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Home My WebLink About02-1020PETITION FOR PROBATE and GRANT OF LETTERS MILDRED J. ZOOK rlo ~, ~ - CS 1-' ~O L O Estate of To: also known as Register of Wills for the Deceased. County of Cumberland in the Social Security No. 1 85-07-8601 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: named Your petitioner(s), who is/are 18 years of age or older an the execut ri x in the last will of the above decedent, dated February T5 , 1925 _ and codicil(s) dated None (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h Pr last family or principal residence at T17 So th Walnut Street Borouuh of (list street, number and muncipality) 83 ears of a e died November 7, ,~ 2002 , Decendent, then Y g ~ , at Ho 1 t P s oro Towns i C mberl nd Count 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: hone Decendent at death owned property with estimated values as follows: $ ~~ nnn _ M (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 $ None Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully requtestn s ~tth T probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. V ~, ~, eresa ee ~,~ 57 North Joanne Avenue Venttt a, CA 93003 ~~ ~a ~. ~° OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~. ss COUNTY OF _ CUMBERLAND The petitioner(s) above-named s•Near(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 well and administer a estate according to law. Sworn to or afiirmed~ and subscribed Teresa P. Lee ~ before me this ~ y day of a ~~ ~ ~o '~''~ egist r No. 21-02-1020 Estate of MILDRED J. zoox ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW November 15th ~~ 2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated_ February 15, 1995 described therein be admitted to probate and filed of record as the last will of Mildred J. Zook and Letters Testamentary are hereby granted to Teresa P. Lee FEES Probate, Letters, Etc.......... ~ 60.00 Short Certificates( 2) .......... ~ 6.00 ~t~~~iX EXTRA PAGE 1 ~ 3.00 JCP ~ 10.00 TOTAL $ 79.00 Filed . N.Q~III~.>•K.15.,..2002 ... .......... . Regi er of Wills SNE AK i2" & SPARE, P. C. I~:I'S~&~.'~~~: No~~06355 44 West Main Street Mechanicsburg, PA 17055-0318 ADDRESS (717) 697-8528 PHONE MAILED TO ATTORNEY NOVEMBER 15, 2002 il~;.,.8i~; ~~;(~~;ao This is to certit~~ rhat the in~i~rniarion here given is correctly copied from an oribinal certificatr :-,~ .data tit~ly fiiL~, 1~-it;~ r(e as Local ~~e~;isr,-a r.-The ori~ii7ai certiticate will be fol-warded to the State Vital Records Office- i--or~ t~c~ ,;;,°I~r filit~„ WAF?NING: It is illegal to duplicate this copy by photostat or photogtaph. Fc'c for this a•rtiricare, k2.t)Q P 8607497 ,~ ' - - H 10i ~a3 Rev 2'07 YPF'PIiINT IN PERMANENT SLACK INK --~ Loc.-,ii i:c'~=istear -~C~~~~ l>~(t~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH _ __ SUTE FfLE NUMBER NAME OF DECEDENTIFvv. Midda. Leal SE% SOCIAL SECURITY NUMBED DATEOFDEATH,MCnm. Oay, rear) ' Mildred J. Zook x. Female x. 185 - 07 - 8601 q~, AGE (tan S,rtnoaY) UNDER 1 YEAR UNDER 1 DAY GATE OF BIRTH BIRTHPLACE tGry and PLACE OF DEATH ICNOCa aMy one - see inalruclaN9 on poet ybel MoMM r pays llolxe I MVaAM !MOrllh. DaY. Berl S4la or fcragnCwnuYl HOSPITAL . T -- HER: ,/ O ~ r" 83 I , Nov 8, 1918 7 Enola, Pennsylvani '"p""n'W~ Ewowal»nr ^ pDA ^ ~ ^ R•+~~ ~ an.r S_ ,Spacihl , M. COUNTY OF DEATH CITY,BORO.TWPOF DEATH fACILffY NAMEIn not ing~tunon. give sheet and numbers VN9 DECEDENT OF HISPANIC ORIGIN? RACE ~Amencan lM Bl ian, ack. Nmae ago •• ISp~vY) / No yha ^ Myae +pecd CU°all ~ ~~ . r . Cumberland k East Pennsboro Ri v /Oy ;'" .°. w ~""'°""°"•"` Whi te . ,o. DECEDENT'S USUAL OCCUPQION KIND OF BUSINESS/INDUSTRV YNS DE DENTE RIN DECED T'S EDUCATION MARITAL STATUS~MUrNd SURVIVING SPOUSE (Gne NrbdvrnK daM dwvg rMY U S A ED fO E51 . . 5 ~ onl i ad Nevw Marti W, WMpwW, dl xaa of rgrkrtp ble: M no(use rwred) ElxnYnlary/SKOnOary aypycb ($~~ . gne n,a,oa1 name) ^ No ~ IPt2) ITa 1 • ,,.. Sexton Church qa "° ~ ,2. ,x. ,.. Divorced ,, DECED NT' , E S NAILING ADDRESS (Seeet. CM/kwn, Slue, ZpCOtlel DECEDENT'S ACTUAL l7a. S,ua Penncylvania Did 17e.^ VM d.c.d.n IIV.AU , ~ 117 South Walnut Street RESIDENCE ~,a,n ISee inarugpne ,E Mechanicsburg, Pennsylvania 170 ~S other vde, b~wrmaM•p7 No. dedeNre Ered ,7°.can Cumberland ,7d.^~vnhm adopt qr,y el Mechanicsburg FATHER'S NAME (Fuse. Middle. Last cMrhoro MOTHER'S NAME (FVeI. Md®e. Ma,tlen Swnamal t,. Walter Holler ,s. Susan Deitz INFORMANT'S NAME (TypuPrnq INFORMANT'S YAILXYO ADDRESS IShsel. Cay/bwn, $We, Lp Cbdal Teresa Lee xp. . METHOD OF pSPOSITgN DATE Of DISPOSITION xde. nn A en r Ca. 93003 PLACE OF OISPOSITN)<!-N4MdCemuYy, Cranway LOCATgN-Cily/Tbwn. Stue. Zp COde ^ (MOMn, D•Y. t°ml Or Oma Place BurY1 ^ Cnmalion~ RarovY h St pn all oo~pn^ NI ^ ~~ y- a .~- - x,e Conolite Crematory Schaefferstown, Pa. 17088 . x,. x,h. ad . ' SIGNATU RAL $F,RVICE LIC SEE OR PER$p1 ACTING AS SUCH LICENSE NUMBER NAME ANO ADDRESS OF FAGLJTV ~ w I2a. ~ x °. itama29a-o MM ~ yarow4dq•,wNh ooourraC a11M 11ma, tlala aM place HUad. Phyan:lan •nal walla ddeamro lSgrwure arp T4b) LK:ENSE NUNBEP DATE SIDNED ' urtM cauw d d.am. (MOMh. Dar. %!ul n.ms zA-ze mtlY M M x>.. completed TIME OF DEATH DATE PRONOUNCED DEAD (Mash. Da ,year ~°• xxc. IC parson •M pmrpunca+dMm. Y 1 VMS CASE REFERRED W MED AL E%AMINERICORONER? ~ / Y..gI crow ,b4 • I M 2t 23 d0 . . . ,.. 27. PART I: Enur tM tliseawa, in~UlNe or complication+whibh caused IM loam Do rot polar IM mod. of tlyi , such es caroiab or raspoalbry eel. +Ilbca p Mart tattoo. I Appo+imaN PART 11: pher epdrkeM con Wione roMr,outing ro auK INA Lot only one cause on eecn.ne. j ~ M~ nd re+upinq n dY undertytlq quN givM n PART 1. IMMEDIATE CAUSE (f~nu ~1 1 ~ I J~sease«cundaarn J e ,j ~ ~~_ p I esWtmq Y, aeaml-~ a _~t~ OUE W IOR A CQVS WEN~I OFy A - SarWMIaIIYYSlC9ndnion+ p t `n'p~JA","_`'al ' n airy, Issdinq b ImmeMab f DUE W (IXi AS AA CCONS E O UEN CE OF): I ` Entar UNDERLYING '' // ~~ ~L - CAUSE IDiseaseM ~nauy c. t J ~ -- I • mu vvealed events DUE W (OH AS A CONS l1ENCE On' -- esunv,g,n oeaml LAST 1 r VNS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJUflV TIME OF INJURY INJURY AT Y+ORK7 DESCRIBE HOW INJURY OCCURRED . PENFUNMED7 AVAILABLE PRNM W lMIXlm. flay. Yaarl COMPLETIONa CAUSE IyI Of DEATH7 Natural Yy Mw i d ^ n a e Yea ^ No ^ ^ AccrdaM Pending lnvestgatron ^ ryr~, xM_ db, M. gd. Ye+ ~ ~ No Ym ^ No Y1 Susida ^ CauW rpr M deNrmin•d ^ PUCE OF IN IURY At h f l . - ome, arm, ureN, adory, olECe LOCATgN (Slr aY , Slalel bwlaq, em. ISpecnvl 2M. 2ee. 29. 7tla. xq, CERTIFIERiChecM Omy or,el CERTIFYING PHYSICIAN IPhysiCan cwtaying cause d Uealn when anaher Phvs,c~an has prorpunced death an0 canpieleo nem 231 SIGNATURE AN EO CERTIFIE ^ . To IM Mat of my anowNdge, dauh occurred dw to m+ eau+al+l arw manner a eMtad ..................................................... 21h. 'PRONOUNCING AND CERTIFYING PHYSICIAN Iphyscan nom p~oneu,eing aealh and <enilymglo cause at deem) LICENSE NUMBE Mai GATE SIG OI (~ D onm Day. Pearl s/ ^ To the ba+t of my krwwledga, deem Occurred at ma lima, dale, and place, and due to the cau+N+) and manner a+tated .. ........... . xip. luJ ~ { 1 i 21d I ~ ~ + ` NAME AND ADORE PERSON WHO ~MPL ED CAUSE ATH - -MEDICAL EXAMINER/CORONER ~ (Item 271 Types Prirlet ~ J ~ On the Meie of a%aminnlon anNOr Investigation, in my opinion, deatK occurred al the elms, dell, and place, and dua,o the uu+e(a) and ^ ltamanner as s1a1W ......................................................... .. ... .................... ... G `J) ~S L ~ J '//~ ~~ ' l I,, ~ // ~~ U I ,1 7x. ^ 1'1 d\v~.(. ~v ~.. V'l~' r y / 11 ~r lw! REGI RAR'S SIGNATURE AND NUMBER DATE FILED (MOnlh. Oay. Pearl ll ~ Y V ~~c~# ~Jl~i1! ~cit~ `C ~~t~tntextt OF MILDRED J. ZOOK I, MILDRED J. ZOOR, of the Borough of Mechanicsburg, County of Cumberland, and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my 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 direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, to my daughter, - 1 - TERESA P. LEE, absolutely and in fee simple. 4. Lastly, I nominate, constitute and appoint my daughter, TERESA P. LEE, Executrix of this my Last Will and Testament. I further direct that no bond or other security be required of my personal representative to guarantee faithful performance of her duties. IN WITNESS WHEREOF, I have hereunto set my hand and ~. seal this ~~ d° day of ? ~-~. ~~.~~; 1995 . ~ ,_~ -, ~ ~..t ~`` - -'°t";'~ ( SEAL ~ e~ Mildred J. Zook Signed, sealed, published and declared by the above-named MILDRED J. ZOOK as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other . - , ~~° 1 ~ r _ , ., t ::~. .., ~ ,~ - 2 - 21-02-1020 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witi~ss to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) thafi, present and saw the testat ,sign the same and'that signed as a witness at the request of testat in 1~_ preserce and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of (Name) 19 (Address) Register ~....~ - (Ntrme) _ (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Teresa P. Lee and Richard C. Snelbaker (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that each is familiar with the signature of Mildred J. Zook testat rix of ~~~~tX the will presented herewith and each )~ that believes the signature on the will is in the handwriting of Mildred J. Zook, the testatrix to the best of their knowledge and belief. Sworn to or affirmed and subscribed before me this 14th day of ,~Nv~ovember ~ 2002 ~f%/rr~1zY1_J~"?~i1~~6(~i`~T_, .y~ lG' .:.~~ ~t~1 c~~st t~„ J , Register /" eresa ee 57 oanne Aveame)Ventrua, CA 93003 (Addr is C. Sne~bak~r r ame 44 W. Main St., Mechanicsburg, PA 17055-0318 (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mildred J. Zook, Deceased Date of Death: November 7, 2002 No. 2002-01020 PA No. 2102-1020 To the Register: I certify that notice of beneficial interest 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 or about November 20, 2002: Name Teresa P. Lee Address 57 North Joanne Avenue Ventura, CA 93003 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. Date: November 21, 2002 chard C. Snelbaker, Esquire 44 West Main Street Mechanicsburg, PA 17055-0318 (717) 697-8528 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-96) NO. CD 002501 SNELBAKER RICHARD C ESQUIRE 44 WEST MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: iss-o7-ssoi FILE NUMBER: 2102-1020 DECEDENT NAME: ZOOK MILDRED J DATE OF PAYMENT: 04/28/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /07/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5931.47 TOTAL AMOUNT PAID: 5931 .47 REMARKS: TERESA P LEE C/O RICHARD C SNELBAKER ESQ CHECK#119 INITIALS: AC SEAL RECEIVED BY: DONNA M. OTTO REGISTER OF WILLS DEPUTY REGISTER OF WILLS /7-/00-/3 /" REV-1500EX(6-00i OFFICtAl USE ONLY COMMONWEALTH OF REV-1500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG. PA 17128-0601 RESIDENT DECEDENT 21 - 02 _lD2Q.... __ -- COUNTY CODE YEAR NUMBER CECECENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SEaJRITY NU MBER I- Zook, Mildred J 185-07-8601 z w OA.TEOFDEATH (MM-DD-YEAR) TQA,TE OF BIRTH (MM-OD-YEAR) THS RETURN MUST BE FILED IN OUPLICATE WITH THE Cl 11/07/2002 11/08/1918 w REGISTER OFWILLS '-' w (IF APPLlo..SLEj SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SEOJRITY NU MBER Cl w ~1 Original Return 0 2. Supplemental Return 0 I- 3 Remainder Return (date of death prior to 12-13-82) ::s:~tIJ 04 0 0 " 0::< limited Estate 4a Future Interest Compromise (date of death after 12-12-82) 5 Federal Estate Tax Return Required w"-" ,,00 ~6 Decedent Died Testate (Attach copy of Will) 0 7, Decedent Maintained a Living Trust (Attach copy of Trust) ~8 Total Number of Safe Deposit Boxes ,,0:-' "-Ol 09 "- Litigation Proceeds Received 0 10. Spousal Poverty Credit (dale cfde~th between 12.:)1.91 and 1.1_95) D 11. Election to tax under See 9113(A)(Alt~chSchO) " >- THI5SECtlqNM\Jst~ECOl\lPWEtEtl. ALLCORIlES i'ONOENCEANDCONFIl)ENTiA\L TI'\)(IJIlFoRMATiON51iO\JLO llEDlRECTEOTO' z NAME COMPLETE MAILING ADDRESS w 0 Richard c. Sne1baker z 44 West Main Street 0 FIRM NAME (If Applicable) .. Mechanicsburg, PA 17055 '" w Sne1baker, Snare, ~ Brenneman & P.C. 8 TELEPHONE NUMBER 1717\ "'97-Q52Q 1 Real Estate (Schedule A) (1) 0.00 OFFIClAl USE ONLY 2 Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 . . 4 Mortgages & Notes Reeeivable (Schedule 0) (4) 0.00 5 Cash, Bank Deposits & Miscellaneous Personal Property 27,023.91 (Schedule E) (5) Z 6 Jointly Owned Property (Schedule F) (6) 0.00 0 D Separate Bitling Requested i= ~ 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 :;) (Schedule G or L) . l- ii: 8. Total Gross Assets (total Lines 1-7) (8) 27,023.91 <t '-' 4,047.69 w 9 Funeral Expenses & Administrative Costs (Schedule H) (9) c:: 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 2,276.99 11 Total Deductions (total Lines 9 & 10) (11) 6,324.68 12 Net Value of Estate (Line 8 minus Line 11) (12) 20,699.23 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been 0.00 made (Schedule J) (13) 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) 20,699.23 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax 0.00 0.00 z rate, ortransfers under Sec. 9116 (a)(1 .2) XOI~l_(15) 0 931.47 ;:: 16 Amount of Line 14 taxable at lineal rate 20,699.23 xOcJ~(16) " I- " 0.00 0.00 "- 17 Amount of Line 14 taxable at sibling rate , 12 (17) ::; 0 0.00 0.00 " 18 Amount of Line 14 taxable at collateral rate , 15 (18) >< " 19 Tax Due (19) 931. 47 I- 120 Ii] CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < ::'Vli<164510CO Dececfent's Complete Address: STREET ADDRESS 117 South Walnut Street Mechanicsburg Boro, Cumberland Countv CITY I STATE 1ZIP Mechanicsbura 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) 931.47 0.00 0.00 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 0.00 0.00 0.00 TotallnteresUPenalty (D + E) (3) 0.00 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 931. 47 A. Enter the interest on the tax dUe. (5A) 0.00 B. Enter the total of Line 5 + SA. (58) 931. 47 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: 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 d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . D 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? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. [] [X] IF THE ANSWER TO ANY OF THE ABOVE QUEST]ONS ]S YES, YOU MUST COMPLETE SCHEDULE G AND F]LE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that i have examined this retum. 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 aii information of which preparer has any knowledge. Yes No 00 00 00 00 IZJ IZJ SIGNAT~RSON RESP0SiBL . _l.A-<,<ki 'f ACORESS OR FILING RETURN j~ SIGNA T Lee, Executrix THAN REPRESENTATIVE 57 North Joanne Avenue ACOR S4 Main street P.O. Box 18 Mechanicsburg, PA 17055 ...:,:.:.:.:.;.:,:.;.:.:,:.:,:,::; .......,:i: :;:':;::: ::::::::::~:':::::-..::::::':::::::::::):::::........,.......'.. .;.;.;.;.;.;,......,. :::::':;i:;i:':;:;::;':;,;.;.; ;.;.;.;.;.;.;.,.;.;.;.,.::,.,.".;.,.:.;.,. ...........'............,........ .......-...-.-.'.-.....'...'.'..'.".",'.'..,'.'..,..'.'.--'.-.-.'.;,.;.". For dates of death on or after July 1, 1994 and before January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P,S,~ 9916 (a) (11) (ilJ For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% 172 PS ~ 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 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 to or for the use of a natura) parent, an adoptive parent, or a stepparent of the child is 0% [72 P,S_ ~ 9116(a)(12)] The tax rate im posed on the net value of transfers to or for the use of the decedent's lineal beneficianes is 4.5%, except as noted in 72 p_s_ 9 9116(1.2) [72 PS. 99116(a)(1)) The tax rate im posed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 PS S 9116(a)(1.3)] A sibling is defined, under Section 9102. as an indiVidual who has at least one parent m common With the decedent, whether by blood or adoption 2W46461.000 REO"V-1508 EX + (1_37) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX R~TURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS. & MISC. PERSONAL PROPERTY ESTATE OF Zook, Mildred J F I~E NU MBER 21-02-1020 It\ctude the proceeds of litigation al1d the date the plOceedS 'Nele lecei\led by the estate All property Jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Citizens Bank, checking account #6100699110 VA~UE AT DATE OF DEATH 26,049.44 2 Bank of America, refund for unused airline ticket 301. 09 3 Gross proceeds from household goods sold by Bricker's Auction 185.25 4 Matt Mummau, return of security deposit on apartment 475.00 5 Comcast Cable, refund on cable TV service 13.13 2':,46AD 2.000 TOTAL(Also enter on line 5, Recaoilulationl $ (11 more space IS needed Insert additional sheets of the same size) 27,023.91 REV-1511 EX+ (1_97) OJMMONVVEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESICENT OECECENT EST ATE OF Zook, Mildred J SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-02-1020 D b e ts of decedent must be renorted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: ,. Myers Funeral Horne, funeral services 1,205.00 B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions 0.00 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 1,000.00 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 79.00 5. Accountant's Fees 0.00 6. Tax Return Pre parer's Fees 0.00 7. Register of Wills, Cumberland County, filing fee for 15.00 Inheritance Tax Return 8 Bricker's Auction, commission on sale of household 61. 25 goods 9 Patriot-News, advertising Executrix notice 114.19 10 Cumberland Law Journal, advertising Executrix notice 75.00 11 I Transportation expenses incurred by Executrix to 1,198.25 I Total ~rom cont~nuat~on pages. . . . ~W46AG 2.000 TOT AL (Also enter on line 9. Recapitulation) (If more space is needed. insert additional sheets of same size) Is ::suu.uu 4,047.69 Estate of: Zook, ~ldred J Schedule H, Part B -- Administrative Costs Item No. Description 11 administrator Decedent's estate (airplane ticket and car rental) 12 Reserve for filing fees, accounting costs and other miscellaneous costs associated with the administration of Decedent's estate TOTAL. (Carry forward to main schedule) Page 2 21-02-1020 Amount 300.00 300.00 REV-1512 EX + (1-97) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESICENT CECECENT ESTATE OF Zook, Mildred J SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-02-1020 Include unreimbursed medical eXDenses. ITEM NUMBER DESCRIPTION AMOUNT 64.31 8.17 166.68 335.96 36.46 83.24 20.76 131. 85 73.98 36.93 60.04 20.76 260.28 7.01 829.93 140.63 1. Heritage Medical Group, medical services, account payable 2 Pinnacle Health Medical Services, medical services, account payable 3 Moffitt Heart & Vascular Group, medical services, account payable 4 Conner-Rich Associates, medical services, account payable 5 Pulmonary & Critical Care Medicine, medical services, account payable 6 Robert J. Kantor, M.D., medical services, account payable 7 Harrisburg Gastroenteroogy LTD, medical services, account payable 8 Quantum Imaging & Therapeutic Assoc., medical services, account payable 9 Sanford & Roumm Rheumatology, medical services, account payable 10 Comcast Cable, cable TV service, account payable 11 UGI, gas service, account payable 12 Jackson Gastroenterology, LTD, medical services, account payable 13 Verizon, phone service, account payable 14 PPL, electric service, account payable 15 Holy Spirit Hospital, medical services, account payable 16 Siegelbaum, Gunder & Lacey Gastroenterology, medical services, account payable 2W46AH2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,276.99 REV-1513 EX"- (9-00) SCHEDULE J BENEFICIARIES COMMONV\'EAL TH OF Pe:NNSYLVANIA INHERITANCE TAX RETURN RESICENT CECEDENT ESTATE OF Zook NUMBER I. Mildred J 1. NAME ANO ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Lee, Teresa P 57 North Joanne Avenue Ventura, CA 93003 FILE NUMBER 21-02-1020 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter AMOUNT OR SHARE OF ESTATE 20,699.23 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ,. :V\l4!5AI1 QOO TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DiSTRIBUTiONS ON LINE 13 OF REV-150Q COVER SHEET (If more space IS needed, Insert additional sheets of the same size) $ 0.00 lllagt 2lltJill ClltO 'Q}2gtCUtt2nt OF MILDRED J. ZOOK I, MILDRED J. ZOOK, of the Borough of Mechanicsburg, County of Cumberland, and state of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby ~ca}:'~, publish and declare this my 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 direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United states, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, to my daugrter, - 1 - TERESA P. LEE, absolutely and in fee simple. 4. Lastly, I nominate, constitute and appoint my daughter, TERESA P. LEE, Executrix of this my Last Will and Testament. I further direct that no bond or other security be required of my personal representative to guarantee faithful performance of her duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal this )5tAday of ~ ' 1995. l1uJuoSv ~ )/1J~ Mildred J. Zook (SEAL) Signed, sealed, published and declared by the above-named MILDRED J. ZOOK as and for her Last will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other. ,0 '" '" j{(~^ 12 -0i '-' G~~" ))) , U {} 6-fZf) I 'A_(J~L ~, C I- i L.& ,/!t-n- - 2 - G~ -/Do-~3 COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX RFP t01-DS) ~~~;t,~~ ._ DATE 06-03-2003 ~~~" - -- ESTATE OF ZOOK MILDRED J DATE OF DEATH 11-07-2002 FILE NUMBER 21 OZ-1020 •03 ~~'~~` -~ ~~~~~ '~-'~ COUNTY CUMBERLAND RICHARD C SNELBAKER ACN 101 SNELBAKER ETAL Amount Remitted 44 W MAIN ST ~;:;~=:'-•~ MECHANICSBURG PA 17Q~8 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ - -------------------- --- ----------------------------- REV-1547 EX AFP (01-03) ------------------------------------------ - - --------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ZOOK MILDRED J FILE N0. 21 02-1020 ACN 101 DATE 06-03-2003 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 El 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) .00 (2) .00 (3) .00 (4) .00 (5) 27,023.91 (6) .00 (7) .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 27,023.91 APPROVED DEDUCTIONS AND EXEMPTIONS: 4,047.69 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 2,276.99 11. Total Deductions (11) 6.324.68 12. Net Value of Tax Return (12) 20,699.23 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14 Net Value of Estate Subject to Tax (14) 20,699.23 . NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 20,699.23 X 045 = 931.47 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) •00 X 15 .00 19. Principal Tax Due Twv nsrr*TC•. (lq)= 931.47 DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 04-28-2003 CD002501 .00 931.47 TOTAL TAX CREDIT 931.47 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ^ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA ~~ ~. COUNTY OF CUMBERLAND 1 Teresa P. Lee being duly ~wnrr, according to law, deposes and says that sloe ' ~ th RxPCUtrix of the Es+ate of Mildred J . Zook late of Borough of Mec_h_anicsburg__ ,Cumberland County, Pa., deceased and that the within is an inventory made by Teresa P r,Pe _- - ,the said FXP~IIt ri x of the entire estate of said decedent, consisting of all the personal property 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 . Sworn and subscribed before me, Executor -Administrator Teresa P. Lee 57 North Joanne Avenue Ventura, CA 93003 Address Date of Death ~ Day November Month Yser 2002 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. O N O I N O I r-I N 0 Z U a tT ~ N A N U .,~ ~ 0 m ~ ~- ~ ~ ///~~ ~~, ~ N N LL ~ ~ - 4-1 y avi ~ pi ~ r Q w o w ,~ O 0 a N c ~- Z ~ ~ ~ J LL ~ ~ N ~ ~,' ,p 6. ~'" Cn O W <L ~ --- Q W ~ i ~ O + Q ~ Z Z r~ I Sa ~ U O Z ~ ~~ U ', r. ~ ~~ ~ I , ~ , "" ~ U i r-I ~ a~ .x • r-I ~ .,°.~ ~ m o ~ ~ U ii m Inventory of the real and personal estate of MILDRED J. ZOOK, Deceased PERSONALTY: 1 . Citizens Bank, checking account #61 006991 1 0 2. Bank of America, refund of unused airline ticket 3. Household goods sold via public auction 4. Matt Mummau, return of security deposit on apartment 5. Comcast Cable, refund on cable TV service TOTAL PERSONALTY: REAL ESTATE: 1 Decedent owned no Peai Estate at the time of her death TOTAL PERSONALTY AND REAL ESTATE: ?. is .`, jC'. ~,`~;, ~`..'. $ 26,049.44 301.09 185.25 475.00 13.13 $ 27,023.91 $ 0.00 S 27,023.91 Page 1 RECEIPT AND RELEASE LAW OFFICES SNELBAKE R, BRENNEMAN & SPARE WHEREAS, Mildred J. Zook, late of Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, died on November 7, 2002, having first made her Last Will and Testament in writing probated before the Register of Wills of said Cumberland County on November 15, 2002, and Letters Testamentary were issued on the same date to Teresa P. Lee, 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 persons 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, Teresa P. Lee, being the principal legatee and distributee named in the Will of said Decedent and the person entitled to share in the residuary distribution of the Estate of said Decedent, do hereby declare end say that I have examined the attached Account and Statement ~f Proposed Distribution, and find the same to be true and ;orrect, and in strict accordance with the terms and provisions 1 LAW OFFICES SNELBAKE R. BRENNEMAN & SPARE of said Will, and I do hereby acknowledge that I, this day have, had and received of and from Teresa P. Lee, Executrix of the Estate of Mildred J. Zook, 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 Mildred J. Zook, Deceased. NOW, THEREFORE, I, the said Teresa P. Lee, do by these presents, remise, release, quit-claim and forever discharge the said Teresa P. Lee, 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 ~ommon Pleas of Cumberland County - Orphans' Court Division, I do iereby agree that the foregoing Account and Statement concerning 2 STATE OF CALIFORNIA ) ~ SS. COUNTY OF ~ ~~~~~'_~ ) On this the C`J~ day of ~~L~ 2003, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared Teresa P. Lee, 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. ~ ~-Q~ ~~ Notary Public r MESA SUBL4 ~ ~ 1403551 ~ NOTARY PUBLfC-CAL{FORNW ~ VEt~TURA COUNTY C My Comm. Expirec ~. ~sionx+~ CH 3.1007 $ oonoow~no LAW OFFICES SNELBAKER. BRENNEMAN & SPARE 4 ESTATE N0. 21-02-1020 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY TERESA P. LEE, EXECUTRIX OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF MILDRED J. ZOOK, DECEASED, LATE OF BOROUGH OF MECHANICSBURG, CUMBERLAND COUNTY, PENNSYLVANIA eresa P. Lee, Executrix as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: November 7, 2002 DATE LETTERS TESTAMENTARY ISSUED: November 15, 2002 DATES EXECUTOR NOTICE ADVERTISED: Cumberland Law Journal November 29, December 6, 13, 2002 Patriot-News December 31, 2002, January 7, 14, 2003 FIRST AND FINAL ACCOUNT PERSONALTY -PRINCIPAL ACCOUNT DEBITS LAW OFFICES SNELBAKER. BRENNEMAN & SPARE 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 #61 006991 1 0 2. Bank of America, refund of unused airline ticket 3. Household goods sold via public auction 4. Matt Mummau, return of security deposit on apartment 5. Comcast Cable, refund on cable TV service TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY -PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Myers Funeral Home, Inc., funeral expenses 2. Verizon, phone service 3. American General Life Insurance, automatic deduction of premium 4. Heritage Medical Group, medical services 5. Pinnacle Health Medical Services, medical services 6. Moffitt Heart & Vascular Group, medical services 7. Connor-Rich Associates, medical services 8. Pulmonary & Critical Care Medicine, medical services 9. Robert J. Kantor, M.D., medical services 10. Harrisburg Gastroenterology, LTD, medical services 11 . Quantum Imaging & Therapeutic Assoc., medical services 12. Sanford & Roumm Rheumatology, medical services 13. Comcast Cable, cable TV service 14. UGI, gas service 15. Jackson Gastroenterology, LTD, medical services 1 6. Verizon, phone service 17. PPL, electric service 18. Holy Spirit Hospital, medical services 19. Siegelbaum, Gunder & Lacey Gastroenterology, medical services 20. Register of Wills, Agent, Inheritance Tax 21 . Register of Wills, filing fee for Inheritance Tax Return 22. Teresa P. Lee, reimbursement for travel expenses related to administration of Decedent's estate 23. Bricker's Auction, commission on sale of household goods 24. Snelbaker, Brenneman & Spare, P.C., attorney services 5 26,049.44 301.09 185.25 475.00 13.13 S 27,023.91 1,205.00 75.00 1.40 64.31 8.17 166.68 335.96 36.46 83.24 20.76 131 .85 73.98 36.93 60.04 41.52 185.28 7.01 829.93 140.63 931 .47 15.00 1,198.25 61.25 1,000.00 Page 1 LAW OFFICES SNELBAKER. BRENNEMAN & SPARE 25. Snelbaker, Brenneman & Spare, P.C., costs advanced: a. Cumberland Law Journal, advertising Executor's notice b. Patriot-News, advertising Executor's notice c. Register of Wills, probate fees d. H&R Block, preparation of Final Individual Income Taxes 26. Reserve for filing fees, accounting fees and other costs associated with the administration of Decedent's Estate TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: 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 interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: PERSONALTY -INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Personalty Principal Account: TOTAL, PERSONALTY, 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 The Accountant charges herself with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: 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: Page 2 312.19 75.00 114.19 79.00 44.00 500.00 S 7,522.31 S 66.54 $ 66.54 S NONE S NONE S NONE $ NONE S NONE S NONE S NONE S NONE S NONE S NONE RECAPITULATION PERSONALTY• PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: S 27,023.91 S 7,522.31 S 66.54 S NONE S NONE S NONE S NONE S NONE S 19,501 .60 S 66.54 S NONE S NONE S 19,568.14 S 19,568.14 LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Page 3 LAW OFFICES SNELBAKER. BRENNE~AAN & SPARE STATEMENT OF PROPOSED DISTRIBUTION Teresa P. Lee, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Mildred J. Zook, Deceased, to wit: 519,568.14 in accordance with the Last Will and Testament of said Decedent as follows: Teresa P. Lee 100% of residue as per Item Three of Will TOTAL FOR DISTRIBUTION: Page 4 5 19,568.14 5 19,568.14 STATE OF CALIFORNIA SS: COUNTY OF Verl~-.,i2C'v Teresa P. Lee, 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 Mildred J. Zook, 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 foregoing First and Final Account and Statement of Proposed Distribution are true and i correct to the best of her knowledge, information and belief. /~, ~ ~ s'J Teresa P. Lee Executrix and Accountant Sworn to and subscribed before me this t5~ day of ~ll(.Y 2003 ~, ~' Notary Public 6. ~ ... ~ tiSA SUBIA ~ ~ ~ 1403551 Q NOTARY AUBLIC-CALIFORNIA ~ N VENTt/RA COUNTY C My Comm. Expires _. ~~ ARCH 3, 200 x~uaa~oooooc LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Page 5 Gd~/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mildred J . Z Date of Death: November 7, 2 0 0 2 Admin. No.: Will No.: 21-0 2-10 20 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 x[] 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 [] No c. Copies of receipts, releases, joinder d approval of formal or informal accounts may be filed with t Clerk of the Orphans' Court and may be attached to this report. ~ Date: 7/24/03 - Si Richard C. Snelbaker Name ,~; Snelbaker, Brenneman & Spare, P.C. 44 West Main Street "~ Mechanicsburg, PA 17055 c, Address .~ :=? (717) 697-8528 ,Y} _ Telephone No. _ _ ~; ~~' Capacity: ^ Personal Representative [~ Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: 19 Date ofDeath: ~~ ~ ~ ~ ~ ~~ °z `~ ._ ~~ ~~ Admin. No.: ~ 3 ~ ~l ~~ Will 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 w ether 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 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 ~ No ~] c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the. Orphans' Court and maybe attached to this report. (/~ Date: ~~/~~ Signature i ~~~~ Name vt'/6 ~ ~o/~P ~T~ ~~ ~'-~ Address -~, ~.~ 5'~ ~. r- ~~ Telephone No. Capacity: ~Rersonal Representative Counsel for personal representative Cad