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Home My WebLink About02-0922 PETITION FOR PROBATE and GRANT OF LETTERS No. ~l-o a.q d.~ To: VIOLET A. HALE Estate of also known as Register of Wills for the Deceased. County of Cumhprl Rnd in the Social Security No. 198-71-9411 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut rix in the last will of the above decedent, dated OrtohPT 10, 7000 and codicil(s) dated None (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in r.nm'hprl ~nrl her last family or principal residence at 325 Wesley Drive Center), Mechanicsburg [Lower Allen Township]. (list street, number and muncipaLity) County, Pennsylvania, with (Bethanv Villa~e Retirement Decendent, then 98 years of age, died Oc tober 4. 2002 fC!<9 at Bethany Vi 11::Lge Retirempnt Cent.p.T, T.olJer-All en Town~hi p, Cllmhprl ::mrl C:ot.1nty, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: None Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) . All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: None Unestimated $ $ $ $ Nonp. WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters t p.~ r ;lmPon r:1 ry (testamentary; administration c.La.; administration d.b.n.c.t.a.) theron. k -m ~-~ Joan M. Staub 800 Shuler Street Mpf"h::mir.c:.hnre, VA 17nC)C) v u c v :2-;; "~ V" "'v C -00 co';:: <):1"';:: _v ","- v~ ;;0 ;;; c " Vi OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I S8 COUNTY OF CUMBERLAND J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of lhe knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~ M A~.~ Joan M. Staub Sworn to or affirmed and subscribed { before me this 1 1 T h day of ~~~~ '" 0;;" " .. - ::: ~ ~ II -q~-~ No. ;;>1-02-922 Estate of "10LET .'^.. M.1\.LE . Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Oc tober 1 1 t9r ?OO? 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 Oc tober 10, 2000 described therein be admitted to probate and filed of record as the last will of VIOLET A. HALE and Letters Testamentary are hereby granted to Joan M. Staub Probate, Letters, Etc. ......... $ Short Certificates( ).......... $ ~ilCf.fffiSn .",~.t,~~. .p.a9.e:~ $ -;Co $ 10_11_2(f~IAL - $ Filed ................................... 235.00 9.00 6.00 5.00 255.00 ,.~ FEES (717) 697-8528 PHONE mailed to atty 10-11-2002 :-.:-; u..: liIU'J,IlU:; REV ':1/116 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local R,gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 8606933 No. ~~IR~.~7 rP-dLJ.Lf./I..-? dOrJ ~ Dare 1,,,j,:<JR..2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH -~PEJP"INl '" ~E"Ill"'NEN' OLACklNk ,.. ~, ,. SWE.U:"""WIIa< Female SOCIAl. T~RI'N NUIIII8E~2 , - - 9413 "'''m81ll!r~'2l102 .. NAME Of DECEDeNT(F... _. ,...) , VlvLE:T AGE Ila>l 601MoYl UNDER 1 YEAl'l - - llIfIT-....ciIC",,-, ~"'f..._C<..n"~1 Mechanicsburg, P I'L'CEOFDERHlCt><<I<Of'I/y,.,.___~",,__ HOSPl'W., ____0 E~O 911. , COUNTYOl'OEArH Cumberland Bethany Village - M. DECEOEN1'$lJSUI4.~ 1c..._oI__do.-iW oI_ing' ... I I!'a'fer."a orker IUNOOFIIUSlNESSIlttDUSTRy Education 'N'.SIlECEDEIflE'iERIH US._OF0ACE57 _0 NDOX DECEDEHTOSEOUC,JlfIllN II.. DECEDENT"$IIU.llINGIlOOflEU(Slr".C~.sr..ZlpCocMI 325 Wesley Drive Mechanicsburg, Pa. 17055 OIIOCEDEHT'S ~,. ",,,'" -- -- 1111. sa... ::"'0 _lAlSWUS._ NI__...*-, ~ed -....... 111-.__- __iP - ,. FRHER'S_(F~.,_.laIll George McLane Joan Staub Cumberland 174.0 ::.:...-=-=... MOTtIEIl'$_(f~.."'-,.._s...-.. Bertha Arbegast , -""""''''"YiJ1lli~u'l'~~~csburg, Pa. 17055 ,_. ". Wl'ORI.WtT'SIWoIl!{lI'l*f'1ir4 o . . , < " fllETHOOOl'DlSPOSl'~ O __141 ~O ""- - ... """" ,,-,-__0 Oct e, 2002 I"t.ACf:OFOISI'OSn'IllN........ot~CreIIIMary orOllotf~olling Green Memorial Park 210. , ANOAllClREJ;:S~al Home, Inc. 37 East Main Street Mechanicsburg, Pa 170 5 H. U.MIIT/: f_fhe_.;nplMor____"'*"_.........oo L.......,__OIl__ ) j"~~'" ;~/'5t,...,.. DUE 1DjOR AS A COtCSEOUENCt: Of): b l(cJ I: OUflDjOR...sACQ<ISEQlJEt<<:;EOf): DUElDjORASACONSEOUENCEOf): wEREAUftlf>SYFlNOlNGS -""""'" COW'\.ETIOHOf'CAUSl: ~~, _ROf'OERH DIll"EOfltUURY ,-,Oay,-I ~ o o U)cRIOH.~_.Zipea. Camp Hill, Pennsylvania 17011 ~--.-. RN 52.2.2..14- L r ""5CASEREFERREOTO:O~..iilf J.oo'L ._. '-- :--...... . 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AflOAODRESSOF PERSON WHO COMPI.ETEOCAUSE OF \lENH 2t)TporP,int 1)... ~.P'\.D '1..01 \10."'~ ""\':'0 ~ o L.AW OFFICES SNELBAKER. BRENNEMAN & SPARE LAST WILL AND TESTAMENT ,Q J - 0:2 - 9 c2~ I, VIOLET A. HALE, of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath unto BETTE SINGISER a sum of money equal to the lesser of One Thousand ($1,000.00) Dollars or flYe per centum (5%) of my net distributable estate, absolutely, if she survives me. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my niece, namely, JOAN M. STAUB, absolutely and in fee simple, if she survives me. If the said JOAN M. STAUB does not survive me, then and in that event, I give, devise and bequeath my said residuary estate unto my niece, namely, GERALDINE B. EBERT, absolutely and in fee simple, or, if she should not survive me, then to her issue per stirpes. LASTLY. I nominate, constitute and appoint my niece, namely, JOAN M. STAUB, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my niece, namely, GERALDINE B. EBERT, to be the Executrix hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, VIOLET A. HALE, have hereunto set my hand and seal to this my Last Will and Testament, which consists of two (2) typewritten pages to each of which I have affixed my signature this ~ay ~eber, A.D. Two Thousand (2000). V~a~ VIOLET A. HALE (SEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by VIOLET A. HALE, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ~~ gy. - J & c ~:::r LAW OFFICES SNELBAKER, BRENNEMAN & SPARE .2. COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, VIOLET A. HALE, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. t/~ a. lLA ~u ~ Witness --gw~:e~ ' ~ Subscribed, sworn to and acknowledged before me by VIOLET A. HALE, the Testatrix, and subscribed and sworn to before me by RICHARD C. .L. Oc4lt.r SNELBAKER and JANE J. COONEY, the witnesses, this /Oa day of g811t8m13~r, LAW OFFICES SNELBAKER. BRENNEMAN & SPARE 2000. 1IanlfI81C.=~ PublIc ~~~~ ~r."",,"~"!' ".._ol ~ <Arl~, -f<dhf1Clnh Notary Public COMMONWEALTH OF PENNSYLVANIA OEPAATMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA t 7128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SNELBAKER RICHARD C ESQUIRE 44 W MAIN STREET MECHANICSBURG, PA 17055 ~------- fold ESTATE INFORMATION: SSN: 198-22-9413 FILE NUMBER: 2102-0922 DECEDENT NAME: HALE VIOLET A DATE OF PAYMENT: 12/20/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/04/2002 NO. CD 001973 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $18,000.00 I I I I I I I I TOTAL AMOUNT PAID: $18,000.00 REMARKS: RICHARD C SNELBAKER ESQUIRE CHECK# 105 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS /'J- c; 71-6~ v QFFIC/.4l USE ONLY REV-1500EX(6-001 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILENU B R 21 2002 .-o92~ __ YEAR NUMBER COUNT'/ CODE SOCIAL SEaJRITY NUMBER 198-22-9413 CECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ Hale, Violet A W OA.TEOFDEATH (MM-DD-YEAR) ClATEQFBIRTH (MM-OO-YEARJ @ 10104/2002 08/03/1904 u W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) C THS RETURN MUST eE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SEQJRITY NUMBER W I-- ::s:::~U) u."" w"-u J:~O Uo..ffi ~ [2{], D4 [2{]e D9 o 2. Supplemental Return 0 3. Remainder Return (date of death priorto 12-13-82) D 4a. Future Interest Compromise (date 01 death atler 12-12-82) D 5. Federal Estate Tax Return Required o 7. Decedent Maintained a living Trust (Attach copy of Trust) ~ 8. Total Numberof Safe Deposit Boxes o 10. Spousal PO\Ierty Credit (dale ofdealh between 12.31_&1 and 1_1.95) D 11. Election to tax under See 9113(A) (Attach Sch 0) Original Return Lim ~ed Estate Decedent Died Testate (Attach copy of Will) Utlgation Proceeds Received THIS SeCTION MUST se COMPLETeD: ALL CORReSPONDeNCe AND CONFIDENTIAL TAX INFORMATION SHOULD se 'DlReCTEO TO: NI\ME COMPLETE MAILING ADDRESS I-- Z W C Z C "- on w ~ 8 Richard C. Sne1baker FIRM NAME (If Applicable) Sne1baker Brenn TELEPHONE NUMBER 44 West Main Street Mechanicsburg, PA 17055 697-852 Real Estate (Schedule A) (1) (2) 0.00 0.00 0.00 0.00 179,653.48 0.00 OFFICIAL USE ONLY 2 Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4 Mortgages & Notes Recervable (Schedule 0) (4) 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 2 e, Jointly Owned Property (Schedule F) (e) 0 o Separate Billing Requested i= S 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ::) (Schedule G or L) I- 0: 8 Total Gross Assets (tolal Lines 1-7) <( U W 9 Funeral Expenses & Administrative COsts (Schedule H) (9) Cl: 10 Debts of Decedent, Mortgage Liabilities, & Liens (S<:l1edule T) (10) 11. Total Deductions (total Lines 9 & 10) 0.00 (8) 4,475.19 1,439.07 179,653.48 (II) 5,914.26 173,739.22 0.00 12 Net Value of Estate (Line 8 minus Line 11) 13 Charitable and Governmental Bequests/See 9113 Trusts for wflich an eleetion to tax has not been made (Schedule J) (12) (13) 14 Net ValUe Subject to Tax (Line 12 minus Line 13) (14) 173,739.22 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ;:: .. I-- :J "- " o u x .. I-- 15 Amount of Une 14 taxab\e at the spousal tax rate, or transfers under Sec. 9116 (20)(1.2) 0.00 0.00 0.00 26,060.88 26,060.88 0.00 0.00 0.00 173,739.22 X.OO_(15) 16 Amount of Line 14 taxable at iineal rate x 045...- (16) 17 Amount of line 14 taxable at sibling rate x 12 (17) x 15 (18) 18 Amount of Line 14 taxable at collateral rate (19) 19 TaxOue 20 o CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPA YMENT > > BE SURE 70 ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W46451.00Q Decedent's Complete Address: 5l'REEf A~O~ESS 325 Wesley Drive Lower Allen Twp. , Cumberland County CITY I STATE I ZIP Mechanicsburq PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C Discount (1) 26,060.88 0.00 18,000.00 900.00 Total Credits (A + B + C) (2) 18,900.00 3 Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total InterestlPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2. enter the difference. This is the TAX DUE. (5) 7,160.88 A. Enter the interest on the tax due (5A) 0.00 B (5B) 7,160.88 AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS IX] IX] IX] IX] I2?J I2?J contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [] [Z] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements. and to the best 01 my knowledge and belief, it is true, correct and complete Declaration of preparer other than ttle personal representative is ba~d on all information of which preparer tlas an,! Know\edge 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;. c, retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which D D D D D D /tt AAL-~.",D DATE -I/;;/n SIGNATURE OF ACORESS Exe utrix REP ESENTATlvE 800 ATE ADD ESS 4 We Street P.O. Box 318 Mechanicsburg, PA 17055 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% {72 PS 99916 (a) (11) (i)] For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivmg spouse is 0% [72 P S, 99116 (a) (1,1) (illj The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiCiary For dates 01 death on or after July 1, 2000 The tax rate 1m posed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S 9 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%, except as noted in 72 PS S 9116(12) [72 PS. 89116(a)(1)] The tax rate Imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P S, S 9116(a)(13)) A sibling IS defined, under Section 9102, as an Ir,dlvldual WhO has alleast one parent In common With the decedent, whether by blood or adoption 2W46461GGG REV-15a8 EX + ,1-97} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESiDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Hale 1 Violet A FILE NUMBER 21-2002 -0 922 I ncllJde the proceeds of litigation and the date the proceeds .....-ere receiVed by the estate. All property jointly-owned with the right of survl'lorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Citizens Bank, checking account #6100702669 VALUE AT DATE OF DEATH 36,314.30 2 Citizens Bank, Certificate of Deposit # 6140884101 20,007.14 3 PNC Bank, N.A., Certificate of Deposit #21001010842 20,063.57 4 PNC Bank, N.A., Certificate of Deposit #21001012358 20,062.52 5 PNC Bank, N.A., Savings account #5030010288 82,907.16 6 Old Guard Insurance, refund of unused premium 67.00 7 Capital Blue Cross, refund of unused premium 224.90 8 Verizon, refund on phone service 6.89 2W46AD2,ooa TOTAL(Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional Meet<<- 01 tt1e -s.ame <<-ite) 179,653.48 REV-1511 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE:SICENT CECECENT ESTATE OF Hale I Violet A FILE NUMBER 21-2002-0922 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 0.00 1. Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s} Commission Paid: 2. Attorney Fees Name : Snelbaker, Brenneman & Spare 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 255.00 5. Accountant's Fees 0.00 6. Tax Return F'reparer's Fees 0.00 7. Register of Willsl filing fee for Inheritance Tax 15.00 Return 8 PNe Bank, check printing fee and service charge 16.00 9 Cumberland Law Journal, advertising Executrix notice 75.00 10 Patriot-News, advertising Executrix notice 114.19 11 Reserve for filing fees, accounting costs and other 500.00 miscellaneous fees associated with the administration TOTAL (Also enter on line 9, Recapitulation) $ 4,475.19 2W46AG 2.000 (If more space is needed, insert additional sheets of same siZe) Estate of: Hale, Violet A Schedule H, Part B -- Administrative Costs Item No. Description 11 of Decedent's estate TOTAL. (Carry forward to main schedule) Page 2 21-2002-0922 Amount 0.00 REV-1512 EX + (1-97) COMMONVvEAL TH OF PENNSYLVANIA INHERlTANCE TAX RETURN RESICENT CECECENT ESTATE OF Hale, Violet A SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2002-0922 Include unreimbursed medical exnenses. ITEM NUMBER DESCRIPTION AMOU NT 1. AT&T, phone service, account payable 7.54 2 Conner Rich Associates, medical services 156.23 3 Bethany Personal Care, resident care, account payable 1,275.30 2W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,439.07 REV-1513 EX+ (9.00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hale Violet A NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)] Singiser, Bette 107 George Street Mechanicsburg, PA 17055 1. 2 Staub, Joan M BOO Shuler Street Mechanicsburg, PA 17055 FILE NUMBER 21-2002-0922 RELATIONSHIP TO DECEDENT 00 Not List Trustee(s) Friend Niece AMOUNT OR SHARE OF ESTATE 1,000.00 172,739.22 ENTER OOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABCVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-15CC COVER SHEET II. NDN-TI'oXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. :'W46AI1.000 TOT AL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15CC COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.00 ---: -' '\W OFFICES NELBAKER. ;~ENNEMAN &. SPARE LAST WILL AND TESTAMENT I, VIOLET A. HALE, of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. larder and direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath unto BETTE SINGlSER a sum of money equal to the lesser of One Thousand ($1,000.00) Dollars or five per centum (5%) of my net distributable estate, absolutely, if she survives me. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my niece, namely, JOAN M. STAUB, absolutely and in fee simple, if she survives me. If the said JOAN M. STAUB does not survive me, then and in that event, I give, devise and bequeath my said residuary estate unto my niece, namely, GERALDINE B. EBERT, absolutely and in fee simple, or, if she should not survive me, then to her issue per stirpes. LASTLY. I nominate, constitute and appoint my niece, namely, JOAN M. STAUB, to be the Executrix ofthis, my Last Will and Testament, but iff or any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my niece, namely, GERALDINE B. LAW OFFICES SNELBAKER. BRENNEMAN & SPARE EBERT, to be thc Executrix hereof, each and both to scrve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, VIOLET A. HALE, have hereunto set my hand and seal to this my Last Will and Testament, which consists of two (2) typewritten pages to each of which I have affixed my signature this ~ay ~eber, A.D. Two Thousand (2000). V~a.J:kL VIOLET A. HALE (SEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by VIOLET A. HALE, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ~ ~J~ -2- C01\Il\lONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, VIOLET A. HALE, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue inHuence. tJtit;C a. i-LA ~ Witness ~e~'~ Subscribed, sworn to and acknowledged before me by VIOLET A. HALE, the Testatrix, and subscribed and sworn to before me by RICHARD C. .b Oc"'-r SNELBAKER and JANE J, COONEY, the witnesses, this /Oa day of ~e~\lRl.B€r, L.A.W OFFICES SNELBAKER. BRENNEMAN Be SPARE 2000. NollIIIuI8oaI llendra Ie. Showers. "*IY PublIc ~~22,~ ~~r, ""~~11~"'!~ A!l'socfatfon at ~CVlY~aOob Notary Public COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU Of INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712.8~060' REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SNELBAKER RICHARD C ESQUIRE 44 WEST MAIN STREET MECHANICSBURG, PA 17055 _n_n.. fold ESTATE INFORMATION: SSN: 198-22-9413 FILE NUMBER: 2102-0922 DECEDENT NAME: HALE VIOLET A DATE OF PAYMENT: 04/28/2003 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 10/04/2002 NO. CD 002500 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7,160.88 I I I I I I I I TOTAL AMOUNT PAID: $7,160.88 REMARKS: JOAN M STAUB C/O RICHARD C SNELBAKER ESQ CHECK#107 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS 17 9/- 6- 'v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION IlEPT. 2BD60l HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RecOrded Re{li~t.;t DATE ESTATE OF DATE OF DEATH JUN -6 ^'1 :s,.fILE NUMBER h, . 'COUNTY ACN 06-03-2003 HALE 10-04-2002 21 02-0922 CUMBERLAND 101 Allount R...itt.d '03 RICHARD C SNELBAKER SNELBAKER ETAL 44 W MAIN ST MECHANICS BURG C:en~~ PA 170~\J1ffi'8 '*' ItEV.15U EX AFP (Gl~DS) VIOLET A J CHANGED IlJ 12J 13J 14J 15J 16J 17J .00 .00 .00 .00 179.653.48 .00 .00 18J MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rif,,=is4"j-EX--AFP-foF03rNoYiCE--OF-YN"iiEifiTANCE-YA:irAPPiAiSEM'ENT.--ALLOiiANCE-Oii----------------- DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HALE VIOLET A FILE NO. 21 02-0922 ACN 101 DATE 06-03-2003 TAX RETURN WAS: I X J ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Est.t. (Schedule A) 2. stocks and Bonds (Schadul. B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Hortg.gas/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule El 6. Jointly Owned ProPerty (Schedule F) 7. Transiers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule Hl 10. Debts/Hortgase Liabilities/Liens ISchedule Il 11. Total Deductions 12. N.t Value of Tax R.turn 13. tharltable/Governaental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax If an assessment was issued previously. lines 14. 15 and,or 16. 17. 18 and 19 will re'flect 'figures that include the total o'f ALL returns assessed to date. ASSESSMENT OF TAX: l5. Aaaunt of Line l4 at Spousal rat. Il5 J 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. A~unt of Line 14 at Sibling rate (17) 18. A.ount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX C S: NOTE: . INTEREST/PEN PAID I-I 947.37 .00 .00 DATE 12-20-2002 04-28-2003 05-27-2003 NU"BER CD001973 CD002500 REFUND 19J 1l0J 4,475.19 NOTE: To insure proper credit to your 8ccountl sublll t the upper portion of this forll with your tax paylltmt. 179,653.48 1;.914 "1(, 173,739.22 .00 173,739.22 00 = 045 = 12 = 15 = .00 .00 .00 26,060.88 26,060.88 1.439.07 IllJ Il2J 1l3J 1l4J .00 X .00 X .00 X 173,739.22 X AMOUNT PAID 18,000.00 7,160.88 47.37- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE Il9J= 26,060.88 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN fl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J \17- 57-/- S- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' IEV-IU7EXAFPUHIS) Re. " fie'.' '03 JON 30 ,~8 :00 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-09-2003 HALE 10-04-2002 21 02-0922 CUMBERLAND 101 bO\.llt Rellitted VIOLET A RICHARD C SNELBAKER SNElBAKER ETAL 44 W MAIN ST MECHANICSBURG e:en PA l-itJW~P~~f H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account, subnit the upper portion of this for. with YOur tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV=ir."ifj-E"x-AFP--foFii3Y------...-iNHERITANcE-i'Ax-sTATEiiENT-i1TAccouifi--.-.-.--------------------- ESTATE OF HALE VIOLET A FILE NO. 21 02-0922 ACN 101 DATE 06-09-2003 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS DF THE STATED ACN IN THE MANED ESTATE. SHOWN BELOW IS A SUHHARY DF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE DF LAST ASSESSMENT DR RECORD ADJUSTMENT: 05-27-2003 PR I NCI PAL T AX DUE: .......___..___.. 26,060.88 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-20-2002 CDOO1973 947.37 18,000.00 04-28-2003 CD002500 .00 7,160.88 05-27-2003 REFUND ,/ .00 47.37- TOTAL TAX CREDIT 26,060.88 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J LAW OFTICES SNEL8AKER BRENNEMAN & SPARE d./- {J;) -9~J.. RECEIPT AND RELEASE WHEREAS, Violet A. Hale, late of Lower Allen Township, County of Cumberland and Commonwealth of Pennsylvania, died on october 4, 2002, having first made her Last Will and Testament in writing probated before the Register of Wills of said Cumberland County on October 11, 2002, and Letters Testamentary were issued on the same date to Joan M. Staub, the Executrix named in the Last Will and Testament of said Decedent; and WHEREAS, said Executrix has entered upon and completed her administration of said Decedent's Estate as set forth in her First and Final Account attached hereto, and intends to distribute the net balance of the assets of said Estate to the person named in the Statement of Proposed Distribution also attached hereto, both of said documents being incorporated herein by reference thereto; and NOW KNOW ALL MEN BY THESE PRESENTS, that I, Joan M. Staub, being the principal legatee and distributee named in the Will of said Decedent and the persons entitled to share in the residuary distribution of the Estate of said Decedent, do hereby declare and say that I have examined the attached Account and Statement of Proposed Distribution, and find the same to be true and correct, and in strict accordance with the terms and provisions 1 of said Will, and I do hereby aCknowledge that I, this day have, had and received of and from Joan M. Staub, Executrix of the Estate of Violet A. Hale, the cash, personalty and/or real estate set opposite my name in the above Statement of Proposed Distribution, in full satisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purports and dividends which were due, owing and payable and belonging to me, by any means whatsoever, for or on account of my full share, part or dividend of the Estate of violet A. Hale, Deceased. NOW, THEREFORE, I, the said Joan M. Staub, do by these presents, remise, release, quit-claim and forever discharge the said Joan M. Staub, her heirs, executors and administrators, of and from my said shares or dividends of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whatsoever, from the beginning of the world to the day and date of these presents. AND, desiring to avoid the delay and expense of the settlement of said Estate by filing the foregoing Account of said administration in the Office of the Register of Wills of said Cumberland County and by having the balance in the hands of the Executrix, as shown by said Account, distributed by the Court of Common Pleas of Cumberland County - Orphans' Court Division, I do hereby agree that the foregoing Account and Statement concerning LAW OFFICES SNELBAKER BRENNEMAN & SPARE 2 LAW OFFICES SNEL8AKER BRENNEMAN Be SPARE the matter of settlement may be recorded with the same effect upon me as if the same had been reported upon by said Court, in a decree of distribution made on such proposed Statement of Distribution by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that I the said Joan M. Staub, do hereby agree that if any debts or demands other than those included in the above referenced First and Final Account, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that I will return to the said Executrix such amounts thereof as may be necessary to pay such debts or demands. IN WITNESS WHEREOF, I have hereunto set my hand and seal this S+h day of ~u.z:t WITNESSED BY: 2003. ~~.~ ftohhv ~ ~~.I- oan M. taub (SEAL) 3 LAW OFFICES SNELBAKER BRENNEMAN &- SPARE COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY CUMBERLAND) OF On this the StJ., day of ~u.,;t- 2003, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared Joan M. Staub, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~~-e~J Notary Public : NotarlaI Seal Sandta K. SI1owers. Nolary PublIC i MucIa~ BolO. Cl.o.b.la.1d COlInIy . My CommI8siOll Expires Nov. 22, 2003 ','r.m!:!ef, p;.~"!"!~I"I_'} }\.~~~ of 4 ESTATE NO. 21-02-0922 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY JOAN M. STAUB. EXECUTRIX OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF VIOLET A. HALE, DECEASED, LATE OF LOWER ALLEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA Joan M. Staub, Executrix as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: October 4, 2002 October 11, 2002 DATES EXECUTOR NOTICE ADVERTISED: Cumberland Law Journal Patriot-News October 25, November 1, 8, 2002 October 22, 29, November 5, 2002 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of the following items of Decedent's Personalty valued as of the date of Decedent's death: 1. Citizens Bank, Checking account #6100702669 2. Citizens Bank, Certificate of Deposit # 6140884101 3. PNC Bank, N.A., Certificate of Deposit #21001010842 4. PNC Bank, N.A., Certificate of Deposit #21001012358 5. PNC Bank, N.A., Savings Account #5030010288 6. Old Guard Insurance, refund of unused premium 7. Capital Blue Cross, refund of unused premium 8. Verizon, refund on phone service 9. Connor Rich Associates, refund on medical services paid 10. Capital Blue Cross, refund of unused premium 11. Commonwealth of Pennsylvania, refund on Inheritance Tax TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: $ 36,314.30 20,007.14 20,063.57 20,062.52 82,907.16 67.00 224.90 6.89 156.23 22.00 47.37 $ 179,879.08 PERSONALTY - PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Alert Pharmacy at Bethany Village, perscriptions 2. Silver Spring Ambulance, ambulance service 3. PNC Bank, N.A., check printing charge 4. AT&T, phone service 5. Connor Rich Associates, medical services 6. Bethany Personal Care, resident care 7. Register of Wills, Agent, estimated Inheritance Tax payment 8. Register of Wills, Agent, balance of Inheritance Tax $ 100.97 30.00 8.00 7.54 156.23 1,275.30 18,000.00 7.160.88 Page 1 9. Register of Wills, filing fee for Inheritance Tax Return 10. Bette Singiser, payment of bequest per hem Second of Will 11. Snelbaker, Brenneman & Spare, P.C., attorney services 12. Snelbaker, Brenneman & Spare, P.C., costs advanced: a. Cumberland Law Journal, adverising Executor's notice b. Patriot-News, advertising Executor's notice c. Register of Wills, probate fees 13. Reserve for filing fees, accounting fees and other costs associated with the administration of Decedent's Estate TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: 75.00 114.19 255.00 PERSONALTY - INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the following income from the investment of Personalty Principal: 1. Citizens Bank, Checking account #6100702669, interest 2. Citizens Bank, Certificates of Deposit, interest 3. PNC Bank, estate checking account, interest 4. PNC Bank, Certificates of Deposit and Savings, interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: PERSONAL TV - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Personalty Principal Account: 1. Greenawalt & Company, P.C., prepartion of Individual Income Taxes TOTAL, PERSONAL TV, INCOME ACCOUNT, CREDITS: REAL ESTATE - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of Decedent's Real Estate as follows: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Real Estate Principal Account: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: REAL ESTATE -INCOME ACCOUNT DEBITS LAW OFFICES SNELBAKER BRENNEMAN & SPARE The Accountant charges herself with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE. INCOME ACCOUNT, DEBITS: Page 2 15.00 1,000.00 3,500.00 444.19 500.00 $ 32,198.11 $ 0.74 45.02 1,057.79 105.4 7 1,209.02 $ $ $ 150.00 150.00 $ NONE $ NONE $ NONE $ NONE $ NONE $ NONE LAW OFFICES SNELBAKER BRENNEMAN 8: SPARE REAL ESTATE - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Real Estate Income Account: TOTAL. REAL ESTATE, INCOME ACCOUNT. CREDITS: $ NONE $ NONE Page 3 LAW OFFICES SNELBAKER BRENNEMAN & SPARE PERSONALTY: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY REAL ESTATE. PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: TOTAL FOR DISTRIBUTION: RECAPITULATION Page 4 $ 179,879.08 $ 32,198.11 $ 147,680.97 $ $ 1,209.02 150.00 $ 1,059.02 $ NONE $ NONE $ NONE $ NONE $ NONE $ NONE $ 148,739.99 $ NONE $ 148,739.99 LAW OFFICES SNElBAKER BRENNEMAN &: SPARE STATEMENT OF PROPOSED DISTRIBUTION Joan M. Staub, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Violet A. Hale, Deceased, to wit: $ 148,739.99 in accordance with the Last Will and Testament of said Decedent as follows: 1. Joan M. Staub 100% of residue as per Item Third of Will $ 148,739.99 TOTAL FOR DISTRIBUTION: $ 148,739.99 Page 5 COMMONWEALTH OF PENNSYLVANIA } SS: COUNTY OF CUMBERLAND Joan M. Staub, being duly sworn according to law deposes and says: that she is the Executrix of the Estate and under the Last Will and Testament of Violet A. Hale, Deceased, and the Accountant herein; that there are no unpaid creditors or claimants of said Estate; that there are no persons interested in the distribution of said Estate other than as stated in the foregoing Statement of Proposed Distribution; and that the facts set forth in the foreqoing First and Final Account and Statement of Proposed Distribution are true and correct to the best of her knowledge, information and belief. 9h;.'- llJ.- M..I- Joan M. Staub Executrix and Accountant Sworn to and subscribed before me this 5..ll day of ~ 2003 ~l1rLr k~~h~n = Notary Public Notarial Seal SandIa K. ShowerS. NotllIy PublIc ~ Bolo, C....oI>..I."o1 CouNy Wr'J lOll Explres Nov. 22, 200S M~_ Pt'~,?,/~,..,.,..,!-.. -,'l"~"r!..t!,..,... "t '''''''''''1';,l;S LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Page 6 Inventory of the real and personal estate of VIOLET A. HALE. Deceased PERSONALTY: 1. Citizens Bank, Checking account #6100702669 2. Citizens Bank, Certificate of Deposit # 6140884101 3. PNC Bank, N.A., Certificate of Deposit #21001010842 4. PNC Bank, N.A., Certificate of Deposit #21001012358 5. PNC Bank, N.A., Savings Account #5030010288 6. Old Guard Insurance, refund of unused premium 7. Capital Blue Cross, refund of unused premium 8. Verizon, refund on phone service $ 36,314.30 20,007.14 20,063.57 20,062.52 82,907.16 67.00 224.90 6.89 $ 179,653.48 TOTAL PERSONALTY: REAL ESTATE: 1 Decedent owned no Real Estate at the time of her death 0.00 TOTAL PERSONALTY AND REAL ESTATE: $ 179,653.48 Page 1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l j 55: Joan M. Staub L;K being duly sworn according to law, deposes and says that s,e ;" t-h", Executrix of the Estate of Violet A. Hale late of ----Lmi'aLAL1~T.QWJ)..sJ:liIL---~- Cumberland County, Pa., deceased and that the within is an inventory made by Joan M. Staub __ _ ., the said Executrix of the entire estate of said decedent, consisting of all the personal prop.rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Swo rn and subscribed before mel ~~~~~ 200J ,___h..__ Nmarial Seal . Sendra K. Showe1s, No(ary Public . -1icsIlurv Bo(o, CIJnbrland C<ultv My CommissIOn ExpIres Nov. 22, 2063 a!(l.!'!'!)er, F'~'~"~"~'-:~;",:", ,~"'.,.~.r!:,,:tj.~ot ~1Yi('ts Date of Oeath 4th 9(rn.A, ?/j ~/J ~.A- Executor - Administrator Joan M. Staub 800 ShuleL StLeeL Mechanicsburg, PA 17055 Address 2002 Day October Year Month INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. N N m o I N o I .-l N >- ..... w "" ..... w -< "- ..... o V> w "" w J: "- u.. ..... ...J u.. ...J -< 0 o -< ~ z o 0 V> z ffi -< "- . ..: +' Cll .-l o -.... :> ~ o I- Z w > Z Cll .-l <<J :Ii .; z Ii I I I . u . "" - Cll H ..... ..c: OJ c " o E-< C Cll .-l .-l ..: H Cll " o H H Cll ..I<: <<J .Q ~ .-l "'Cll .. C "-U) -ti ~ ~ .. '" u '" o .... ~ c ~ o ~ U '{j H <<J ..c: u ..... ....1':: o o CD .. "- >- - c " o U -0 c .. -;: '" .<l E " U -0 ~ u:: - - o '" - .. ...J STATUS REPORT UNDER RULE 6.12 ~dj( Name of Decedent: Violet A. Hale Date of Death: October 4, 2002 Will No.: 21-02-0922 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: l. State whether administration of the estate is complete: Yes [] No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No Q b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [i] No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed w' the Clerk of the Orphans' Court and may be attached to this re rt. Date: ~5/0 3 Si rv') N co Richard C. Snelbaker Name Snelbaker, Brenneman & Spare, P.C. 44 West Main Street Mechanicsburg, PA 17055 -:::': Address co I c:> :..;:J = (717) 697-B52B Telephone No. (f: "'"' p r' . ~ <J.C Capacity: 0 Personal Representative !:XI Counsel for personal representative