 1
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are
to be designated by name of company, certificate number, dote of certificate, name in which stock is registered,
and number of shares and class of stock.
(3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered
and type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in
book, name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc. List and describe as fully as possible.
(7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedne... List and describe as
fully as possible.
(8) All other contents.
ITEM ITEM DESCRIPTION
NO.
1 Harris Savings Bank C.D. 070002986 issued 7/23/99 to
Jessie Prowell or Jeffrey Prowell - $10,000.00
2 Harris Savinqs Bank C.D. 7-21-094254 issued 10/16/86 to
Floyd Prowell or Jessie Prowell - $20 000.00
3 Harris Savings Bank C.D. 07-51-192757 issued 2/12/91 to
Jessie Prowell - $ln.nnnnn
4 r.l"n T.;f'" "nn "nnnttv "nnn; h, Nn r.l\ n""n",n
issued 2/8/2001 to Jessie M. Prowell in the principal amount of
$15,000.00 with Jeffrey L. Prowell as named beneficiary
5 Deed of Susie Garver to Floyd L. Prowell and Jessie S. Prowell,
his wife, dated 4/4/1951 for property 413 Fourth Street, New
Cumberland Borouqh, Cumberland Countv. PA. recorded in Cumberland
County Deed Book R, Volume 14. Paqe 104
6 New Cumberland High School 1934 Class Ring - no stone
7 New Cumberland High School 1933 West Shore Champion Football Pendant
8 Ladies Brooches (2)
9 MHS Pin
10 Ladies Gold Rinq - no stone
11 Elgin Man's Watch
12 Ladies Weddinq Bands 131
13 Child's Ring, Cross Pin and GAR Button
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE SIGNATURE
PRINT NAME PRINT NAME AND CHECK APPROPRIATE BOX BelOW;
Richard L. Placey Jeffrey L. Prowell
PRINT TITlE CHECK APPROPRIATE BOX:
Attorney for Estate ~xecutor{trix) DAdministrator(trix)
o Estate Representative 0 Joint owner of safe deposit box
NOTE: Attach additional 8'12" x 11" sheet (s) if necessary or use duplicates of this page of form.
REV-1S02 EX~ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX ReTURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
All real property owned solely or as a tenant in common must be reported at fair market value. 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 knowledge 01 the relevant facts.
Real property which ls)ointly.owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
,.
DESCRIPTION
VALUE AT DATE
OF DEATH
Real estate situate in the Borough of New
Cumberland, Pennsylvania, more particularly
bounded and described in Cumberland County
Deed Book "R", Volume 14, Page 104, known and
numbered as 413 Fourth Street, New Cumberland,
Pennsylvania
(Valued at price for which sold. See deed
and settlement sheet attached.)
$ 86,000.00
TOTAL (Also enter on line 1, Recapitulation) $
86,000.00
(If more space is needed, insert additional sheets of the same size)
Ii
I'
II
I.
iI
I'
'I
I,
"
II
II
'I
il
I
II
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MADE THE
One Thollsaltd Nine
IDqis lJubrutufr,
y-tl... da)' of
Hllndred and Fifty-one (1951)
I
I
I
II
I:
April
, ilt tlu year of our Lord
ilttweeu
SUSIE E. GARVER, widow, of the Borough of
New Cumberland, County of Cumberland, and
state of Pennsylvania, GRANTOR, party of
the first part / } q
~8~ - ! f?-. L
FLOYD L. PROl\'ELL and JESSIE S. PR01-,'ELL, his
wife, of the Borough of New Cumberland, County
of Cumberland, and State of Pennsylvania,
GRANTEES, parties
ii
II
il
of the secoltd part: Bitue.o.ott4.
&oltsidemtion of the sum of ONE DOLLAR
That the said party of the first part, for and in
($1.00) and other valuable considerations,
lawflllmoney of the United States of America, well and trll/)' paid by the said parties of the
second part to the said part y of tlu first part, at altd before the sealiltg m,d deli,'ery of these ,
preSt'll!S, tIle receipt wlureof is hereby ackl/tJ'lvledged, has grantcd, bargailled, '
sold, alicued, enfeoJjed, released, COll'i1t')/t'd alld l:onjirmed, and by these jJresents do es grant, bargain,
sell, aliell, enfeolf, release, COU'l.!t'y and cOltjir11l unto tlu said jJart ies of the second part, their
heirs (utd asst"glls,
1\11 "hat piece or parcel of ground, situate, l;>'ing, and being in the Borough
of New Cumberland, County of Cumberland, and StatR of Pennsylvania, same
being more particularly bounded and described as fo11o>1s, to wit:
BEGINNING at a point on the northerly side of Fourth Street, in the aforesaid
Borough, distant one hundred fifty-six (156) feet three (3) inches
west of the westerly side of TIeno street; thence continuing in a westerly direc-
tion along the said northerly side of Fourth Street eighteen (18) feet nine (9)
inches to a point on the dividing line between Lots Numbers 7 and 8; thence in a
northerly direction along the said dividing line between Lots Nos. 7 and 8, and
at right angles with the said Fourth Street, one hundred forty (140) feet to a
twenty foot wide public alley; thence in an easterly direction along the said
public alley, eighteen (18) feet nine (9) inches to a point at property now or
late of Floyd Hostetter; thence in a southerly direction along property now or
late of the said Hostetter, one hundred forty (140) feet through the center or
partition wall of a double two and one-half story frame dwelling house, td the
northerly side of Fourth Street, the point or place of Beginning, and having
thereon erected a two and one-half story fr~ne dwelling house.
The above described tract of land being a portion of Lot Number Seven (7) in the
General Plan of George W. Buttorff's Addition to the Borough of New Cumberland,
as recorded in the Office of the Recorder of Deeds in and for the County of Cum-
berland, at Carlisle, Pennsylvania, in Deed Book "Nil, Vol. 5, Page 500.
I
BEING the same premises which Emma J. Lefever and William H. Lefever, her hus-
band, by deed dated August 13, 1925, and recorded in the Cumberland County
Recordeyo1 5 0ffice in Deed Book "1')11, Vol. 10, Pape 39, granted and conveyed unto
':::;usie E. Srunner. "he said :::'usie 7:. Brunner inter-married with ::::. 1'1. Carver; the
said C. M. Garver now being deceased, the title vested in Susie E. Garver, widow,
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~~ I ILEMENT ~TATEMENT Titlepro for Windows Tlll
RIVERSIDE LAND TRANSFERS, L.L.C.
307 Market Street B. TYPE OF LOAN
) Lemoyne, PA 17043-0109 01.FHA o 2. FMHA o 3. CONV.UNINS.
(717) 441-1555 D4.VA 05. CONY. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
\30660
MORT. INS. CASE NO.:
~. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "{p.o.c,r were paid outside the closing; they are shown here for infonnation purposes and are not included in the totals.
'. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER
ryan 0, Kleeman Jessie Mae Prowell Estate Sun Trust Mortgage. Inc.
I. PROPERTY LOCATION: H. SETTLEMENT AGENT: Riverside Land Transfers I. SETTLEMENT DATE:
\3 4th Street Oct 3\ 2002
10 Lot 7. Buttorfs Addition Thursday
lew Cumberland Borough PLACE OF SETTLEMENT: 03:00 PM
:umberland County. PA
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
)0. Gross Amount Due From Borrower 400. Gross Amount Due to Seller
)1. Contract sales price 86,000.00 40\. Contract sales price 86,000.00
l2. Personal Property 402. Personal Property
l3. Settlement Charges (line 1400) 4.923.63 403.
l4. 404.
l5. 405.
Adjustments for items paid In advance by seller(s) Adjustments for Items paid In advance by seller(s)
l6. CityfTown tax 406. CitylTown tax
l7. CountylCity tax 1013112002 to 12/3112002 56.95 407. Countylclty tax 1013112002 to 12/3112002 56.95
)8. Assessments 408. Assessments
19. School Tax 1013\12002 to 6/3012003 612.51 409. School Tax 1013112002 to 6/3012003 612.51
10. Refuse 1013112002 to \ 2/3112002 22.67 410. Refuse 10/31/2002 to 12/3112002 22.67
11. 411.
12. 412.
20. Gross Amount Due from Borrower 91,615.76 420. Gross Amount Due to Seller 86,692.13
lO. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller
:>1. Deposit or earnest money 1.000.00 501, Excess deposit (see Instructions)
J2. Principal Amount of new loan(s) 85,325.00 502. Settlemenl charges to seller (line 1400) 6,438.56
J3. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
J4. 504. Payoff of First Mortgage Loan
J5. 505. Payoff of Second Mortgage Loan
J8. Appraisai Fee Credit 19.50 506.
J7. Lender Credit 853.25 507.
J8. 508.
J9. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
10. CityfTown tax 510. CitylTown tax
1\. County/City lax 511. County/City tax
12. Assessments 512. Assessments
13. School Tax 513. School Tax
14. 514.
15. Sewer 10/1/2002 to 10/31/2002 7.20 515. Sewer 10/112002 to 10/31/2002 7.20
16. 516.
17. 517.
L. SETTLEMENT CHARGES Paid From Paid From
700. Total Sales Commission based on Price: $ 86,000.00 6.00 % Borrower's Selle~.
Division of Commission at: $ 5,160.00 Total Funds At Funds At
701. 2,605.00 Homestead Group, Inc. ~
702. 2,555.00 Century 21 At The Helm
703. Commission paid at Settlement 5,160.00
704.
800. Item. Payable In Connection With Loan
801. Loan Origination Fee 1.00 Sun Trust Mortgage, Inc. , 840.65
802. Loan Discount , Sun Trust Mortgage, Inc.
803. Appraisal fee to Jim Perry 319.50{poc}
804. Credit Report to Equlfax 14.65
805. Inspection Fee to Jim Perry 75.00
806. Mortgage Insurance to
807. AssumptIon Fee to Flood Cert life of loan. First American 4.50
808. Tax Service Fee to Valutree Real Estate Service 69.00
809. Document Review Fee to Sun Trust Mortgage Inc. 195.00
810. Commitment Fee to Sun Trust Mortgage Inc. 200.00
811. Flood Cert Fee to First American Flood Data 12.00
900. Items Required By Lender To Be Paid In Advance
901. Interest from 10/31/2002 to 10/31/2002 @ 14.90 IDay 14.90
902. Mortgage Ins. Premium 0 Months to Federal Housing Administration 1,260.98
903. Hazard Ins. Premium 1 Years to Liberty Guard 310.00{poc}
904. 0 Years to
905. 0 Years to
1000. Re.erve. Deposited With Lender For
1001. Hazard Insurance 3 Months @ $ 25.83 IMonth 77.49
1002. Mortgage Insurance 0 Months @ $ IMonth
1003. CityfTown Taxes 0 Months @ $ /Month
1004. County Taxes 9 Months @ $ 27.75 IMonth 249.75
1005. Assessments 0 Months @ $ IMonth
1006. School Taxes 5 Months @ $ 76.77 /Month 383.85
1007. 0 Months @ $ /Month
1008. Agg. Adj. 0 Months @ $ /Month (319.89)
1100. TItle Charge.
1101. Settlement or closing- fee to
1102. Abstract or title search
1103. Title Examination
1104. Title Insurance Binder
1105. Document preparation
1106. Notary fees Cash 10.00
1107. Attomey's fees
(includes above items No.:)
1108. Title Insurance Riverside Land Transfers 924.75
(Includes above items No.:) 1101-1104,1108 basic 100/300/8.1
1109. Lender's coverage $ 85,325.00
1110. Owner's coverage $ 86,000.00
1111. Wire Fee to Riverside Land Transfers 20.00
1112. Express Mail to Riverside Land Transfers
1113. Closing Service Letter to Riverside Land Tranfers 35.00
1200. Government Recording and Transfer Charges
1201. Recording Fees : Deed $ 39.50 Mortgage $ 50.50 Release $ 90.00
1202. City/County tax/stamps: Deed $ 860.00 Mortgage $ 860.00
1203. State tax/stamps: Deed $ 860.00 Mortgage $ 860.00
1204. Recorder of Deeds
1205.
1300. Additional Settlement Charge.
1301. Refuse OcUNovlDec to New Cumberland Borough 33.82
1302. Pest Inspection to Home Spec 45.00
1303. Transaction Fee to Homestead Group 100.00
1304. Transaction Fee to Century 21 At The Helm 125.00
1305. Sewer July/Aug/Sepl. to New Cumberland Borough 20.74
1400. Tota,' Settlement Charge. (enter on lines 103 & 502, Sections J & K) 4,923.63 6,438.56
RE\)-1Sb3 EX+ '(6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 8
STOCKS & BONDS
ESTATE OF
JESSIE MAE PROWELL
All property jolntly-owned with right of survivorship must be disciosed on Schedul, F.
FilE NUMBER
21-02-0704
ITEM
NUMBER
1.
DESCRIPTION
44 shares common stock Prudential Financial, rnc
Hi-32.45; Lo-30.50
Valued at 31.475 per share
(See valuation attached)
VALUE AT DATE
OF DEATH
1,384.90
TOTAL (Also enter on line 2. Recapitulation) $ 1, 384.90
(If more space is needed, insert additional sheets of the same size)
Historicill Prices Page I of I
"\!'JlSoOtFlNANCE W Search -Finance Home - Yahoo! -!::!!!!Q
Historical Prices - PRU (Prudential Financiallnc) As of Jul-29-02
More Info: Quote I Chart I News I Profile I Research I Moos
ADVERTISEMENT
Start: IJUI _12912002
End: IJul .12912002
Ii Daily
r Weekly
r Monthly
r Dividends
Ticker Symbol: Ipru
~
Date Open High Low Close Volume Adj.
Close*
Jul-29-02 30.65 32.45 30.50 32.20 3,578,700 32.20
Download Spreadsheet Format
* adjusted for dividends and splits please see F AQ.
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hllp:lltable.finance.yahoo.comld?a=6&b=29&c=2002&d=6&e=29&f=2002&g=d&s=pru
9/18/02
REV-1508 EX~ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX ReTURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
*waypoint Bank Certificate No. 721094252
principal - $2,002.76
Interest - $ 77.18
VALUE AT DATE
OF DEATH
$ 20,079.94
2. *Waypoint Bank Certificate No. 751192757
Principal - $16,170.96
Interest - $ 4.64
16,175.60
670.00
10.00
5.00
10.00
5.00
15.00
25.00
3.00
5.00
NO VALUE
3. Household Goods
4. Lamtlsflrooches (2)
5. MHS Pin
6. Ladies Gold Ring
7. Elgin Man's Watch
8. Ladies Wedding Bands (3)
9. Child's Ring, Cross Pin and GAR Button
10. Class Ring
11. West Shore Football Pendant
12. Miscellaneous Personal Effects
*See bank letter attached.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
37,003.54
ReV-1509 EX- (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
If an asset was made joint within one year of th, decedent's date of death, it must be reported on Schedul. G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
Jeffrey Prowell
573 6th Avenue
Menlo Park, CA
Son
94025
B.
c.
JOINTLY.QWNED PROPERTY:
LETIER DATE DESCRIPTION OF PROPERTY %OF OATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANClAllNsmunoN AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF OEATH OECO'S VAlUE OF
NUMBER TENANi JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLV-HElD REAL ESTATE. VALUE Of ASSET MEREST DECEDENTS INTEREST
,. A. 7/99 Waypoint Bank Certificate
No. 700002986
principal - $10,000.00
Interest - $ 3.59 10,003.59 50% 5,001.8
2. A 1/97 PNC Bank Checking Account
No. 5140050707
principal - $13,868.45
Interest - $ 3.69 13,872.14 50% 6,936.0
(See bank letters attached)
TOTAL (Also enter on line 6, Recapitulation) $ 11,937.87
o
7
(If more space is needed, insert additional sheets of the same size)
08/09/2002
PLACEY & WRIGHT
3631 N FRONT ST
HARRlSBURGPA 17110
~lWaYRqtf\t
LOOK FOR US. WE'LL GET YOU THERE.
The information which you requested on the account(s) of JESSIE PROWELL
(Social Security Number 203-10-2742) is/are as follows:
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership JTO
Name of Joint JEFFREY
Owner, if any PROWELL
Date Ownership 07/23/99
Was Establish,ed
700002986
CERTIFICATE
07/23/99
10000.00
3,59
10003,59
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested
721094252
CERTIFICATE
10/16/86
20002.76
77.18
20079.94
SOLE
7511 92757
CERTIFICATE
02112/91
16170.96
4.64
16175.60
SOLE
~erelY, ~HfV.
KA~~oUdG
SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG, PeNNSYUlANIA 17105-1711
Toll Free 1-866-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com
SEP-13-2002 D3:3~
PNCBRNK C 1 F DEPfl>TMEI{T
412 705 0057 P.01/0,
0PNCBAN<
September 18, 2002
Richard L. P1acey
3631 North Front Street
Hanisburg, PA 17110-1533
R.E: Estate of Jessie M. Prowell, deceased
SSN: 203-10-2742
DOD: 7/2912002
Dear Mr. Placey:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
CheddDll Account
Ac.ccunt #5140050707
Established 11/20/1997
JESSIE M PROWElL
JEFFREY L PROWELL
DOD balance: $13,868.45" S3.69 l!.CCIlled interest
For Brokerage w.formatioD, ]>leasecalll-800-762-6111. INV #68293047
Please note that this office only provides date of death balance. for deposit acoounts
(IRA., CDs, Checldna and SavinllS accounts). Wc do not proc:ess any fiDancial
trall.actions or provide statements. lfyou need assistance with any of these items,
please call1-888-PNC-BA..''IK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely.
Gtwndh.. uJ&h-
Rach..U.. Wells
HlOO-762-1775
P7-PFSC-04-F
Soo flrot Ave.
Pilisburih PA 15219
M<mh<< FDIC
TDTAL P. 01
REV-1510 EX. IS-g"*-
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
ESTATE OF
This schedule must be completed and filed it the answer to any of questions 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY
INCtlXJE THE NAME OF TliE TRANSFEREE. THEIR RELATIONSHIP TO DECEDCNT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBE' THE DATE Of TRANSfER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST "Al'!'\JCABlE\ VALUE
1. Glenbrook Life and Annuity Company
Annuity GA0540683. Beneficiary
Jeffrey L. Prowell. Transferred
July 29, 2002. 15,000 100% 15,000.
TOTAL (Also enter on line 7 Recapitulation) S 15,000:.00
(If more space is needed, insert additional sheets of the same size)
00
. GLENBROOK UFE
Glenbrook Life end Annuity Company
Telephone: 1-800-755-5275
Fex: 1-847-402-5313
.4M_of_AUs_aroup
P.O. Box 94042
Palatine, IL 60094-4042
',.",1...111.,.'...1,1,..".11',,'.11....,'.1.1..1,
JESSIE M PROWELL
413 4TH ST
NEW CUMBERLAND PA 17070-1802
July 10, 2002
JAMES LOOP
PNC INSURANCE SERVICES, INC
331 BRIDGE STREET
NEW CUMBERLAND PA 17070-2129
(7171f - 9 ft I ---6 ~ ? I
,
The following statement provides information regarding the Glenbrook Excel Annuity GA0540683 that you
purchased from Glenbrook Life. Please examine this statement carefully.
Check Reconciliation:
Total Withdrawal
Amount Received
65.08
65.08
I
Transaction(s) Processed:
Transaction
Tvpe
Eamgs. Withdrwls.
Effective
Date
07/09/02
Current
Effective
Annual Rate
5.600%
Transaction
Amount f$)
-65.08
$ -65.08
Total:
I
Account Value Summary as of 07/09/02:
Date of
Purchase
Payment
02109/01
Current
Effective
Annual Rate
5.60%
Fund Value
($)
15,000.00
Total Account Value:
$ 15,000.00
If you have questions concerning your annuity or any of the above information, please contact your representative
or Glenbrook Life and Annuity Company at 1-800-755-5275.
~
B12F2854.NOl
IU00D291:rf_BI2F~
~.,
REV.'6ll EX. (12.99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,.
Stone & Murray Funeral Home $ 4,744.00
2. Post-funeral luncheon 395.00
B. AOMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(sYEIN Number of Personal Representative(s) nla
Street Address
City Slate _Zip
Year(s) Commission Paid:
2. Ahorney Fees Placey & Wright 6,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address nla
City Slale_Zip
Relationship of Claimant to Decedent
4. Probate Fe.Gumber land County Register of Wills 223.00
5. Accountant's Fees
6. Tax Return Pre parer's Fees
7. Net expenses re sale of 413 4th Street, New Cumberla d 5,753.63
8. Cumberland Law Journal - estate advertising 75.00
9. The Patriot-News Company - estate advertising 91.15
10. Executor's expenses re clean-up of house and
packing and storage of personal property in lieu
of executor's fee 2,990.22
11 . Reserve for future costs, taxes and expenses 1,000.00
TOTAL (Also enter on iine 9, Recapiluiationj $ 21,772.00
Debts of decedent must be reported on Schedule I.
(if more space is needed. insert additional sheets of the same size)
REV:1512EX+ (6:98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTlES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE lAX RETURN
RESIDENT DECEDENT
ESTATE OF
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. AT&T - debt of decedent
2. Verizon - debt of decedent
3. PP&L - debt of decedent
4. New Cumberland Borough - debt of decedent
5. UGI - debt of decedent
6. American Water Company - debt of decedent
7. Comcast - debt of decedent
8. Yard Care at 413 4th Street - debt of decedent
9. Family Practice - medical debt of decedent
10. Holy Spirit Hospital - medical debt of decedent
VALUE AT DATE
OF DEATH
$ 29.64
72.62
150.12
60.30
54.66
66.77
23.91
100.00
42.92
125.00
TOTAL (Also enter on line 10, Recapitulalion) $
(If more space is needed, insert additional sheets of the same size)
725.94
REV.1St3 EX. (9-00)
..
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE ..
BENEFICIARIES
JESSIE MAE PROWELL
FILE NUMBER
21-02-0704
ESTATE OF
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
RELATIONSHIP TO DECEDENT
Do Not Ust Trust&e(s)
AMOUNT OR SHARE
OF ESTATE
Jeffrey Lynn Prowell
573 6th Avenue
Menlo Park,CA 94025
Son
Entire Estate
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRiATE, ON REV-151lO COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ . 00
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TEST AMENT
OF
JESSIE MAE PROWELL
I, JESSIE MAE PROWELL, of New Cumberland, Commonwealth of Pennsylvania,
do hereby make, publish and declare this to be my Last Will and Testament, revoking any and
all previous Wills and Codicils, and hereby will and dispose of all the property which I own at
my death in the following manner:
I.
,
I nominate, constitute and appoint my son, JEFFREY LYNN PROWELL, as
the Executor of this my Last Will and Testament. Should he be unwilling or unable to serve
for any reason, then I nominate, constitute and appoint my grandson, ZACHARIAH
ROBERT PROWELL, as successor Executor of this my Last Will and Testament.
II.
I direct that all my just debts and funeral expenses be paid out of my estate as soon as
practicable after my death.
ID.
I give, devise and bequeath all my household goods and personal effects to my son,
JEFFREY LYNN PROWELL.
IV.
All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, I give, devise and bequeath to my son JEFFREY LYNN PROWELL.
V.
Should my son, JEFFREY LYNlN PROWELL, predecease me, or survive me by a
period of less than thirty (30) days, my entire estate shall go to my grandson, ZACHARIAH
ROBERT PROWELL.
VI.
All gifts of any kind herein made shall be delivered directly to the beneficiaries free
from their control, debts, contracts and engagements, and such gifts shall not be subject to the
assignment or anticipation or pledge by them, or to execution, attachment, or any other
process for the enforcement of judgments or claims of any sort against them.
2
VII.
All inheritance, estate, succession or transfer taxes, whether State, Federal or
otherwise, or any other tax in the nature thereof, which may be payable by reason of my
death, shall not be apportioned but shall be paid, together with any interest or penalties, out of
the principal of my residuary estate as if such taxes were administration expenses. I further
authorize my Executor to prepay taxes on future and remainder interests if deemed advisable.
Vill.
My Executor, his successor, or any other fiduciary named, constituted or appointed in
this my Will or during the administration of my estate, shall be excused from posting bond in
all jurisdictions regardless of any law or rule of court to the contrary.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this I ::/1-. day of
__) \)-....f'.JL.,.. , 2000, to this My Last Will and Testament.
JA/';>~ Hbap;~db
IE MAE PR WELL
(SEAL)
3
Signed, sealed, published and declared by the above-named JESSIE MAE PROWELL,
as and for said person's Will in the presence of us and each of us, who, at said person's
request, in said person's presence and in the presence of each other, have hereunto subscribed
~...bU ,_ / ~ ~A
\r. II \ f (i .
our names as witnesses thereto the day and year last above written.
V~~~V~.~
0~__~
Address
~ C~,-,Q..Q.,,~ ~A. II u\ l)
Address
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
.
We, JESSIE MAE PROWELL,\)u(~ ~f'- 9C-1:>\dh and
rvc:..\\ \.., ~\\ ~~ \ t tt\ ,the Maker of this Will and the witnesses, respectively, whose
names are signed to the foregoing instrument, being duly qualified according to law, do depose
and say that we were present and saw the Maker sign and execute the instrument as her Last
Will and Testament; that she signed willingly and that she executed it as her free and voluntary
act for the purposes therein expressed; that each of us in the hearing and sight of the Maker
signed the Will as witnesses; and that to the best of our knowledge the Maker was at that time
eighteen (18) or more years of age, of sound mind, and under no constraint or undue
influence.
L/Y.>/~ n(~&~~/
?fESSIE MAE PROWELL .
j:)~ 8~1
V~c.\V~~
4
"
SUBSCRIBED, sworn to and acknowledged before me by JESSIE MAE PROWELL, the
aker, and SUb~ribed and sworn to before me by U,'>\{..~ \)~\ L\\' , and
c....\: (IL\"-+\ c......\-t Yo , witnesses, this il... day of ~"N , 2000.
l' J("\\ 'i~ (~\;""r t,
~
\\\~\,~,.,,,
(Selll)
Notary Public
Notarial See!
~ J. Martini, NOlS/V PublIO
Hllfl1Ilden Twp., Cumberland SO""'Y
M commissIon Expires Apnl1, 2002
y -
Member, pennsylvania ASsoclat~oo cI Notalies
5