HomeMy WebLinkAbout10-28-14 J 15�5610140
REV-1500 EX (02-11)(FI)
PA Department of Revenue
OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box 2soso� INHERITANCE TAX RETURN
Harrisburq, PA 17128-0601 RESIDENT DECEDENT 2 1 1 4 0 2 3 2
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY Date of Birth n�iMDDYYYY
1 8 8 1 2 3 5 4 5 0 2 0 2 2 0 1 4 1 2 1 2 1 9 2 2
DecedenYs Last Name Su�x DecedenYs First Name MI
R 0 S S M A R G A R E T A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FIL�IN APPROPRIATE OVALS BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death
Prior to 12-13-82)
� 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required
death after 12-12-82)
QX 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust � 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
� 9. Litigation Proceeds Received � 10. Spousal Poverty Credit(Date of Death � 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach ScheCt�0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TA�IFORMATION,riflOUL I�ECTED T0:
Name Daytir�gg�ephone�ber� r.�
��� _.� -::�
G E R A L D J S H E K L E T S K I E S Q 7 �� �� � 7�i ?�. ��+a 3 5
REGI$TER OF WILLS US�O,N�Y
";:)
I —`3 ~� I
First Line of Address �
4 1, 4 B R I D G E S T . � �°:;, c i
� �
Second Line of Address ._.�
P . 0 • B 0 X E I
City or Post O�ce State ZIP Code L DATE FILED
N E W C U M B E R L A N D P A 1 7 0 7 �
�orrespondenrs e-mai�address: G S H E K L E T S K I a�S T 0 N E L A W • N E T
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 and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNA RE OF P RSON ESPONSIBLE FOR FILING RETURN TE
ADDRESS
HELEN M • SZEMESI 268 B T • APT 3 HARRISBURG PA 17102
SIGNATUR PA O THA E TE_ -
�- w
ESS
GERALD J • SHEKLETSKI ESQ • 414 BRIDGE ST • NEW CUMBERLAND PA ],707�
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 150567,0140 1,50561,01,40 � �
�
J 150561024�
REV-1500 EX(FI) DecedenYs Social Security Number
oecedent'sName: MARGARET A • ROSS
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 5 0 0 0 0 . 0 0
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2• •
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. •
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. •
5. Cash, Bank Deposits and Misceilaneous Personal Property(Schedule E). . . . . . . 5. 2 5 2 � . 0 �
6. Jointl Owned Pro ert Schedule F 3 2 1 7 7 . 4 4
y p y( ) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous N�-Probate Property
(Schedule G) Separate Billing Requested . . . . . . . 7. .
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 8 4 6 9 7 , 4 4
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9 2 � 2 6 � . 2 9
10. Debts of Decedent, Mortgage Liabilities, and Liens(Schedule I) . . . . . . . . . . . . . 10. •
��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 0 2 6 � . 2 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 6 4 4 3 7 . 1 5
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. .
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 6 4 4 3 7 . 1 5
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 _ � . � � 15. 0 . 0 �
16. Amount of Line 14 taxable
at lineal rate X .0_ � . � 0 16. 0 . � �
17. Amount of Line 14 taxable
at sibling rate X.12 � . � � 17. � . � �
18. Amount of Line 14 taxable
at co��atera�rate x.�5 6 4 4 3 7 . 1 5 �8. 9 6 6 5 . 5 7
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 9 6 6 5 . 5 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 1505610240 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 14 �232
DECEDENT'S NAME
MARGARET A • ROSS
STREET ADDRESS
9 COURTLAND ROAD _____ _
CITY STATE ZIP
CAMP HILL PA 17011,
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 9,6 6 5 • 5 7
2. Credits/Payments
A.Prior Payments 9,6 6 5 • 5 7
B.Discount
Total Credits(A+B) (2) 9,6 6 5 • 5 7
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0 - 0 0
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 • ��
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ...................................................................... ❑❑ �
b, retain the right to designate who shall use the property transferred or its income ............................... X
c. retain a reversionary interest ..........................................'......................................................... ❑ �
d. receive the promise for life of either payments,benefits or care. .......................................................
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ 0
3. Ditl decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X
4. Did 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.
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
is 3 percent[72 P.S. §9116(a)(1.1) (i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116(a)(1.1)(ii)].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 tlates of death on or after July 1, 2000:
• The tax rate imposetl on the net value of transfers from a deceased child 21 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 percent[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 beneficiaries is 4,5 percent,except as notetl in p2 P.S.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined,
untler Section 9102,as an indivitlual who has at least one parent in common with the decedent,whether by blootl or adoption.
REV-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARGARET A . ROSS 21 14 0232
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market vatue 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 knowiedge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OFDEATH
DESCRIPTION
1 • ALL THAT CERTAIN TRACT OR PARCEL OF LAND WITH THE 50,aaa • 00
BUILDIN�S AND IMPROVEMENTS THEREON ERECTED, SITUATE IN
LOWER ALLEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA
KNOWN AS 9 COURTLAND ROAD, CAMP HILL, PENNSYLVANIA
17011 • SOLD TO JONN J • MALLIOS AND JAMES T • MALLIOS
ON SEPTEMBER 19, 2014 • COPIES OF THE SETTLEMENT SHEET
AND DEED ARE ATTACHED HERETO •
TOTAL(Also enter on Line 1,Recapitulation.) $ 5 0,0 0 0 • 0 0
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
REsioENroECE�ENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
MARGARET A • ROSS 21, 1,4 0232
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. 2001, PONTIAC GRAND A�1 GT AUTOf10BILE 1�50� • 00
VIN — I,G2NF1,2E51,�1637497 SOLD ON �1AY 21„ 201,4 , TO
�1ARIZOL A • FOTOPOULOS • COPIES OF SALE DOCU�1ENTS
ATTACHED •
2 • 2013 FEDERAL INCOf1E TAX REFUND CHECK 1�020 • 0�
TOTAL(Also enter on Line 5,Recapitulation) $ 2 ,5 2 0 • ��
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARGARET A • ROSS 21 14 0232
If an asset was made jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
a. HELEN M - SZEMESI 268 BOAS ST • , APT • 3 NIECE
HARRISBURG , PA 171D2
s.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE �NCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 01-69 PNC BANK CHECKING ACCOUNT 64,354 • 88 5� • 32,17? - 44
#5140053916
TOTAL(Also enter on Line 6,Recapitulation) $ 3 2,17 7 • 4 4
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(OS-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARGARET A • ROSS 21 14 0232
DecedenYs debts must be repoRed on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. NEILL FUNERAL HOME, INC • 8 ,988 • 00
3501, DERRY ST • , HARRISBURG, PA 1,7111
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. AttorneyFees: STONE LAFAVER & SHEKLETSKI 6,000 • 00
3, Family Exemption:(If decedenYs address is not the same as claimanPs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. ProbateFees: LETTERS TESTAMENTARY 348 • 50
5 Accountant Fees:
6. Tax Return Preparer Fees:
�. CUMBERLAND LAW JOURNAL — LEGAL ADVERTISING 75 • 00
8 • THE SENTINEL — LEGAL ADVERTISING 190 • 54
9 • SHORT CERTIFICATES 15 • 00
10 • UGI CORPORATION 293 • 70
11 • VERIZON 65 • 62
12 . PPL ELECTRIC UTILITIES 79 • 94
1,3 . PENN UNITED — TRASH BAGS 30 • 00
14 • PENNSYLVANIA AMERICAN WATER 66 • 36
15 • LOWER ALLEN TOWNSHIP — SEWER AND REFUSE 11,7 • 70
16 • 2D14 COUNTY/LOCAL REAL ESTATE TAX 584 • 31
17 • HAMPDEN TOWNSHIP EMS SERVICE 796 • 0�
18 • ERIE INSURANCE — HOMEOWNER ' S INSURANCE 44 • 00
TOTAL(Also enter on Line 9,Recapitulation) $ 2 0,2 6 0 • 2 9
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MARGARET A. ROSS 21 14 0232
DecedenYs Name Page 1 File Number
Schedule H - Funeral Expenses &Administrative Costs- 67.
ITEM
NUMBER DESCRIPTION AMOUNT
19 • SETTLEMENT EXPENSES ON SALE OF 9 COURTLAND ROAD, 500 • 0�
CAMP HILL, PA 17011 • LINE 502 OF SETTLEMENT SHEET
20 • 201,4 COUNTY REAL ESTATE TAX $533 • �4 LESS $150 � 41 382 • 63
(REIMBURSEMENT AT SETTLEMENT - SEE LINE 407 OF
SETTLEMENT SHEET) _ $382 • 63
21 • 2014-2015 SCHOOL TAX $1,047 • 58 LESS $81,5• 10 232 • 48
(REIMBURSEMENT AT SETTLEMENT - SEE LINE 4�8 OF
SETTLEMENT SHEET) _ $232 • 48
22 • LOWER ALLEN TWP • 3RD QUARTER SEWER/TRASH $122 • 70 108 • 03
LESS $14 • 67 (REIMBURSEMENT AT SETTLEMENT - SEE LINE
410 OF SETTLEMENT SHEET) _ $108 • 03
23 • HARRISBURG LOCKSMITH SERVICE 84 • 00
24 • PPL ELECTRIC UTILITIES 112 • 04
25 • PENNSYLVANIA AMERICAN WATER 99 • 37
26 • UGI CORPORATION 103 • 48
27 • LOWER ALLEN TOWNSHIP - 2ND SEWER/TRASH 122 • 70
28 • PENNSYLVANIA AMERICAN WATER 33 • 5D
29 • PPL ELECTRIC UTILITIES 27 • 31
3❑ • UGI CORPORATION 57 • 33
31 • PENNSYLVANIA AMERICAN WATER 34 • 55
32 • PPL ELECTRIC UTILITIES 23 • 7�
33 • UGI CORPORATION 25 • 12
34 - PENNSYLVANIA AMERICAN WATER 31 • 49
35 • PPL ELECTRIC UTILITIES 26 • 41
36 • UGI CORPORATION 26 • 71
37 • PPL ELECTRIC UTILITIES 26 - 28
38 • PENNSYLVANIA AMERICAN WATER 32 • 51
39 • UGI CORPORATION 25 • 86
40 • PPL ELECTRI� UTILITIES 26 • 41
41 • UGI CORPORATION 8 • 71
42 • PAUL S • CORNMAN HOME IMPROVEMENTS - POWER WASH 400 • DO
43 • SHORT CERTIFICATES 15 • 0�
SUBTOTAL SCHEDULE H-B7 2,565 • 62
REV-1513 EX+(Ot-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARGARET A • ROSS 21 14 0232
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
�. HELEN M • SZEMESI Collateral 64 , 437 • 15
268 BOAS ST • , APT • 3
HARRISBURG, PA 17102
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
8.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX�1 7-96)
DEPAFTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 019763
SZEMESI HELEN M
268 BOAS STREET
HARRISBURG, PA 17102
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
"""" iold
""""" _""'_'
101 � 59,665.57
ESTATE INFORMATION: SSN: � �
FILE NUMBER: 2114-0232 I
�ECE�EtvT ivAME: ROSS MARGARET A �
DATE OF PAYMENT: 1 O/07/2014 I
POSTMARK DATE: 1 O/07/2014 �
CouNTY: CUMBERLAND �
DATE OF DEATH: 02/02/2014 I
�
TOTAL AMOUNT PAID: 59,665.57
REMARKS: RECEIPT TO ATTY
CHECK# 6520
INITIALS: CJ
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
TAXPAYER
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,_ .- -_ - � _ ,
LAST WILL AND TESTAMENT
OF
MARGARET A. ROSS
I, MARGARET A. ROSS, of Camp Hill, Cumberland County,
Pennsylvania, make, publish and declare this as and for my Last
Will and Testament, hereby revokir.g all other Wills and Codicils
i�eretofore rnade by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, to my niece, HELEN
M. SZEMESI, of Apt . #3 , 268 Boas Street, Harrisburg, Pennsylvania
17102 . Should she predecease me then to ROBERT M. SZEMESI, son
of my niece, HELEN M. SZEMESI, of Apartment #3 , 268 Boas Street,
Harrisburg, Pennsylvania 17102 .
SECOND: No provision is made in this, my Last Will and
Testament, for JOSEPH SZEMESI, son of my niece, HELEN M. SZEMESI .
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisaY,la Vult.�lOUt COl1Z'� a�proval ar.d effect:_'„'A �1nt;'1 2r-r„�l
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it .
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
�
i
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
c�iversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
� (H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes .
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FOURTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
2
M
r
_.._._.._.-,-»,.,�..---^—,.,>..,a«-.
FIFTH: I nominate and appoint HELEN M. SZEMESI,
Executrix of this, my Last Will and Testament . In the event of
the death, resignation or inability to serve for any reason
whatsoever of the said HELEN M. SZEMESI, I nominate and appoint
ROBERT M. SZEMESI, Executor of this, my Last Will and Testament.
I direct that my Executrix or Executor, as the case may be, and
their successors, shall not be required to post security or a
bond for the performance of their duties in any jurisdiction.
S1� WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this ��I.� day of
��ot�e� , 2 0 0 9 .
.-, G�. ��
� (SEAL)
MARGAR A. ROSS
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
(, f
Address
3
A. Settlement `�tatement U.S.Department of Nousing and Urban Development
r B.� Type of l„`ar OMB A roval No.2502-0265
1. ❑FHA 2. ❑FmHA 3. pConv.Unins. fi.File Number 7.Loan Number 8.Mortgage Insurance Case Number
4. VA 5. Conv.lns. 32675MALLIOS
�a orm ia grva you a s mian � ca . Qun pa o y •s aqan ars w�n.
�C.Note: nema ma�xea•ID.o.c.l'wrs w�A ouaid�tlr dow�u»y ar.,�w�,n«.b.�r«mauo�p,�o....m w�a�mww r u»iaw. TideExpress Settlement Sysler
WARNING:X b a auns to klar�irpy m�k�fNw s �nb b IM Unit�tl S41y m MI�a oUwr tYniar Mrm.P�nYtlM upan
�����„a.,r.�„d�m Fo,da,r...ru.ie u.s.coa.s.cua,'i�o�,na s.cyu„ioi o. Printed 09/16/2014 at 15:41 CL'
D.NAME OF BORROWER: John J.Mallios and Jamas T.Mallios
AD�RESS: 3967 Brookrid e Dr. Mechanicsbur Pa 17050
E.NAME OF SELLER: Estate of Margaret A.Ross
ADDRESS:
F.NAME OF LENDER:
ADORESS:
G.PROPERN AODRESS: 9 Courtland Road,Camp Hill,PA 1T011
Lower Allen Townshi
H.SETTLEMENT AGENT: Ceda�Cllfl AbsUad Agency,Inc.,Telaphane:717•7747435 Fax:717.774-3869
PLACE OF SET7LEMENT: 414 Brid e Str New Cumberland PA 170T0
I.SETTLEMENT DATE: 09N9I2014
J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE FROM BORROWER 400,GROSS AMOUNT DUE TO SELLER
101. Contract sales ce 50 000.00 401. ConUact sales ' 50 000.00
102. Personal Pro 402. Personal
103. Settlement char es to borrower line 1400 1 104.00 4Q3,
104.
404.
105.
Ad ustrnenls for items aid b seller in advance Ad ustments for itema aid b seller in advance
106. Cit Itown taxes 406. Ci Itown tau
t07. Ca,nt taxes 09119H4to11131H4 150.41 407. Count taxes 09H9H4to12131h4
108. Schooitaaes 09I19H4to06130H5 150.41
815.10 408. Schooltaxes 09H9114to06130h3 815.10
109. �.
110. 3rd tr sewedtrash rtn 09N 9N 4 to 09130H 4 14.67 410. 3rd sewedlrash rtn 09h 9N 4 to 0913W14 14.67
i i t. 411.
112. 412.
120.GROSS AMOUNT DUE FROM BORROWER 52184.18 420.GROSS AMOUNT DUE TO SELLER
100.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 50 980.18
201. De sil or e est mone 5 000.00 1. Ex i s i
202. Prind al amount of new loans 502. Settlement ch es to seller line 1400 520.00
203. E�cistin loan s taken sub e�t to 503. Existi loan s taken sub ect to
204.
504. Pa off f First Mat Loan
205.
206. 506.
207.
507.
208. 5�
209. 509.
Ad ustments for items un aid b aeller Ad ustmenb for itema un aid seller
210. Cit Aown laues 510. Cit Itown tax
211. Counl taxes 511. Count taxes
212. School ta�ces 512. Schod taxes
213. 513.
214.
514.
215. 515.
216. 516.
217. 517.
218.
z�9 518.
519.
220.TOTAL PAID BYIFOR BORROWER 5 000.00 520.TOTAL REDUCTION AMOUNT DUE SEUER 520.00
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross artrounl due irom barower line 120 52 184.18 601. Gross amount due to seller�ine 420 50 980.18
302. Less amounts aid b/la borrower line 220 5 000.00 602. Less reduction amount due seller line 520 520.00
303.CASH FROM BORROWER 47184.18 603.CASH TO SELLER 50 460.18
SUt3STITUTE FORM 1099 SELLER STATEMENT:Th�in/wmanm conumaG t�eren u impp����iniqmabon uM is baug hmigl�eC�o Ih�Inlemal Revan�o$arv�e M
a ne9ligence psnalry ar a1Mf aenqqn WI W imp{ye0 On y0u d IM i W11 u r�!!tl b 0!t000f�l0 YM VN IR$GlfM111YIM NM 11 t1A f101 D!!fl Y�8!�requua0 W RN a re4Yt1.
�rtro 407 aDov�cauuw�a ttr G�a��ProceW�d MIa Vnaacmn. �aC.TM Contrw saN.Pnc�ae�rnWd on
Vou are requre0 Dy law ro proNtle Mo sealamaM agen�(Fetl.Taa IO No:
num0ar.You may be suqaq lo awl or cmm�N DwulUa w�powd by in..�j vnU�yaur carect uxpayer idenUOcaom numGx.M you Ao na GrrnnCs Wur oorrxt taypayer Mentification
wIWY.1 cvuy tIW MN nimDr�hown m Ihn Wtemenl u my caraq taxp�ya�Wx�uficalbn rnmDer.
�IN:__-__. _� __ SELLER�S)SIGNATURE(5�'
/
SElLER1S)NEW A/AILING AppRESS:
SELLERIS�PHONE NUMBER$: (M) `W)
U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number:32675MALLIOS PAGE i
SE7TLEMENT STATEMENT TitleEx ress SetUement S stem Printed 0 911 6120 1 4 at 15:41 CLT
l. S LE ' T CHARGES PAID FROM PAID FROM
700.TOTAL SALES/BROKER'S COMMISSION based on nce 50 000.00= BORROWER'S SELLER'S
� Divisan of commission line 700 as follow: FUNDS AT FUNDS AT
701. to SETTLEMENT SETTIEMENT
7U2. lo
703. Commission aid at SetUement
800.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Lo�Ori ination fee 96
802. Loan Discount %
803. A aisal Fee
804. Credit Re
805. Lenders�ns ion Fee
806. Mort e A lication Fee
807. Assum tion Fee
808.
809.
810.
811.
900.ITEMS RE UIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From ro /da
902. MoA insurance Premium ta to
903. Hazard Insurance Premium fa to
904.
905.
1000.RESERVES DEPOSITED WITH LENDER FOR
1001.Hazard Insurance r�, ��
1002.Mort insurance mp, ��
1003.Ci Pro Tax Rq, �
1004.Count Pro Tau �. qq.���
1005.Schod taxes mo. 87.30 Imo
1009.A r ate Anal sia Ad'ustment 0.00 0.00
t 100.TRLE CHARGES
1101.Se lemen or in fee '
110Z.Ab V or tit se
1103.Title examinaUon
1104.Title insurance binder
1105.Document Pr aration
1106.Not F
1107.Atlome's fees
indudes ve items No:
1108.Title Insurance to Cedu CII(f Abstrad A en Inc. 625.00
indudes above items No:
1109.Lender's Pol'
1110.Owners Poli 50 000.00 •625.00
111 t.
1112.
1113.
1200.GOVERNMENT RECOROING AND TRANSFER CHARGES
1201.Recordi Fees Deed 79.00 Mort Release 79.00
1202.Cit ICount tau/tam Deed 500.00 Mort 500.00
1203.State Taxlstam Deed .00 Mat 500.00
1204.
1205.
1300.ADDITIONAL SETTLEMENT CHARGES
1301.Surve
1302.Pest tns ion
1303.2014 Count taxes to Bonnia K.MilleN P.O.C. 533.04 Seller
i304.2014 School taxes to Bonntt K.Miller' P.O.C. 1 047.58 Seller
1305.Tax cert fee ro Stone LaFaver fl Shekletski 20.00
i 306.3rd tr sewernrash to Lower Ailan Townahl P.O.C. 122.70 Seller
1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Sectiai J and 502 Section K 1 204.00 520.00
MUD CERTIFIGTqH OF BUYER AND SELLER
I�a�.a carefully reN a 0.1 Senlamenl St rq b IM WN d mY knoxAaOga�ny pMpf.�i��p��kp�yt�tlaWnent d ecayflt�rq tliiOWawnany meM on my 1
or ny ma in inia trans � uwt ■capy d tM HUQ7 S�ItlrrMM SW�mwil a un
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amr
Eslale of AAargar6l A.Rma
E�vvi"" �� �Lii7M1.OA
oY nB13�wa.YwT�Bsi,u-acuuni �/� . _--
V
WARNIN(3-IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE i�a MUPt Seltlemen�Sla�ement wmU I h y►�prepere0la a true anC acc�ra d Ihis
UNI7F.D STATES ON THIS OR ANV SIMM.Afi FORM PENAITIES UPON CONVICTpN Uenaac4on.I heve wubW p wy qyy T���y�p pe yypy�y�y in a yy�ry� � ��
f:AN IN(:l UDE A FINE ANO IMPRISONMENT FOR OETAIL$SEE TITLE 1!: n�
US.COUE SECTION t001 ANO SECTION 1010.
SETTLEMENT AGENT DAT�___��l��
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Z:\RE�DED\Ross.Margaret—9 CouRland Road 1
Tax Parcel#: 13-23-0557-091
Addrees:9 Courtland Road
Camp Hill,PA t701 t
D_
THIS INDENTURE made the /�'J�hday of .S���ic�.�-- , in the year 2014,
between HELEN M. SZEMESI, Executrix of the Last Will and Testament of MARGARET A.
ROSS, late of Lower Allen Township, County of Cumberland, and Commonwealth of Pennsyl-
vania, of the first part, hereinafter called the Grantor,
- �ND-
JOHN J. v1ALLIOS and JAMES T. MALLIOS, as joint tenants with rights of
survivorship, of the second part,hereinafter called the Grantees;
WHEREAS, the said MARGARET A. ROSS became in her lifetime seised, as of fee,
of and in a certain tract of land, together with the improvements thereon erected, situate in
Lower Allen Township, County of Cumberland, and Commonwealth of Pennsylvania, and
Imore particularly described hereinafter; and being so thereof seised, died on February 2, 2014,
havrng tirst made her Last Will and Testament in writing dated October 7, 2009, duly probated
� and registered in the Office of the Register of Wills of Cumberland County on March 12, 2014,
wherein and whereby she appointed as Executrix, the said HELEN M. SZEMESI, to whom
Letters Testamentary were duly issued by said Register of Wills on March 12, 2014, wherein
, and whereby said premises hereinafter described were not specifically devised, all as in and by
� said Will and the records of said Register of Wills, recourse thereunto being had, appears:
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� YOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in
consideration of the sum of FIFTY THOUSANI} and NO/100------($50,000.00)-------Dollars,
i which has been paid to they by the said Grantees at or before the sealing and delivery hereof,
; receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and
i contirmed, and by these presents does grant, bargain, sell, alien, release and contirm unto the
' said Grantees,
i I
; .��LL THAT CERTAIN tract or parcel of land with the buildings and improvements
! thereon erected, situate in Lower Allen Township, Cumberland County, Pennsylvania, more
' particularly bounded and described as follows, to wit: ;
�
� BEGINNING at a point on the westerly line of Courtland Road, which point is two
hundred eighty (280) feet northwardly of the northwesterly corner of Cumberland and
; Courtland Roads and at dividing line between Lots Nos. 63 and 64 on the hereinatter j
mentioned Plan of Lots; thence along said dividing line at right angles to Courtland Road in a �
' �vesterly direction one hundred twenty (120) feet to a point at dividing line between Lots Nos. �
;
�6 and 63, Tract No. 3, on the hereinafter mentioned Plan of Lots; thence along said dividing �
line and along the easterly line of Lot Ivo. �6 on said Plan in a northerly direction sixty(60) feet �
� to a point at dividing line between Lots Nos. 62 and 63, Tract No. 3, on said Plan; thence along �
' said dividing line in a line at right angles to Courtland Road in an easterly direction one I
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hundred twenty (120) feet to a point on the westerly line of Courtland Road aforesaid; thence
along same South 24 degrees 15 minutes 30 seconds East, sixty(60) feet to a point, the place of
BEGINNING.
BEING Lot No. 63, Tract No. 3, on Plan of Lots known as Cumberland Park, which
Plan is recorded in the Cumberland County Recorder's Office in Plan Book 6, Page 3.
HAVING THEREON ERECTED a dwelling house known and numbered as 9
Courtland Road, Camp Hill, Pennsylvania.
BEING the same premises which Cleo A. Ross and Margaret A. Ross, his wife, by
Deed dated January 27, 1969, and recorded January 30, 1969, in the Office of the Recorder of
Deeds of Cumberland County in Deed Book "B", Volume 23, Page 935, granted and conveyed
unto Cleo A. Ross and Margaret A. Ross, his wife. Cleo A. Ross died on February 4, 1969,
thus by operation of law vesting title in Margaret A. Ross, deceased.
TOGETHER with all and singulaz the buildings, improvements, ways, streets, alleys,
passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances
whatsoever, thereunto belonging or in any wise appertaining and the reversions and remainders,
rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and
Idemand whatsoever of her, the said MARGARET A. ROSS, at and immediately before the
time of her decease, in law, equity, or otherwise howsoever, ot; in, to or out of the same.
� TO HAVE AND TO HOLD the said lot or piece of ground above described, with the
� buildings and improvements thereon erected, hereditaments and premises hereby granted or
� mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the
i only proper use and behoof of the said Grantees, forever.
�
� �YD the said Grantor, for herself and her respective heirs, executors and
administrators, does covenant, promise and agree to and with the said Grantees, their heirs and
assigns, that they, the said Grantor, has not heretofore done or committed any act, matter or
thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may
� be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever.
I
� IN tiVITNESS WHEREOF, the said Grantor has hereunto set her hand and seal the �
� day and year first above written. i
�
Si�med, Sealed, and Delivered • !
I •
in the Presence of :
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' . �%%��L�-�i?f�� • ��.J� � - SEAL) �
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i Witness : HELEN M. SZEMESI, Executrix of the Last
i
: Will and Testament of MARGARET A. ROSS �
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COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND :
On this, the �°�� day of � ' r— , 2014, befare me a Notary Public,
the undersigned officer, personally appeazed HELEN M. SZEMESI, Executrix of the Last Will
and Testament of MARGARET A. ROSS, known to me or satisfactorily proven to be the
person whose name is subscribed to the within inshument, and acknowledged that she executed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereto set my hand and notarial seal.
COMMON NOTAuiAL�YLVANIA
CAROL L.TRCXELL,Notary Public � ,
New Cumbe�la+'�d��r0��umbe�land Co. Notary Public
My Commission Expires Dec.27, 2017
�
I hereby certi that t recise addr f the Grantees is �d� �v �
�C /D�..
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DATE: � / l
Attorney tor�
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TAMMY SHEARER
RECORDER OF DEEDS ,;, � r. .��.�;.
CUMBERLAND COUNTY -�' '-`' �"'�`'.:':;`w;.
_._.. � .:.>::...
"��t.�..,��� ,.,�^ '
1 COURTHOUSE SQUARE ._ . -
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CARLISLE, PA 17013 : , � � �
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717-2-�0-6370 � .. � �" ; _ '
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Instrument Number- 201-121803
Recorded On 9/25/201=1 At 10:23:=17�l�t "Total Pages- �
• Instrument Type- DEED
Invoice i�lumber- 169103 Liser ID - S`V
"Grintor- ROSS, ��I�1RG:�RET A
"Grantee - �i�LLIOS,JOHN J
"Customer- SII�IPLIFILE LC E-RECORDING
"FEES
STATE TRANSFER TAX $500 .00 Certification Page
STATE WRIT TAX $0 .50
STATE JCS/ACCESS TO $35 .50 DO NUT DETACH
JUSTICE
RECORDINC�3 FEES — $11.50
RECORDER o� DEEDS This page is now �art
P�cEz CERTIFICATION �gis .o0 of this legal document.
FEES
AFFORDABLE HOUSING $11 .50
COUNTY ARCHIVES FEE $2.00
ROD ARCHIVES FEE $3.00
WEST SHORE SCHOOL $250.00
D ISTRICT
LOWER ALLEN TOWNSHIP $250 .00
TOTAL PAID $1,079.00
I Certifv this to be recorded
in Cumberland Cou�t�;�'A
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RECORDER OF DEED5
*-Information denoted by an asterisk may change during
the verification process and mav not be reflected on this pa�e.
� Erie
� Insurance'
. Your Auto Policy Deciarations (Amended)
Coverage provided by:
Erie Insurance Exchange
100 Erie Insurance Place Erie, PA 16530
www.erieinsurance.com Amendment Effective 02/1112014
Named Insured Policy N�ber—'--"� u�ERIE Agent Agent Phone
ESTATE OF MARGARET A ROSS Q 04126 CO UMERS INSURANCE AGENCY INC (717)763-7631
9 COURTLAND RD olicy Period 240 S 8TH ST
CAMP HILL,PA 17011-6610 01124/2014 to 01/24/2015 CAM HILL, PA 17011-5513
NAIC Code .consumers-insurance.com
26271
Total Annual Policy Premium: (This is not a bill.Your invoice will follow in a separate mailing.) . $610.0
Your premium is based ort Good DrhreF rate� .
YOUR COLLISION COVERAGE AND DEDUCTIBLE APPLY TO PRNATE PASSENGER AUTOS YOU OR A RESIDENT RELATNE
RENT FOR 45 DAYS OR LESS.THIS IS SUBJECT TO LIMITATIONS,TERMS AND CONDITIONS IN THE POLICY.
Vehicles Covered: Vehlcle Rating Information:
Vehicle VIN State Use Annual miles
1. 2001 PONT GRANDAMSE 1G2NF12E51M637497 PA Pleasure up to 8,500
Driver Rating Information:
Drivers Included Age Status Gender Vehlcle
MARGARET A ROSS 91 Single Female 1
If a driver is not a resident relabve as defined in your policy,coverages,benefits and rights may be limited. Refer to your policy and its
endorsements for terms,definitions,limitations,reductions,exclusions and conditions.
Discounts that apply: Vehicle:
Age 55 or aver Discount 1
Anti-Lock Brake Discount 1
Mul�-Policy Discount-Auto/Home 1
Passive Restraint Discount/Dual Airbags 1
Pay Plan A Discoun� 1
Prior Bodily Injury Limits Discount 1
Safe Driver Discount 1
Thank you for being a responsible driver.The Safe Driver Discount has been applied to your policy premium.
Feature Fifteen applies to your policy. Because you've been a loyal ERIE customer for at least 15 years,no surcharge will ever be
applied to your policy for future at-fault accidents.
00000� �
PA DEC 04/13 AGTPLG 02/11/2014 20:47:28
C229934 _ � . �
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A. PA TITLE NUMBER(AS SHOWN ON ATTACHED TITLE) �' MAKE OF VEHICLE MODEL YEAR
�y "� } I PURCHASE PRICE I
�Q �'/ >�"r��`� -�i "-� c�_—y � K J /�� y'�e [�� �/ (See Note on Reverse.) �j � `"...�
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CL� c.� ���
s V VErHICLE IDENTIFICATION NUMBER CONDITION
��a J�j"�/� �I G �� � f/} ��� �C� O GOOD O FAIR O POOR LESS TRADE•�N
e
B LAST NAME(OR FULL BUSINESS NAME) FIRST NAME MIDDLE NAME
,W TAXABLE AMOUNT
� J
CO-SELLER
;N . �7. SALES TAX DUE .-
X 6,�.06�.X�,�.��,OR ;�:,j .._..._
LAST NAME(OR FULL BUSINESS NAME) FIRST NAME MIDDLE NAME pA DL/PHOTO ID# DATE OF 81 TH X 8%(.OB) ��
C *(See Note on Reverse)
O US.ID�
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C tp.:EXEMPTION�
w —+" � �� � `� � � � REASONCODE(mus4� � � �
� � CO-PURCHASER LA NAME FIRS NAME MIDOLE NAME PA DL/PHOTO ID# DATE OF BIRTH be a number from 1 to. � � . . . .�
W 23w0)�:.. �
y ¢ � 1B.FIRST � � 18.SECOND��� �.
� v - �' �ASSIGNMEN'F . � �ASStGNMENT � . �.
� � STREET � COUNTY CODE .�EMPTION NO. � � . EXEMpTIdN NO:.. �
y �7��� �-��bYl f�,�' � �� .�-- ,
2. TITLE FEE `} U. /'�
CJ
CITY STAT ZIP CODE DATE AC�UIRED/ REFER TO COUNTY COOES
� (� � / / ��,�(' PURCHASED
�v�-� J� J OF YELLOW COPY SE SIDE 3. LIEN FEE
LAST NAME(OR FUIL BUSINESS NAME) FIRST NAME MIDDLE NAME PA DLIPHOTO ID# DATE OF BIRTH
D oR eus.ion
4. REGISTRATION OR
PROCESSING FEE � �U'
CO-PURCHASER LAST NAME FIRST NAME MIDDLE NAME pq DL/PHOTO ID# DATE OF BIRTH
WW FEE EXEMPT NUMBER � �
y AS ASSIGNED BY THE
z = DEPARTMENT � � �
� � STREET COUNTY CODE
5. OUPLICATE REG.
< a � FEE NO.OP
NN CARDS_
��fy STATE ZIPCODE DATEACQUIRED/
PURCHASED REFER TO COUNTY CODES 6. TRANSFER FEE
LISTING ON REVERSE SIDE
OF YELLOW COPY
E• MAKE OF VEHICLE VEHICLE IDENTIFICATION NUMBER
7. INCREASE FEE
J�
Up
_� MODEL YEAR BODY TVPE(CP,TK,ETC.) CONDiTION 8. REPLACEMENT FEE
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O GOOD O FAIR O POOR
TOTAL PAID 9� 10. .. .
PLATE TO BE ISSUED BY O TRANSFER OF PREVIOUSLY ISSUED PLATE (ADD 1 THRU 8) ,
F. '" ~
DEPARTMENT(PROOF OF O TRANSFER&RENEWAL OF PLATE�
INSURANCE MUST BE O TRANSFER&REPLACEMENT OF PLATE 11.GRAND TOTAL SEND ONE C CK IN /
ATTACHED.) (ADD 9 8 10) THIS AMOU T� ��V' U� `�
O EXCHANGE PLATE TO BE O TRANSFER OF PLATE&REPLACEMENT OF STICKER
ISSUED BY DEPARTMENT p�,qTE NO. � � � � REASON FOR REPLACEMENT - '
O TEMPORARY PLA7E ISSUED � � � � O LOST O DEFACED O STOLEN O NEVER RECEIVED(Lost in Mail)
BY FULL AGENT(Note:This
plate will expire 90 days from EXPIRES Month Year NOTE: If"NEVER RECEIVED"block is checked,applicant must complete Form MV-44.
pZ date of issuance.) VIN
a p . . TRANSFERRED FROM TITLE NO.
O~Q
vy . SIGNATURE OF PERSON FROM WHOM,SIGN HERE RELATIONSHIP TO APPLICANT
�c7 � PLATE IS BEING TRANSFERRED(IF
a w TEMP.PLATE NO:,:
Q y ._.� ...O T H E R T H A N A P P L I C A N T)
VEHICLE PUR�kFRSED WEIGHT GVWR UNLADEN WEIGHT REQ.REG.GROSS WT. RE�.REG.GROSS GOMB.WT.
INFORM 70N F APPLICAB E INCLUDING LOAD (IF APPLICABLE)
,t�/�/� �POLICY NO. OR POLICY.EFFE�{T E POLICY PIRA�I N
INSURANCE�� Y V I 1 ATTACH BINDER Q DATE ""_1 � �� DATE ��^ �!
1 CERTIFY THAT ON MONTH �AY YEAR ISSUING AGENT(PRINT NAME) AGENT NO.
ISSUING I HAVE CHECKED TO DETERMINE THAT THE VEHICLE IS INSURED AND
AGENT ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPLICANT,IN �SSUING AGENT SIGNATURE TELEPHONE NO.
INFORMATION COMPLIANCE WITH ALL APPLICABLE PROVISIONS OF THE VEHICLE
CODE AND DEPARTMENT REGULATIONS. ( �
G`. INVE CERTIFY THAT I/WE HAVE EXAMINED AND SIGNED THIS APPLICATION AFTER ITS COMPLETION.IIWE FURTHER CERTIFY THAT ALL STATEMENTS HEREIN ARE TRUE AND CORRECT AND
MAKE APPLICATION FOR CERTIFICATE OF TITLE FOR THE VEHICLE DESCRIBED IN SECTION A.IF ANY EXEMPTION IS CLAIMED,THE PURCHASER FURTHER CERTIFIES THAT HE/SHE IS
AUTHORIZED TO CLAIM THIS EXEMPTION.I/WE ACKNOWLEDGE THAT I/WE MAY LOSE MY/OUR OPERATING PRIVILEGE(S)OR VEHICLE REGISTRATION FOR FAILURE TO MAINTAIN FINANCIAL
RESPON5161LITY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRATION.IIWE ACKNOWLEDGE THAT I/WE MAY BE SUBJECT TO A FINE NOT EXCEEDING$5,000 AND
Z IMPRISONMENT OF NOT MORE THAN TWO YEA(tS FQR ANY FALSE STATEMENT THAT MAKE ON THIS APPIICATION.
O
� �ST Signature of First Purchaser or Authon � 'r Teiephone'jNo,_� �
� ASSIGN- ���� � �� �r t �,,� ��� �
� MENT Signature of Co-PurchaserRGe of Authonzad Signer (
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V Telephone No.
2ND Signature of Second Purchaser or Authorized Signe
ASSIGN- ( )
MENT ignature o o- urchaser it e o uthonzed igner
F{,� O NOTE: IF A CO-PURCHASER OTHER THAN YOUR SPOUSE IS LISTED AND YOU WANT THE TITLE TO BE LISTED AS"JOINT TENANTS WITH RIGHT OF SURVIVORSHIP"(ON DEATH OF ONE
Z W Q OWNER,TITLE GOES TO SURVIVING OWNER.) CHECK HERE O. OTHERWISE,THE TITLE WILL BE ISSUED AS"TENANTS IN COMMON"(ON DEATH OF ONE OWNER,INTEREST OF DECEASED
�F� OWNER GOES TO HISIHER HEIRS OR ESTATE.)
Q~Z NOTE: IF THE VEHICLE IS TO BE USED AS A DAILY RENTAL OR LEASED VEHICLE,CHECK THIS BLOCK O. If BLOCK IS CHECKED,COMPLETE AND ATTACH FORM MV-iL.
MESSEkGER NO.
_.-`�.PPLIC���T'S C;OPY/TF�4PORP.F2Y RF 51STRATIC�N(VALID FC�R 90 DAYS)
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I Mar, 28. 2414 3: O7PM PNC Bank No. 9104 P, �/�
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March 2$,2014 .
Gerald J Shekletski, Esq -
Stone,Y,afaver& Shekletski
414 Bridge St
PO Box E �
Ne�c�v Cumberiand,P,A �7070
R�: Name: Mazgazet A�oss
SSN: 1$8-12-3545
170b: 02/02/2014
Taeax�Mr. Shelrletsl�i:
Tn response to yaur request for T�ate of l�eath(DOb)balances far the customer noted above, our
records show the fallovving:
Checking Account
Account#5140053916 Estab��shed: 01/01/1969
� Tv1ARCrARET A RfJSS
HELEN M SZEMES�
DQD balance: $ b4,3S4_88 noz�-i�uterest bearing
Please note that this o�f�ice pxovides date of deatk�balances far deposit accounts(T�As,Cl]s, Checlong an,d
Sa'vings). 'OVe do not process any financial transactions or provide statement,s. Zf'�ou need assisCance with
any o�ft}aese ite�oas,p�ease ca�i l.Sgg_pNC-BANK(1-888-�62-2265)or seop by your local phYC$atxk b;ran,ch
office.
Sincerely,
�Tatxor�al Fznancia,l Servxces Center
PNC Bank,N.A.
Member�'�7YC
This message rs inrended for rhe use of rhe individual or entity ta which it is addressed and may
cantain informatian that isprivilege� confidential and exemptfrom disclosure under applicable law.
If the reader of this message is not the intended recipient or the ernployee or agent responsible for
delive�ing this message to the interu�ed recipfent;you are�iereby notified that any disseminatiori,
distribution ar copying of rhis communrcations is sdrictly pro�Zibited. If you have recefved this
communication rn et�ror,please notify me immediately by reply or by telephone at 800-762-�775 and
irramediately destroy this faxed document.
Pa�e 1 of 1
STONE LAFAVEI3 & SHEKLETSKI
ATTORNEYS AT LAW
414 BRIDGE STREET
DAVID H.STONE POST OFFICE BOX E OF COUNSEL
GERALD J.SHEKLETSKI NEW CUMBEBLAND.PA 17070 CHARLES H.STONE
www.s[onelaw.net JON F.LAFAYER
TELEPHONE(717)774-7435
FACSIMILE (7l7)774-3869
October 27, 2014
Register of Wills of Cumberland County
1 Courthouse Square
Room 102
Carlisle, PA 17013
Re: Estate of Margaret A. Ross
File No. 21-14-0232
Greetings:
Please find enclosed two original Inheritance Tax Returns, and an original Inventory
form in the above referenced estate.
Enclosed is a copy of the cover page of the Inheritance Tax Return and a copy of the
Inventory form. Please time stamp those copies and return them to us in the enclosed self-
addressed, stamped envelope, which I have provided for your convenience.
Thank you for your attention and assistance in this matter. Please don't hesitate to contact
us should you have any questions regarding this matter.
Very truly yours,
STONE LaFAVER & SHEKLETSKI r.�,
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Gerald J. Shekletski, Esquire = ����
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