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HomeMy WebLinkAbout02-1015PETITION FOR PROBATE and GRANT OF LETTERS Estate of 1`1IRIAi~! A, FOGS also known as Deceased. Social Security No. 19~~2-~"~3~ No. 21' ~0~-1015 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 is/are 18 years of age or older an the execut ors named in the last will of the above decedent, dated T~Zay 30~ , 19~ and codicil(s) dated November 1'~, 199 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Curnb P r l and County, Pennsylvania, with her last family or princiLal residence at ~.~~ South Sporting hill Road Igechanicsburgs YA 1700 (list street, number and muncipality) D endent, then ~~ years of a e, died , November 3. 2002 , at ~~~anor Car. e ~Ie~h and ~el~abl'Ci-t~ion, amp Il1I, 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: 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: P?one WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Te s t amAxlt ary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ,N f v 'O ~~ v Racl:iard L. Foose `~ ° ~1 ~ncFlwee Road .~ .s G .~ ~~~; T~a,~y }~i n,~L7oi s ,~; a ~w 7 ~ C b0 / / Q II! Sharon L. Strock Z2I ti•lest I~Zain Street Sh i raman~i:~wn ~ PA l 7nl l OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ss COUNTY OF CUi'~ffiLRLI~iID The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will wel and truly a finis ,er the es ate according to law. Sworn to or affirmed and subscribed ~ before me this 1 ~ h day of a November ~ ?00? 1 0 Regi ter $ 76,000.00 No. Z{•o2- lO~s Estate of ?°~1=~~~~T~ ~~ • ~,oasL ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Tlovember 1 4f:'.~ ~y 202, 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 T~zayr 30, 1978 described therein be admitted to probate and filed of record as the last will of i~~Iiriam 1~. Foose and Letters ~' e s t ame nt ary are hereby granted to Richard L. 1+oose and Sharon L. Stroek FEES Probate, Letters, Etc......... . Short Certificates( ) ......... . ~s~~i~x..extra . gage codicil ToTA~oP Filed 1.1 -.1.4_ _ 2 0 0 2.... _ ... . $ 200.00 $ 9.00 s$ 9.00 $ 10.50 $ `~~~:QD mailed Register o ills J. Robert Stauffer (Tyro. OF>35F~ } ATTORNEY (S . Ct. LD. No.) T~Zarket Square ~ld~;. T~iechanicsbur~;, P~~ x-7055 ADDRESS '717-766-9673 to atty 11-14-20~l~oNE I f; U~.HrI~ V.1 \ !"un This is to cernfi~ u~at the intorniarion here given is correctly copied from an original certificate or dr~ati-1 cluiy filed w~tl~ me as Local Registrar.~'i he original certificate will be forwarded to the State Vital Records Office for perrna~lent ~ilin~;. WARNING: It is illegal to duplicate this copy by photostat or photograph, fee t~,r this certittr_ <re, 52.00 P_ 860.7427 ,. iY PE/PRIN7 IN PERMANENT BLACK INN ,III'''p,~TH OF pF~ ~ ~ ~ •- III~~ -may`: r i~ ~ ~ ~ Lcxa, hL ~ISrrar 'yy~~ ~ ~ ( J\ c f m. z , _ ~ _, r _ ,,,,,,,,,, i:l r.' COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH H,05.~of Rev 2107 NAME OF DECEDENT Iivs. MWda. LaPI ~~z~~ ~. ~% SOCML SECURITYNUMBEp wean __ _s __ DALE OF DEA7N M an. Oay. marl f Miriam A. Foose ,. Female ,_ 195 - 52 - 5315 .. November 3, 2002 AGEIIaa Bxmoay, UNDEp1YFiW U110ERf DN'_ DATE OF BIRTH BNyTHPUCF (C•ly arA - PLACE OF DEA7NICMce avy.x.e--xy,nync4x~smolnn vael -- ---- Monln Day '~perl Sla»alcregn CaunNYl Ma%M r wr Hasa . Ma»Iw HOSPITAL: OTHER: -__.. _._____-.__._.-_.__.____ 1914 Mechanicsburg, Pa 88 y» ? Mar 6 Irlptlrare ^ ERIQapMwN O DDA ^ ~ R ~ ~~ a a ~ , s. s. 7. .a .n[. sPe =+YI v. COUNTY OF DEATH CRY, BORO. TWP OF DEATH FACARV NAME III na mv~Mm. give Wee1 and rwmoari NNS DECEDEM dF HISPANIC ORIGIN? RACE - Amsrcan In6an. 04cA, YMee atc Ispech) No ® yM ^ N Ye.. apacdy cee.n . Cumberland Camp Hill Manor Care Health and Rehabilitation Maarun.PuNfoRCan.qp White IW . In. Ed. s. fo. ' _ DECEDENT S USUAL OCCUPATION NWOlX BUSINESSIINDUSTRY VMS DECEDENT EVER IN DENT'SEp1CAT10N MARITAL STATUS~Man»d SURVIVING SPOUSE {Cave hrradvAxN aa»de motl U. S. ARMEDFOR C E57 n an rover Mani W. Wvbeed, In Me }.~n~anai namal d a ab a e~ [ F ~J »a uq : na use C°wN• D.»r[.d lspe[M ir•al Own Home Yaa ^ W W EI"'r"rl•""B•4°"d'R' Homemaker jO'n 1''a5" Widowed • ,,.. ,7e- ,7. n la. m. DECEDENT'S MAILING ADOfiESS ISo M.CryROwr. S1aY. Zy Ca0e1 UECEDENT'S Penns Iyania ACTUAL l7 g l ~ 17 Ham ® den 355 South SDOrtinq Hill Road a. a . _ c. p ,,,~ da W,aecedan w.d in RESIDENCE a.cw.m ---- • - Mechanicsburg, Pennsylvarna 1705 See aouocaana wen a an«sa.f Cumberland '°""'"p7 p w „ W" ~ Il ' ,,,- ;, ~ ~anry_ I, „ ----..----------------- ~A,r~a.n FATHER S NAME IFYtl. Made. Lasl 110THER'S NAME (Erg. Maade. Man»r Surname) William Oscar McCartney Ann M ,a a oyer IN uaFOfIMANT'S NAME (TYPa'Prnll INFORMANT'S MAKMID ADORE551SbW.Cay/bwn,$Wa Zip Codel _____- _ ,a Sharon L. Strock ,~, 121 West Main Street Shiremanstown, Pa 17011 METHOp OF DISPOSITgN GATE OF DISPOSITgN PLACE OF DISPOSITN]N-Hama aCemelery C»mabry LOCNgN-ciry/r Stale Li CwM ~~ - Bur»I ~ CramMNn ^ Rarrgvaa Yan Slale ^ (Main. DeY. y6arl , a OIMr Place , . p IAa,.aanL] -~pa[syl- O • 71a. Nov 7, 2002 mN. Mechanicsburg Cemetery ,fe. Mechanicsburg, Pennsylvania x,a - SIGNATU F1XJE VM:ELM:ENSEE Of-PERSOl1 ACTING AS SIICN '~Z G ~ LICENSE NUMBER . ~a NAME ANp AOONE550F FACILITY I ~ ` /W'- ~ 77.. ve. FD-014318-L 7z<. M ers Funeral Home, Inc. 37 Easl Main Stre el Mechanicsburg, Pa 1 7055 » Aems 27ac Mh ourarea al the nme, said am pMCa valad LICENSE NUMBER _ DATE SIGNED Pnyaeun» nd avaAa al INM of death n unM cause a aam (5q»lure and Tilbl (Haan. wy vm,l n.. Tae. 7x. Hams 2a-28 mutl Oe comgNed NY NAE OF DEATH DATE PRONOUNCED DEAD IMalm. Day. yiea) VMS CASE REFERRED TO MEDN:AL EXAMINERICORONER7 - goon rdp prolgal[aa Waln. _ 7a- 2:15 P.M. M ,• November 3, 2002 ,N. "°• ^ "4~ 77. PART L Enbr rM diseases. nhrr»s a COmpY[afprra edrich causal IM wain. Do ml soar IM node of ayirp, such as cards[ a resprafory anal, sl it ar Man faAao I Appoauna» PART N: OUw agnilkanl caloara» woo Wvg b WMn Oa L W oriy or» [apse on aaU Y». ~ NYan.M NMraM npl naWmN m iM unGartyvp urrb Yrven n PART 1. WMEDI~ cE CAUSE IFvul 1 I oNal and waM ~ Jneave maim ~'l .~` ~ I VV~K ewraaq r'aea~l-+~ • 1~1E lq(g1I.$_pC ENCE OFI: ~ ~A ~ r --__. _ --_ .. mrydsiorra N r' 1lAX-~ t~yj'6° f `- ' Ss rmME y a %arry, MaMq nxrvrrediau OIIE lE710R ASA CONSEQUENCE OFt: -~ I Enr« uNOEpLYNVIi i ~ [ - -- - CAUSE IO~suaaaa~npvy - ew vr.tlaa vvwus pIE TO (Oq ASACONSEOUENCE IJEI' .._--.-. - ... ' i .esuWq n waerl LAST O _ WAS AN AUTOPSY MERE AUTOPSY FINDWGS 17ANNERaDEATH DATE OFIWURY TIME OFIWURY BUURY AT WORK7 DESCRIBE HPNINJURY OCCURRED. PERFORMED? A1a11lABlF PRMNi lO IMmm. Day N,arl o ~ETaN GF GAUSE NM r ® H ^ » omsia. Yas ^ No^ AccWeN ^ Pargrp lmealgalon ^ p~ vYa ^ No I~ v« ^ rb ^ sle[w ^ Could trot w ae»rminad ^ 7a. 7NN. M- _. PLACE a' IW URY - AI hon», qrm, tlraN. lapory. o1N[e LOCAT l50 . Ciy S vl ' Ix.im», eft. 15pe[iv) 7M. sac M. ]Oe. 701. DERTIFIEpICneG myorW SIGNATURE T L CER7 IE 'CEATIFYING PNYSN:IAN IPnyscwr cerNpaJ cause d aeam.vnen assns pnvsaan nas paquncea wain alw tasseled Nan 1JI ~~ io Yra Netl of mY ano»ladga, wam occu»ad dw b Ure caueelal and manner ae aMled .................................................. ^ "' I V 71b. •. 'PRONOUNCING AND CERTIFYING PNYSICIAMIPn sr[an don x:v.u Mm deals arw l se d ae al m 1 a tt~l LICENSE NUM DAfE SMaN~'D`1.4~ (laY •+ I M (~ ~ I O Z - , u y i y y 0 i u e : To Yr pMl of m Nrn Y Y yvbdQa, wab oc[wrad M tlva here, dale, and place, arW dw to IM cauaelel and manner as rMlea ......... .............. ^ // 7 ` , d l L 71e. ' - `D O NAME AND ADDRESS OF E ON HO PL EDGAUSE OF DEATH ~ (llem 271 Typo a Pnnl LL 'MEDICAL E]IAMINER/C0110NER On Ne Nadia of taaminellon andlp Inveslfgalion, in my oplmon, death occurred al lire lima, date, and place, and due fo the oase(s) aM ~t manner as alaied .... ... ...... .. ................... ...............-.... ........... .......... ^ )la ... ......... /7 a~ t yjY ryf Y)~ ~~~i ~ 77. UK~IY~ (~ ~ a-.J REGISTRA 'S NATU ANO R E UM R PATE F IL M On m Day. Y E D I ah (n ~ ` ~ ~ ~ ~ /I F j.~ p/~' ` / ~t / A . 2 LAST WILL AND TESTAMENT OF MIRIAM A. I{'DOSE I-D 2- 1015 I, MIRIAM A. FOOSE, of the Boroagh of Mechanicsbur C~:~unty off' ~,umberland and State of Pennsylvania, being of sound ar:d dis- posing rztind, memory and understanding, do make, publish and de- :-;fare th;_s myr Last Will and Testament. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever the same may be situated, to my husband, Richard L. Foose, absolutely and unconditionally. 3• In the event my husband, Richard L. Foose, should predecease me or should he die at about the same time as I do, such as in an accident common to both of us, or should he die within thirty (30) days of the date of my death, then in such event, I give, devise and bequeath my entire estate, real, personal and mixed, whatsoever grid wheresoever the same may be situated, to my four children, to wit, Jacqueline A. Arenson, Gary L. Foose, Richard L. Foose,Il, and Sharon L. Strock, share and share alike, per stirpes. LASTLY, I nominate, constitute and appoint my husband, Richard L . Foose , Executor of this my Last Will and Testament , and in the event that my said husband should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, Richard -1- L. Foose,II, Executor of this my Last Will and Testament in his place and stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this f} ~/~ day of May, A. D. 197. a,.. -c--~'-e.~cz-rv1 ~ ~ _~_..ex--~-rt,~, ( SEAL ) -"' 'riam A. Foose Signed, sealed, published and declared by the above named Mir•i_am A. Foose, as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at the request of said testatrix, in her presence and in the presence of each other. ,./ ~-- -2- d ,y R C O D _~ C 1 L 2i-oz-~o~5 I, ?1IPIAI~I A. Z'OOS%, of the Iorough of Mechanicsburg, Count, of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do mare, publish and declare this a Codicil to ray Last Z^1i11 and Testament. 1. ~ hereby revoke the appointment of my son, RICIIARD L. FOOSC, as sole Executor of my Last ~~°Ji11 and Testament, and I do hereby nominate, constitute and appoint my son, RICI-LARD L. EOOSE, and my daughter, S?IARON L. STROCI~, Co-Executors of my Last L^~ill and Testament, and direct that they be excused from postin bond or other security for the faithful performance of their duties in any 3urisdiction. 2. 1 hereby ratify and confirm my Last ti,1i11 and Testament in all other respects and to all intents and purposes not inconsistent herewith. 1N ti^~ZTI~TI~SS ti^~IfEREOP', i have hereunto set my hand and seal this /'Ir`k, day of I~Tovember, A . D. , 1995 • Iiriam A. ~'oose -1- Signed, sealed, published and declared by the above named, TI7t~T1~I~~T A. ~00S~, as and for a Codicil to her Last tilill and 2'estament, in the presence of us, irho have subscribed our names hereto as witnesses, at the request of said testatrix, in her presence and in the presence of each other. -2- COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, ~''ls?IAi A. OOSE the testat r=i.X whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as a Codicil to my Last Will and Testament dated that I signed it willing- ly; and that I signed it as my free and voluntary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged before me by ~ SAT,. ~, ,_ i.l~x~ A FOOSE the testatrix , this ,~' day of Tovember A. D. 1995. ~~ .., ,. {r z_ r ~ - - ' ~ '= ~_ -- COMMONWEALTH OF PENNSYVLANIA ) COUNTY OF CUMBERLAND ) Nc~a!ia; Seal Marilyn Kay Eakin, Plotar)+PubC~ M~'.aniotwrg Boro, Cumberfand County S S . My Commis pion Expires Nav. 6,1997 Member, PennsytwaniaAssocfazion of Noharies We, the undersigned, J. F'LOBERz S~~"~Ul~'~ T~ ~l. n T- ; ~7 ? *^' y the witnesses whose names are and S"~~5~~,.,~ :i~:~~~ 1CC0_ , signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testat rile <%TRIAI'? A. LOOSE signed and exe- cute the instrument as a Codicil to her Last Will and Testament; that the said testat rix , 'IIRTAI~ A. ~'OOSL executed it as /her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testat r iX signed the Codicil as witnesses; and that, to the best of our knowledge, the testatrix was, at the tune, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and subscribed to `•~ ~-/ / /~l?1/L.~ eL~ l/U~' ; __ before me this f .~ day of November ~ 199. , 199 ~' ~ --~, ~,; i r Ma1'tlyn "uT fin' Cp~y j'11(S~U~~~g{~0N,6,1~ ~ ieA REGISTER OF WILLS OF CUT•ZB}~ ~T11ivI~ COUNTY OATH OF SUBSCRIBING WITNESS a- ~ J. Robert Stauffer and John P~i. Eal~in c>mkoil ' (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that the 5r i~Tir i am A . Fri os e present and saw the testat rix ,sign the same and that then ' request of testat in signed as a witness at the rix her _ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). ~ -~- Sworn to or affirmed and subscribed before G~~r~G me this 1 ;3th day of 1`~Iovember ~~'~ ~ (Name) ~ 2002 T~~et Sru.are Bld? ~lechanicsbu.rb, ~t. (Addres ~ u~ Register ~ ~ 1 r (Name I'Zarket Square Bld ., T~Zecha.nicsbur~, (Address) OF WIL OF ~ ~ OF NON-S CRIBING (each) a subscriber he to, (each) being duly q ified according to al - familiar with the s ature of codicil tes t o one of the su cribing witnesses to) th will that lieves the signature on the to the best of me to or affirmed knowledge subscribed before day of 19 belief. COUNTY ASS and say(s) that presented ewith and codicil Il is in the handwrite of (Address) ,,. 170 ~Il ~~ ~ 17 05 (Address) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~ ss: RIC.LIARD L. FOOSL and STTAR~T~I L. Srt'TZOCIt _ _ -- -------- erng u y - SWUrT7 -- according to law, deposes and says that they _ a2'G the _ _ ____ Executors ------- - - -_- - of tha [stale of _ _14T~T_AI~I A-,.._.FOOSF --- late of i`Iampden `L'o~~ansh:i_p Cumberland Countyy, pa., deceased and Chet the within is an inventor made b I~;LC~1~lI'Cl T,, StrOCK y y ~~oose _and. SL~x'on L. __, the said.___Executors__ of the entire estate of said decedent, consisting of all the person proparty and real estate, except real Pstate outside the Commonwealth of Pennsylvania, and that the figures ~ppos' ea h ite r o t e Inventory represent it's fair value as of the date of decedent's death . ~- f l !I s ~~ra~z r~ -' - _________ and subscribed before rne, ---- -- -----1 . U.az'~'------- ---------2nQ3---- ~`_ --.__._. Executor - dKd3676YfYn~dE '7 - 121 ~w'est T~Iain St., Shiremanstown, PA Date of Death Day d >1 1~1c1:;1wee Road, Dauphin, P!1 170113 Address ld o v_e__mb e r ----- ----- -M on f h ---- Year 2002 INSTRUCTIONS I. An inventory must bo filed within Three months after appointment of personal representative. 2. A supplement inventory must be filed within tfrirty clays of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , Z ~ ~ ~ ~ ~ a W O w ° ~ r o u.. ~ -- w ~ Z ~ z o 0 z W Q rs. G1 d O w ~. ~,'~ «~-, H H ~i •,-+ ,C m H S=, N ~. 0 m q -v 0 N or 0 ~o o~ T 0 U 'D c ~o :. d E 7 U m LL m o ~ A ~ d ~ -L~ ~I .~ O .~c 0 O m r m 0 Q Inventory of the real and personal estate of I~:IIR :I11I~I ~ . ~~ OOSL deceased (1) Commerce Bank, Ct~eck~r.n~; tlccou.nt I'Io. ~>1322661.}.7. 9,1.}.06 88 (2) Commerco E3ank, Savings account TIo. 6162?61).}.9. 52,463 41 (3) Country r~'feadov~s, refund on x>rel~aid car©. 6 6 8 1 Tot al .............~~ 68,.518 1~2 ~/~ CERTIFICA'T'ION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: '°~TRT ~P~~ A. FOOSE Date of Death: :November 3, 2002 . Will No. 2002-~~015 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on November 21, 2002 Name Address 1'IC~~!RD L. FOOSI-51 I~IcL'lwee Road, Dauphin, PA 1701 Sr~.~RO~i L. STROC~~-121 '.•3est Tiai.n St.. Shiremanstown, Pri 1'7011 ~7'AC~UELZi~E A. ,~III~?T?:LS-9109 t{lest B9th St,, Overland Park, Kansas 60,212 GARY L. FOOSE-1~3 ?~rhitfield Drive, Jackson, 'T'ennessee, 3u30, Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: I'!ovember .?_1. 2002 None Signature Na-ne J, Robert Stauffer Address T~arl~cet Square L~ld~. T~~Zec~.anicsbur~. "~'~ 170 Telephone (71,17-766-9673 Capacity: Personal Representative X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002063 STAUFFER J ROBERT ESQUIRE MARKET SQUAB BUILDING MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 195-52-5375 FILE NUMBER: 2102-1015 DECEDENT NAME: FOOSE MIRIAM A DATE OF PAYMENT: 01 /21 /2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /03/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 52,688.39 TOTAL AMOUNT PAID: REMARKS: SHARON STROCK C/O J ROBERT STAUFFER ESQUIRE CHECK#1001 SEAL INITIALS: VZ RECEIVED BY: DONNA M. OTTO REV-1162 EX111-961 52,688.39 DEPUTY REGISTER OF WILLS REGISTER OF WILLS i?-ice -8 BUREAU OF INDIVIDUAL TAXES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX APP (O1-OS) DATE 03-17-2003 ESTATE OF FOOSE MIRIAM A DATE OF DEATH 11-03-2002 FILE NUMBER 21 02-1015 COUNTY CUMBERLAND J ROBERT STAUFFER ATTY ACN 101 MARKET SQUARE BLDG 1 W MAIN ST Amount Remitted MECHANICSBURG PA 17055. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER POR_TION_ FOR YOUR RECORDS ~ -------------------------------------------------------- -------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMEWT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FOOSE MIRIAM A FILE N0. 21 02-1015 ACN 101 DATE 03-17-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 68,518.42 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (91 5,6 32.18 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) - q-6 18 12. Net Value of Tax Return (12) 62,886.24 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (141 62,886.24 NOTE: If an assessment was issued previously, lines reflect figures that i l d t 14, 15 andior 16, 17, 18 and 19 will nc u e he total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (151 .00 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 62,886.24 X 045. 2,829,88 17. Amount of Line 14 at Sibling rate (17) • 00 X 12 - . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .0 0 X 15 - .00 19. Principal Tax Due (19)= 2,829 88 TAX CREf1TTC• . DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 01-21-2003 CD002063 141.49 2,688.39 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT 2,829.88 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE cTnF nr TYTC rno~ rnn ~..~r....,.~-_.._ (1) .00 (2) .00 (3) .00 (4) .00 (5) 68.518.42 (6) .00 (7) .00 (8) G 0~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: T~iIiiI~1T•i A. FOOSL Date of Death: T?over~~ber 2002 Wi11 No. 2_002-01015 __ 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: 1. State whether administration of the estate is complete: Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ;r b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did r_he personal representative state an account informally to the parties in interest? Yes ~~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be a~ tacked to this report. Date: ~~ri1 ^,0, ?~';0~ gnature J. ~o.:e.rt ~t«ut'~r~ Name (Please t~j~e or print) 7r~~~.rC U ~JC '. c~rf. I)~Ci.v• ~~~ ~ ~ ~=3t~uitl~ T'echa~~ c,.~'our;:~~ .i 1 ~~r _ ~~~'~? Address Gtr: t d L- Jld4~! £D. -.. ,~ •~~{ (MAH:rmf/AM3) Tel. No. Capacity: Personal Representative y Counsel for personal representative .' REV-1500EX(6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 w ,.., ,,:$., u"'" w"u :r:oo u"'-' .... .. 0( I- Z W C W o W C z o ~ :J l- ii: <( o w 0:: z o !.i I-' :J l1. ::E o o ~ ~~, ,.., z w c z o .. ., w '" '" o u INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FOOSg, Hiriam A. DATE OF DEATH (MM-DD.YEAR) ~DATEOF B,IRTH'iMM.DD'YEAR) ~..v:-"--.l,--_;~oo;'--____,__~E.ch 6L19111. __ (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST. FIRST, AND MIDDLE INITIAL) N/A [i] 1. Original Return o 4. Limited Estate 06. Decedent Died Testate (Allach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maint<lined a Living Trust (AlIacl1copyofTrust) o 10. Spousal Poverty Credit (dale ofdealh between 12-31-91 and 1-1-95) C/ OFFICIAL IISE '" Y ,( - /00 ~ ~ __ ..._...__...__._.___,..,~.___ _.,._._._.~.___ _____.._____..n. FILE NUMBER .z .L - .Q. Z- COUNTY CODE YEAR Q. ..1. Q. ..1. .5 NUMBER SOCIAL SECURITY NUMBER 195 - 52 5315 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date afdeath prior to 12-13.92) D 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I)....LL C RRl!llPON l! ~. NAME J. TIobert Stauffer, Atty. COMPLETE MAILING ADDRESS Market Square Bldg. 1 Hest Main St. Hechanicsburg, PA 17055 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inler-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (tolal Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Une 8 minus Une 11) (1) (2) (3) (4) (5) (6) (7) (9) (10) . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(l.2) O. 00 , .0 _ 62,886. 21~ , .0 1:1:2 0.00, .12 0.00, .15 16. Amount of line 14 taxable atlineat rate 17. Amount of line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 0.00 0.00 0.00. 68,518.1~2 . 0.00 OFFICIAL USE ONLY 0.00 (6) '5.632.18 0.00 68,518.42 (11) (12) (13) 5,632.18 62,886.24 0.00 (14) 62,886.24 (15) (16) (17) 0.00 2,829.88 0.00 0.00 2,829.88 (1B) (19) > Decedent's Complete Address: " STREET ADDRESS '~905 1'rindle Hoad CITY Hechanicsburr-:, I STATE I ZIP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2, Credits/Payments A, Spousal Poverty Credit B, Prior Payments C, Discount (1) 2,829.88 0.00 0.00 141.49 Total Credils ( A + B + C ) (2) 141.49 3, InteresVPenalty if applicable D, Interest E, Penalty 0.00 0.00 5, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE, (5) A Enter the interest on the tax due, (5A) 0.00 0.00 2,688.39 0.00 TotallnteresVPenalty ( D + E ) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund (4) B, Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) 2 , 688 . 39 Make Check Payable to: REGISTER OF WILLS, AGENT ~'':''''~ ,~.,.,.....!liIIt.llJ;!I,JlIJtll....,"..}p.:JP~~~~'';~~,~~If('',~"""",,,,,,,,,,,,,,,,?,,''''''''"''''''''''''''_''~_"_ ,"..,.,.. '~'.'.' ,...,~~",~ ,.. ".,., _.....'.~.~~, _""',~ _.~ 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;. ....,. ......' ,. " .. ..,.." .,..... D I!J b, retain the right to designate who shall use the property transferred or its income; ,........ . D g c. retain a reversionary interest; or ................. ...................... ................... ................. 0 Ii] d. receive the promise for life of either payments, benefits or care? ......... ....... ................................... ............... 0 Ii] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ,," """"""""'"",,,," ,,",,'''''''''''',,'''' '''''''''''''' D IiJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 IiJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ... ............................... .. ..... .............. .......................................................... 0 Ii] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Ul1der penal 01 pe~ury. r declare that I have examined this retllrn, including accompanying schedules ard statements. and to the best of my knowledge and beliel, it is true, correct and complete Declaralio pre eroth r an epersonal representaUveis based on all inlormaliol1 of which preparer has any knowledge / x:f)GA07l)'~ J;;;~ ri 121 West Main St. Shiremanstown. PA 17011 DATE NSIBLE FOR FiliNG RETURN )1 ADDRESS <)1 McElwee Road Dauphin, PA 17018 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS Market Square Bldg., HechanicsburR. FA 17055 . _ ,~ ~..=~," ~ ~.",'.~. ~..~ '"~ .' _"l',l;!".',.l,"f,.,\, ~, ~~'""'_'<'."'"'~_' '''~''''~.'~ . "~ "~ ,". - .....- 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% 172 P,S, ~9116 (a) (1.1) (i)], For dates of death on or after January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% 172 P.S. ~9116 (a) (1.1) (iilJ. The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death 10 or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P,S, ~9116(al(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 P,S, ~9116(1.2) [72 P.8, ~9116(a)(I)J, The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P,S, ~9116(a)(1.3)I, A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Commerce _Bank.. December 16, 2002 Mr J Robert Stauffer Attorney At Law Market Square Building 1 W Main St Mechanicsburg, PA 17055 RE: Estate of: Miriam A Foose Social Security #: 195-52-5315 Date of Death: November 3, 2002 Dear Sir/Madam: In reference to the letter regarding the above mentioned Estate, we would like to inform you of the information that we have researched and found. Type: Checking Account #: 513226647 Date Opened: 1/17/01 Date Closed: 11/21/02 Primary Owner: Miriam A Foose Date of Death Balance: $9,406.88 Type: Savings Account #: 616226149 Date Opened: 1/25/01 Date Closed: 11/22/02 Primary Owner: Miriam A Foose Date of Death Balance: $52,463.41 Commerce Bank I Harrisburg, N.A. P.O. Box 6599 100 Senate Avenue Camp Hill, Pennsylvania 17001 ~8599 r.r:v l~~\~n, II 0;1 It)';~\ SCHEDULE E CASII, BANI( DEPOSITS, & MISC. PERSONAL PROPERTY COMM(lrIWr^llIrnr rTWmYlVl\lM INHFHI'^,JCF '^X nrlURN RESIUEfH UECEOENI ESTATE OF FILE NUMBER 21-02-101 2002-01015 llIRIAE A. FOOSE Include Illp, rlfocp,pds or lillq<lHoll mill IIlp, d<lle lhp plor.f'!nd5 well' 1p.C('ivp.d hy 'lie f'!slntr> ^" plopp./ly Jolnlly-owllp.d willi flip. tight 0' stlfvlvorshlp must hI! dIsclosed on Schedule F. -.-IIFM--- ... .-.-.....------.----- . ---.-. ------..---.--------------..- VALUE AT DATE NUMREf1 lJESCRlr IIIJII OF DEA TH ._._---_._~-~-----~---~---------~- 1; 9,406.88 52,463.41 6,648.13 1. Z. 3. Checking Account No. 51322661.7 with Connerce Bank. Savings Account No. 616226U~9 with Commerce Bank. Country J1oadows, ref'und. TOTAL (AI'o enler on line 5, Recapilulallon) $ 68,518.112 -_._~--- . .... " . ... _ _ ~._. _ _l_~' REV.1511b.(197) '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT HIIUAH A. FOOSE FilE NUMBER 21-02-101,5 2002-01015 ESTATE OF Oebls of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. None - Prepaid. 0.00 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Richard L. Foose, II 1,700.00 Name of Personal Representative (5) Sharon T" . Strock 1,700.00 ~~aJt~'j'jn~ ~,,\"ljPi(S)1 EIN Number of Pe",onal Representative(s) StreetAdd~SS . t 121 Hest Hain St. City ShiremanstoHn State PA lip 17011 Year(s} Commission Paid: 2001 2. Attorney Fees J. Robert Stauffer, gsq. , attorney fee. 1,700.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant N/A Street Address City State lip Relationship of Claimant to Decedent 4. Probate Fees Hegister of Hills of Cumberland County, rennsyl vania, T"etters 'restamentary. 238.,50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland T"aw Journal, Estate Notice. 7,5 . 00 8. Country Neadows, Pharmacy. L~.67 9. 'rhe Sentinel, Estate Notice. 8,5.01 10. Refister of Wills, Filing Inventory and Pennsylvania .nheritance TaJC Return: 2~.00 11. Register of Hills, filing Account. 10 .00 TOTAL (Also enler on line 9, Recapitulation) $ ,5,632.18 .. (If more space IS needed, Insert additional sheets of the same size) REV-1513EX.(1-9il ESTATE OF NUMBER I. '* SCHEDULE J BENEFICIARIES FILE NUMBER 21-02-1015 2002-0101.5 RELATIONSHIP TO DECEDENT Do Nol List Trustee(s) Daughter Son Son Daughter AMOUNT OR SHARE OF ESTATE One-fourth share of estate. One-fourth share of estate. One-f'ourth share of' estate. One-f'ourth share of estate. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHI:H AN ELECTION TO TAX IS NOT BEING MADE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDEN1 DECEDENT rnHIAN A. FOOSE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (Include outright spousai distributions) 1. JACQUELINE A.HINNIS 9409 West 89th St. Overland Park, Kansas 66212 GARY L. FOOSE 183 Whitfield Drive Jackson, Tennessee 3830.5 HICHARD L. FOOSE, II 51 McElwee Road Dauphin, PA 17018 SHARON L. STROCK 121 West Main st. Shiremanatown, PA 17011 2. 3. 4. 1. B. 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, Insert additional sheets of the same Size)