The URL can be used to link to this page

Home My WebLink About02-1030E:rare of Hilda F. Fry also known ~ Deceared. SOCIQ! Security No. 191-18-3212 The petition of the undersigned respectfully represents that; Your petitioner(s), who is/a~d8 years of age or older an the executor named in the last will of the above decedent, dated January 25 , I q 96 and codiciI(s dated Wilbur F. ~'ry, firs name ecu or i February 1, 11 D. Fry, named Co-Executor -rPnounzri/~ (state refevant drettmstances. e.g. renunciation. death of executor. etc.) Decendent was domiciled at death in Cumberla Cot~t~t~, Pens ~Iv~nia, with r~st~f~tr~~'I ~tp;in~t~a! residence at Messiah Vil age, p r en ip, (list street. number and muacipaGty) .„ . Decendent, then 84 years of age, died tvc-~~rPtni~r 15, 2002 x~ at nrtPGG;ah Village, Cumberland County, PA ~ ' Except as follows, decedent did not marry, waz not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the vietitn of a killing and was never adiudicated incompetent: - - Decendent at death owned property with estimated values as follows; (If domiciled in Pa.) Ail personal property S 150, 000.00 (If not domiciled in Pa.) Personal property in Pennsylvania ~ (If not domiciled in Pa.) Personal property in County S Value of real estate in Pennsylvania S situaied as follows: WHEREFORE, petitioner(s) respectfull}• request(s) the probate of the lazt will and codiciI(s) presented heretivith and the grant of letters Gta ntar~~ (testamentary; administradon e.t.a.; administration d.b.n.c.t.a.) theron. N V C y ~ 7 .~ Y z ~ Gary ry ~ ~ ~ W. Bailey Ro ~~~ ~Tatzerville, IL 60565-4125 N 4. u ~ S C 00 N No. 21-02-1030 To: Register of Wills for the Cottnry of Ctiutiberland in the Commonwealth of Pennsylvania OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ys COU\1TY OF T.A~m The petitioner(s) above-named swear(s) or affirm(s) that the statetnenu in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that az personal represen- tative(s) of the above decedent petitioner(s) will well an truly aydy~,minister the estate according to law. Sworn to or affirmed and subscribed ,/` ti before me this 18th dayy of Ga a+' NOVEMBER X2002 'o _ RPOfCfPr No. 21-02-1030 Estate of Hilda F Frv ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW NOVEMBER_19 ~20__~ 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 January 25, 1996 described therein be admitted to probate and filed of record as the last will of Hilda F. Fry and Letters Testamentary arc Hereby granted to Garv M Fry FEES Probate, Letters, Etc. ......... S 23~ • 0,_,~ - a s S~ltgrt~ertificates( ) .......... S ~.~_ Renunciation ................ S 5.00 JCP S 10.00 TOTAL S 262.00 Fiie~ ... NOV....19~. 2002 ............... . 1 ~ Regisca of Wills 4~ Da'Gid Stone #39785 ATTORNEY (Sup. Ct. l.D. IYo.) 414 Bridge St., New Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE . !_', ._ ,. ,..i:.. ._. s .,'~'t' t:-it ,. ~t)1-1'~C~~F CU~?lL.t) „'O€~ ~In f7T r'SC13Y ::~..lt.t-IGai~. 7P ... ,.~f _, ~ ,. j ,r,; _ ,,. -. I, it 174' It`ite'.li~~~C:Lj CO Tht ~(d'li ~li~r.d~ li:.~l)1-Ci5 {_~~`3i~t' ~QI _, .._ - ;nJ«hl~'3I~ ~:~; ~; s ~il~:gal t~ dupd:Cat~ this ct~p~ by {~hottz~t~t ssr ~~st~a~:~z,,:.. .,:, -. t ti_ ~~ ~ J,r,~~., s~r ~~ . 43... .~ ' 2, ~. t -F '( P 8 6 4 4 3 ~=F~9.~r ~~~~' ~~~ N w~ g 2002 -- MF~T ~F _ _ _ _ _ _ __ _ _ _ -------- +J Rev ~:B7 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH t.AME OF DECEDENT (F~rst. Middle. cis) i SEX SGCIAL SECURITY NUMBER DATE OF OF17H,MCnm. Day. %ear) Hilda F. Fr 2. female 7. 191 - 18 - 3212 e~ November 15, 2002 :GE tLasl Birthday) UNDER !YEAR UNDER 1 DAY DATE OF BIRTH BIRTHPLACE fCay ar.0 PLACE OF DEATH I(;he[a ivy nna - >ee mauncuu.v nn ~hel siu91 Months r Daya Houra . Minutes IMOnm. Day, %eerl Slalea FCre~yn Counuyl HOSPITAL: OTHER: anuary 17 , ew Cumberland, P opal»nt ^ ER/outpan.nt ^ oGA C "e"'"g °ina Hom. ~ R.adenp ^ ,Speuty, ^ 84 Yre 1918 r 6. 7. M. OF HISPANIC ORIGIN? RACE -Amaraan InNan. &uk. Wnee. etc. T ( OUNTY OF DEATH CRY, BORO. TWP OF DEATH FACILRV NAME 111 not urv~lukon. ywe sueel and numl%rn WAS DECEDEN ~ I lSpecMl No ~ Yea ^ II ea SOacdy Cuban y , , Messiah Village ;.aaan.puendRican.etc. le white Upper Allen Twp. Cumberland ~ ~ an. DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS/INDUSTRV WAS DECEDENT EVERIN DECEDENT'S EDUCATION MARRAL STATUS-Married SURVIVING SPOUSE II d Never Married Widpwed Ae e maaen name) f w . yrv , , I ete (Give IoM d work done during moil U.S. ARMED FORCES? S ~ onl n. hest rauecmr ~ Eleme lary/Secondary College Divorced (Specrty) of workirp Igs; tlo rid use veered.) V ^ N o es . ,,,_ Owner/Operator „p Retail Grocery „ „ 12`072' ('°«s«1 ,. Widowed ,,. nECEDENT'S MAILING ADDRESS (SVeet. GNROwn. Slate. try Cotlel DECEDENT'S Penns lvania ~ Upper Allen t„p ACTUAL 17a. Stale y Did 17e. Yee, decedere lived in 100 Mt. Allen Drive RESIDENCE deceeenl li PA 17055 Mechanicsbur ve to a ISee ~nstructana on omen sae) lownahlpT No, deceGra lived Cumberland ,7d ^ wanin.nUM kmda Gl GMrmro g, to . ,Te. cdeney i ETHER'S NAME (First, Middle. Last) MOTHER'S NAME ,Fast. M,dWe. Maiden Surname) h l b i B l Ruth Evelyn Parthemore aug a s v n ,a. A ,g. II lFORMANT'S NAME (TypelPrinl) I NFORMANT'S MAILING ADDRESS (Street, GNROwn, Stele. Zip Code) IL 60565 Na erville 200 West Bails Road ,,,.. Gar M. Fr , , ,gb. k,tTHOD OF DISPOSITION OQE Of DISPOSITION PLACE OF DISPOSRION -Name of Cemetery Crematory LOCATION ~ CityRown, Slau. Zip Code ^ (Mom". Day, Year) «Other Place l f Slat ^ R ~ rom e emova Crematan Burial 2002 Mt. Olivet Cemetery Fairview Twp. , PA 17070 l ^ November 19 ^ O h S , t er ( pecM l analgn 2/D. 21c. 21d. 21e. .;~GNA7URFA Fy~J SERVICE LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY part emore FH & CS, Inc. PA 17070-0431 New Cumberland Box 431 P 0 FD 012 848 L / _ J , , . . 22G. /' 2,b. • eta ~ C amplete i 2 ec Ny w en prtdyeg To IM Dent of my knowledge, death occurred al the urns. date and place staled. LICENSE NUMBER DATE SIGNED Y p.rysicten is rat avaiWble at lime of Oealh to (SgnaWre and tole) (Hoorn. DaY. earl wetly rouse of death. 2L 27b. 2k. Il~~ms 2a-2e must De completed Dy TIME OF DEATH DATE PRONOUNCED DEAD (M«llh, Day, Year) WAS CASE REFER RED TO MEDICAL EXAMINER/CORONERT [Y~ • p.,rson woo pronountea deal". 11/15/2002 xe. 10:20 A M xs Yee^ NotjLl ,~. . . 2/. PART D Enter the diseases, m(uries or complications which puled the Oealh. Do rot sorer the mode of dying, wch as cardae or respiratory arrest. shock or "earl ladure. r Appronmap interval Oelween PARTII: Olney signifkanl eontlitions contributing m death. Dot ml resu0mg in IM urldedying pose groan to PAAT 1. List onry one cause on each Nne. ~ t onset era deem IMMEDIATE CAUSE (F~nal ~ ! .ease « condmon ~ D ~ 1 ~ ~~ ^ ~ _- ~ , ~~-,~ „ , ~~~~~- ~elnngmdaam)~ ~ ~ a. OT1E~d10~P.?SOUE~E ~ vvv S.~QUenuaOy DSl conddbna D. it any, leading b immediate DUE AS A CON EOUENCE OF1: 1 l c..use. Enta UNDERLYING ' - CAUSE (Olseasea alury c. - d.,l lnalaled events DUET ( A O SEQUENCE tJH: 1 ,. ,clung n seam) LAST d t N AS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORKT DESCRIBE MOW INJURY OCCURRED. P~_RFORMEDI AVAllJ18LE PRIOR TO (Mmm. Day. Year) COMPLETION OF CAUSE OF DEA7HT Natural ~ Homicide Yea ^ No ^ ^ Actidenl ^ Pending Investigation 70e 70D. M. 70c. 700. ^ N ~ y Vea ^ No ^ Suicide ^ Could not De delermined ^ . PLACE OF INJURY ~ At lame, term, sveel lactary, office LOCATION (Street. C~ry/TOwn, Slate) es o bwlding, att. ISpecdv) 2de. 28b. 29. 70s. 70f. C ~RTIFIER ICheck only oriel SIGNATURE AND TITLE OF CERTIFIER 'CERTIFYING PHYSICIAN (PhysKan cenAymg cause of deem when anolner pnysic~an has pronounced deem ano completed Item 231 ~ ~ To Ills Wet of mY krowMdge, death occurred due to lM cause(s) sod manner as statN ................................................... - 710. ' LICENSE NUMBER DATE SIGNED IMOnm. Day, Yearl ' 'PRONOUNCING AND CERTIFYING PHYSICIANtPhy51Cian tarn pronourciny death antl cenilying to cause of tleaml ( ~ „G,MD 058 244 L Jid. ~' I __ ., ~ To 1M heel of my knowledge, tleath occurred al ma Ilme, data, and Place, and dW to IM caufe(a) and manner as elated .......................... NAME AND ADDRESS OF PERSON WHO COMPLETED CAU DEATH (Item 27) Type a Print i -MEDICAL EXAMINER/CORONER Michael DeMichele, MD On the basin of examination andfor Investigation, in my opinion, death occurred al the time, date, and place, and due to Ins cause(s) and ^ manner aa,tated .................................................................................................. 108 Lowther Street, Lemoyne, PA 17043 a 72. REGISTRAR'S SIGNATURE AND NUMBER ~(4~ /~ ~I ~~' !9 J' riI DATE fILE~lMOn1/~Ye~~ I ` /~ L 3 __-_ - 7a. LAST WILL AND TESTAMENT OF HILDA F. FRY 21-02-1030 I, HILDA F. FRY, of the Borough of New Cumberland, Cumberland County, Pennsylvania, being of sound mind, memory and understanding do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. I. I direct that my Executor hereinafter named shall pay all my > just debts and funeral expenses as soon as conveniently may be done ~~~ after my decease. ~- ~ II. "'~, All the rest, residue and remainder of my estate, whether real ~~ personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my husband, Wilbur F. Fry if he survives me by a period of thirty (30) days. If my said husband does not survive me by a period of thirty (30) days, then this gift to him shall be divested and I then give devise and bequeath my entire estate unto my two sons, Stevan D.Fry and Gary M. Fry in equal shares, per stirpes. III. I hereby nominate, constitute and appoint my son Gary M. Fry as guardian of the estates of any minor children of Stevan D. Fry who may take a share under this will. IV. I hereby nominate, constitute and appoint my husband Wilbur F.Fry as Executor of this, my Last Will and Testament. If the said Wilbur F.Fry should predecease me, fail to qualify or cease to act as such, then I nominate, constitute and appoint my sons, Gary M. Fry and Stevan D. Fry as Co-Executors. If either of my said sons should predecease me, fail to qualify or cease to act as such, then the other son shall serve alone. V. No fiduciary acting under this will shall be required to post bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, HILDA F. FRY, the Testator, have unto this my Last Will and Testament set my hand and seal this ~~-f,~. day of January, A.D. 1996. ~_.-, ~ ~-~'~ ( SEAL ) Hilda F. Fry SIGNED, SEALED, PUBLISHED AND DECLARED by Hilda F. Fry, the above named Testator as and for her Last Will and Testament, in the presence of us who have hereunto subscribed our names as witnesses at his request, in the presen ~_of the Testator and of each other. REGISTER OF WILLS OF 21-02-1030 COUNTY OATH OF SUBSCRIBING wIT'NESS codicil ' (each) a subscribing witness to the wiI1 presented herewith (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat~_, sign the same and that ' request of testat in h__ presence and (in the presence of each other) (indthe presen esof the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this _ day of 19 Register (Name) (Address) (Name/ (Address/ REGISTER OF WILLS OF ~~D COUNTY OATH OF SON-SUBSCRIBING R'ITNESS Stevan D. Fry and Virginia S. Fry (cacti) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Hilda F. Fry tcstat rim of the presented heretivith and that they believes the signature on the will is in the handwriting of F. Fry to the best of their knowledge and belief. Sworn to or affirmed and subscribed before me this ~ Rrh day of N(1~TFMR ER ]r~ 2,002 Register (~ (Na 2 TEVAN D. FRY i ~- (Addresses , (Name/ VIRGINIA S. FRY 200 W. Bailev Rd., Naperville, IL 60565-4125 21-02-1030 RENUNCIATI®N In Re Estate of Hilda F. Fry deceased. To the Register of Wills of Cumberland County, Pennsylvania The undersigned Stevan D. Fry, son and iaamed Co-Executor of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Garv M. Fry, named Co-Executor WITNESS hand this day of ~ STEVAN D. FRY (Signature) (Address) (Signature) (Address) (Signature) (Address) 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 REV-1162 EX111-96) NO. CD 002164 STONE DAVID HEAN ESQUIRE 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ESTATE INFORMATION: ssnl: is~-is-3212 FILE NUMBER: 2102-1030 DECEDENT NAME: FRY HILDA F DATE OF PAYMENT: 02/ 1 3/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 5/2002 101 ~ 54,500.00 TOTAL AMOUNT PAID: REMARKS: GARY M FRY C/O DAVID H STONE ESQ SEAL CHECK#1008 INITIALS: DO RECEIVED BY: DONNA M. OTTO 54, 500.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Hilda F. Fry Date of Death: Will No. To the Register: November 15, 2002 21-02-1030 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 December 19, 2002. STEVAN D. FRY GARY M. FRY 10403 BARBAROSA CR. 200 W. BAILEY ROAD THONOTOSASSA, FL 33592 NAPERVILLE, IL 60565-4125 Notice has now been given to all persons entitled thereto under Date ,~- I~' ~3 D I D S ONE '~ E qu e 414 eet New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative 55: ~viJi~'r~'')t'r :ai~'r3~.:~si~t~2~ _ ____ _Gar M.__Fr~ _ being duiv ~wnrn _ - accordingro law, deposes and says that he is the EX2Ct1tOr of the estate of Ni lda F. Fry late of _- Up.PeY_ Allen TWp. , __ _ _ __ ___ __ __ Cumneriand County, Pa., deceased and that the within is an inventory made by _ Gary M. Fry _ the said EXeCUtOr of the entire estate of said decedent, consisting of ail the personal pro party ar.d real estate, except real estate outside the Commonwealth ^r` ?ennsylvania, and that the figures opposite each it=m of the Inveniery represent it's fair value a<_ of the dare cf decedent's death . and subscribed before me, 19 vale of ~eafn _- - ---1-r„3----- ~ey '"~ Gary M. Fr Executor - A 'mstra+ar I- 200 West Bailey Rd. ----- j Naperville, IL 60565 ~ Address l ll _- LUU~ Month Yeer !td5~~l7~°. ~ 3C3~~5 i. An inventory ..,,.st be filed within three months after appointment of personal representative. '. ,~, :upr`iement i~;ventory must be filed within thirty days of discovery of additional assets. ~. Additional _.._c=s may be attached as to personalty or realty fee Article i'~, -fiduciaries ~.ct of 1949. O cY1 0 N O N z w -.Z n N W ~ W ~. J L1. ~ d O ~~ w ~n 4J S-~ W ~T-1 r--~ .,~ x m a a_ 3- 7 O -~7 .~ i~ _- ~ i i i I i ~+ I ~. ~ I v d i c O I~ d i I i Q O E ____- Inventory of the n,~~~~~~,ersonal estate of Estate of Hilda F Fry From 11/15/2002 To 07/23/2003 Hilda F. Frv Description Accrued Income _ deceased value Total Form 706 Schedule B Common. Stocks State Street Research-Govt Inc. State Street Research-Gov't Inc. State Street Research-Govt Income State Street Research-Gov't Income 13,524.76 35,827.49 51,655.34 9,115.44 1 Form 706 Schedule C Checking Accounts Allfirst Bank-Checking Acct. 6.42 32,27.57 142, 50.70 ;I '. REV-1500 EX (6-00) \'1- IDI- OFFICIAL USE ONLY - COMMONWEALTH OF REV -1500 PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 - 20~ ~03~ __ -- COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ... Fry, Hilda F 191-18-3212 z w DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FilED IN DUPLICATE WITH THE C W 11/15/2002 1/17/1918 REGISTER OF WILLS u w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C w [X] 1 Original Return 0 2. Supplemental Return 0 3, Remainder Return (date of death prior to 12.13-82) >- ~~(/) 04, 0 0 U"':': Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 5, Federal Estate Tax Retum Required w'-U ",00 [X] 6 Decedent Died Testate (Attach copy of Will) 0 7 _ Decedent Maintained a Living Trust (Attach copy of Trust) -, Total Number of Safe Deposit Boxes U"'..J '-CD 0 '- Litigation Proceeds Received 0 10, Spousal Poverty Credit {<:l~te olde~tM between 12-31-91 ard 1-'.95) D 11. Election to tax under Sec, 9113(A){AttaonScnOJ < 9 THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: >- NAME COMPLETE MAILING ADDRESS z w 0 David H. Stone, Esquire z 0 FIRM NAME (If Applicable) 414 Bridge Street '- "' New Cumberland, PA 17070 w Stone LaFaver & Shekletski '" '" 0 TELEPHONE NUMBER u 717-774-7435 -, n 1 Reai Estate (Schedule A) (1) 0.00',-" dFFICtAL USE ONLY \...;,. 2 Stocks and Bonds (Schedule B) (2) 110',123.0'3 3, Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0'.0'0' Mortgages & Notes Receivable (Schedule D) (4) 0'.0'0' I 4. -~ 5. Cash, Bank Deposits & Miscellaneous Personal Property 32,427.67 (Schedule E) (5) ., Z 6 Jointly Owned Property (Schedule F) (6) 0'.0'0' 0 D Separate Billing Requested -.., ;:: ._-. - :5 7 Inter~Vivos Transfers & Miscellaneous Non-Probate Property (7) 0'.00' ::> (Schedule G orL) ... a: 8, Total Gross Assets (total Lines 1-7) (8) 142,550'.70' <( u 11,010.67 W 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 0:: 10 Debts of Decedent, Mortgage Liabilities, & Liens (Sdledule I) (10) 8,0'37.47 11 Total Deductions (total Lines 9 & 10) (11) 19,0'48.14 12 Net Value of Estate (Line 8 minus Line 11) (12) 123,50'2.56 13 Charitable and Governmental Bequests/See 9113 Trusts for which an ejection to tax has not been 0'.0'0' made (Schedule J) (13) 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) 123,50'2.56 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax 0'.0'0' 0.00 z rate, or transfers under See, 9116 (a)(1.2) x.OO_(15) 0 i= 16 Amount of Line 14 taxable at lineal rate 123,50'2.56 x.04~(16) 5,557.62 <t >- :J 0.00 0.00 "- 17 Amount of Line 14 taxable at sibling rate x .12 (17) :;; 0 0.00 0'.0'0' U 18 Amount of Line 14 taxable at collateral rate x 15 (18) X <t Tax Due 5,557.62 >- 19 (19) g E -- ~ 20 D _~.:I~t:~::II:a.l.'IF~::I:~:{.tIJ:t~':~=I:lIJ~JmEa:.l'~=I;:~i1.:.,..G > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W46451,OOO Decedent's Complete Address: STREET ADDRESS 100 Mt. Allen Drive CITY J:!.~chanicsburq Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2 Credits/Payments A Spousal Poverty Credit B Prior Payments C Discount I STATE PA I ZIP 17055 (1) 5,557.62 0.00 4,500.00 236.84 Tolal Credits (A + 8 + C) (2) 4,736.84 3 Interest/Penalty if applicable D. Interest E Penalty 0.00 0.00 Totallnlerest/Penally (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 -t 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) 820.78 A Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A This is the BALANCE DUE. Make Check Payable to: REGISTER OF IiVlLLS, AGENT (58) 820.78 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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 Of 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? . , , . . . . , . . . , . . . . . . . . . . . . . . .. 0 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . , . . . , . . . , . . . . . . . . . . . . . ., D !ZJ 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 01 perjury. I declare that I have examined this return. inclucting accompanying SChedules and statements, and lolhe best of my knowledge and belief, it is tllJe. correct alld complete DeclaratiOIl of preparer other than the personal represelllalive is based on all inlonnatiQIl of wt1ich p,eparer has arli 1<.I"low\6dge Ves No D D D D 00 00 00 00 3 4. IX] IX] SIGNA TUR~ OF P SON RESPONSIBLE FOR FiLING RETURN ~ Rd. IL 60565 REPRESENTATIVE DATE 8/,{l';)'/D.3 Ie . ADDRESS SIGNA DATE / ?.c.:). e ee Cumberl nd, PA 17070 For dales 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. 9 9916 (a) (1.1) (i)l For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or fortha use of the surviving spouse is 0% [72 P.S. 9. 9116 (a) (1.1) (ii)l The statute does not exempt a 'ransfel \0 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. FOl 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 natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 89116(a)(1.2)1 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. 9 9116(1.2) [72 P.S. 9 9116(a){1 )}. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. S 9116(13.)(1.3)]. 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. 2W4646,000 REV-1~03EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Fry, Hilda F FILE NUMBER 21-2002-1030 All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CESCRIPllON 1. State Street Research-Gov't Inc. Class A 4,854.673 shs. @ $7.38 per share #574-5202460, VALUE AT DATE OF DEATH 35,827.49 2 State Street Research-Gov't Income Class A- #813-5202460, 1,283.865 shs. @ $7.10 per share 9,115.44 3 State Street Research-Govt Inc. Class A- #531-5202460, 1,043.577 shs. @ $12.96 per share 13,524.76 4 State Street Research-Govt Income Class A- #575-5202460, 7,164.402 shs. @ $7.21 per share 51,655.34 TOTAL (Also enter on line 2, Recapitulation) $ 110,123.03 2W46963.000 (If more space is needed, insert additional sheets of the same size) REV.150~ EX + (1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Fry, Hilda F FILE NUMBER 21-2002-1030 Include the proceeds of litigation and the dale the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F, ITEM NUMBER DESCRIPTION 1. Allfirst Bank-Checking Acct. #0034554963 VALUE AT DATE OF DEATH 32,427.67 2W46AD2.000 TOTAL (Also enter on line 5 Recanitulation) $ (If more space is needed, insert additional sheets of the same size) 32,427.67 REV-1~"'1 EX + (1.97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Fry, Hilda F FILE NUMBER 21-2002-1030 Debts of decedent must be renorted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1 Parthemore Funeral Home -funeral expenses 7,840.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name 01 Personal Representati\le(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: David H. stone, Esquire 2,500.00 3. Family Exemption: (If decedent's address is net the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 262.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Cumberland Law Journal-advertising grant of letters 75.00 8 The Patriot News Co.-advertising grant of letters 102.67 9 Register of Wills-short certificate 6.00 J.O Register of Wills-filing Inheritance Tax Return and 25.00 Inventory J.J. Reserve for closing expenses 200.00 TOTAL (Also enter on line 9, Recapitulation) $ J.J.,0J.O.67 2W46AG 2000 (If more space is needed, insert additional sheets of same size) REV-1512 EX + {HIT) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Fry. Hilda F SCHEDULE I DEBTS OF DECEDENT. MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2002-U30 , Include unreimbursed medical exnenses. ITEM NUMBER DESCRIPTlON AMOUNT 7,837.36 1. Messiah Village-services rendered for October and November 2 PharMerica-debt of decedent for medicine at home 193.06 3 paul Dalby DPM-debt of last illness 7.05 2W46AH2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8,037.47 REV-1S13 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMON\fI/EAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Frv. Hilda F NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Fry, Gary M 200 w. Bailey Rd. Napervil1e, IL 60565-4125 2 Fry, Stevan D 10403 Barbarosa Cr. Thonotosassa, FL 33592 FILE NUMBER 21-2002-1030 RELATIONSHIP TO OECEDENT Do Not List Trustee($) Son Son AMOUNT OR SHARE OF ESTATE 61,75L28 61, 75L 28 ENTER OOLLAR 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 1. 2W46AI 1 000 TOTAL OF PART" _ 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) $ 0.00 "I ';\'r,u;~ ~ ! ,: "~:ll;l\ ;-;.. -~~th~~:', . " ~ ...". 'I - .'I~ 'i? ..." , ~"! , ' ~ ' ); _1~h'r"I"5 1'1' f:.f:.' , ;> > ~f 1; OJ''''' I .1 "'-,,f~:, ~t_" I. j'''': . ....,' - . '''',.' , 21-02-1030 LAST WILL AND TESTAMENT OF HILDA F. FRY I, HILDA F. FRY, of the Borough of New Cumberland, Cumberland County, Pennsylvania, being of sound mind, memory and understanding do hereby make, publish and declare this as and for my Last will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. I. \- '0 I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ~, II. All the rest, residue and remainder of my estate, whether real personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my husband, Wilbur F. Fry if he survives me by a period of thirty (30) days. If my said husband does not survive me " t' by a period of thirty (30) days, then this gift to him shall be divested and I then give devise and bequeath my entire estate t 5 i: unto my two sons, stevan D.Fry and Gary M. Fry in equal shares, per stirpes. III. :" S, , "f ~~- I hereby nominate, constitute and appoint my son Gary M. Fry as guardian of the estates of any minor children of stevan D. Fry tf' 'ir:, , ii' who may take a share under this will. I!l allflrst Allfirst Financial Ccnt~f 1\1.1\. PO, Bo:.: (Jon :VJill';i)oro. n:. jC)',J.'dj February 12, 2003 Stone LaFaver & Shekletski Attorneys At Law 414 Bridge Street Post Office Box E New Cumberland, PA 17070 RE: Estate of Hilda F. Fry Date of Death: November 15, 2002 Social Security Number: 191-18-3212 Dear Mr. Stone: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type........................... Checking Account Account Number............. .......... 0034554963 Ownership (Names oj).. ............ Hilda F. Fry Opening Date................ ...... .....08/28/64 (closed 12/24/02) Balance on Date ofDeath.........$32,421.25 Accrued Interest $ 6.42 Total................................... ....$32,427.67 This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement For funher account information, closures and/ or reimbursernent of funds refer to below branch 2775 Paxton Street Harrisburg, PA 17111 Phone- (717) 255-2240 Sincerely, Of/arlit/lfj tJtt~i1tlcfO Charlene Warrington, Assobiate 1 (302) 934-2722 ~' ~ .., u '.: , " ,. .," ., .: " ." '" OJ STATE STREET RESEARCH -, INVESTMENT SERVICES SERVICE CENTER February 25, 2003 DAVID STONE 414 BRIDGE ST NEW CUMBERLND PA 17070-1927 REFERENCE: 01667706 GOVERNMENT INCOME-CLASS A ACCOUNT NUMBER 00005202460-7 HILDA FRY C/O GARY FRY Dear Mr. Stone: I am writing as requested, to provide the following information concerning the above referenced account as of the close of business on November 15, 2002: Account # 531/5202460 574/5202460 575/5202460 813/5202460 # of Shares 1,043.577 4,854.673 7,164.402 1,283.865 Net Asset Value $12.96 $7.38 $7.21 $7.10 Dollar Value $13,524.76 $35,827.49 $51,655.34 $9,115.44 Please be aware that the Net Asset Value (NAV) per share changes daily, the dollar value of the account will change accordingly. I hope that this information is helpful. You may contact an Investor Services Representative at 1-87-SSR-FUNDS(1-877-773-8637) with questions or concerns. Our representatives are available Monday through Friday 8:00am-6:00pm EST. You may also contact us 24 hours a day by E-Mail at INFO@SSRFUNDS.COM. Please use fund/account number 531/5202460 when contacting our office. e' ['. ,,, . .... "i' '''{,-,' ," P.O. Box 8408 BOSTON, MA 02266.8408 PHONE: 1-87-SSR-FUNDS (1-877-773 8637) E-MAIl.. ADDRESS: INFQ@SSRFUNDS.COM Thank you for investing with State Street Research. Sincerely, Uf1.Llll ~ tl UJ. Cornelie S. Dikland Investor Communications COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002973 STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 fold ESTATE INFORMATION: SSN: 797-78-3272 FILE NUMBER: 2102-1030 DECEDENT NAME: FRY HILDA F DATE OF PAYMENT: 09/04/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 5/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $820.78 TOTAL AMOUNT PAID: REMARKS: GRAY M FRY C/O DAVID H STONE ESQUIRE CHECK# 1018 SEAL INITIALS: DO RECEIVED BY: DONNA M. OTTO REV-1162EX111-961 5820.78 DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DAVID H STONE STONE ETAL 414 BRIDGE ST NEW CUMBERLAND CUT ALONG THIS LINE ---------- REV-1547 -Gii -w ~:: -:'.- ESTATE OF FRY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% AFP (O1-V3) DATE 10-21-2003 ESTATE OF FRY DATE OF DEATH 11-15-2002 IiILDA F FILE NUMBER 21 02-1030 ESQ _ COUNTY CUMBERLAND ACN 101 Amount Remitted PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~' RETA_IN LOWER POR_TION_ FOR_ YOUR RECORDS -~ -03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCI DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HILDA F FILE NO. 21 02-1030 ~.,.. TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A) ORIGINAL RETURN 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 "'^ a°y DATE 10-21-2003 ( ) CHANGED (1) (2) .00 110 123 03 NOTE: To insure proper (3) . 00 credit to Your account, (4) . 00 submit the upper portion (5) . 32 427 67 of this fora with Your . tax payment. (6) .00 (7) . o0 APPROVED DEDUCTIONS AND EXEMPTIONS: (8) 142,550.70 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabiliti 11,010.67 (9) es/Liens (Schedule I) 11. Total Deductions (10) 8 037.47 12. Net Value of Tax Return (11) _ 1 9 0 •8 1 G 13. Charitable/Governmental Bequests; Non-elected 9113 Tru 14 (l2) t 1 23,502.56 s . Net Value of Estate Subject to Tax s (Schedule J) (13) .00 NOTE: if an assessment was issued reflect figures that incl d p l l~ = (14) a 123,502.56 u e the tota of ALL ASSESSMENT OF TAX: returns assessed~toTdate and 19 will 15. Amount of Line 14 at Spousal rate , (15) 16. Amount of Line 14 taxable at Lineal/Clas A .00 X 00 = .00 s rate 17. Amount of line 14 at sibling rate (16) 123, 502.56 X 045 = 5 557.62 ~ 18. Amount of Line 14 taxable at Collateral/Cl '00 X 1 2 .00 ass B rate (18) 19. Principal Tax Due ' 00 X 15 = 00 TAX CREDITS• (19)= . 5,557.62 DATE NUMBER 02-13-2003 CD002164 09-04-2003 CD002973 PAID (-) .00 ~ALANCE OF UNPAID INTEREST/PENALTY AS OF 09-05-2003 AMOUNT PAID ,~uu.UU 820.78 TOTAL TAX CREDIT 5,557.62 BALANCE OF TAX DuE .oo INTEREST AND PEN. 2.25 TOTAL UuE 2.25 LESS THAN Sl, NO PAVMENS IS REQ UU Mp~ se pVE OF jlilS FORM FOR iHg~RUCt O - l ZF ~OSp~ DVE Z 5 REF~ECtEO Asa CREDIT.. _.. eUE Z __..~ ctoE ~cR~ , BUREAU OF INDIVIDUAL TAXES COMMONWEALTH OF PENNSYLVANIA 'INHERITANCE TAX DIVISION DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REV-1607 E% RFP (01-03) DATE 12-15-2003 ESTATE OF FRY HILDA F DATE OF DEATH 11-15-2002 FILE NUMBER 21 02-1030 COUNTY CUMBERLAND DAVID H STONE ESQ ACN 101 STONE ETAL 414 BRIDGE ST Aeount Remitted NEW CUMBERLAND PA 17070 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payeent. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS __~ __ --------------------------------------------------------------------------- REV-1607 EX AFP (01-03) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ~~~ ------------- ESTATE OF FRY HILDA F FILE N0. 21 02-1030 ACN 101 DATE 12-15-inn; lnis 51AItMENT iS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-21-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 5,557.62 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 02-13-2003 CD002164 236.84 4,500.00 09-04-2003 CD002973 .00 820 78 11-14-2003 CD003228 2.25- 2.25 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 5,557.62 .00 .00 .00 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 EX111-961 NO. CD 003228 STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 fold ESTATE INFORMATION: ssN: psi-i8-3272 FILE NUMBER: 2102-1030 DECEDENT NAME: FRY HILDA F DATE OF PAYMENT: 1 1 / 1 4/2003 POSTMARK DATE: 1 1 /1 4/2003 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 5/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $2.25 TOTAL AMOUNT PAID: 52.25 REMARKS: STONE LAFAVER & SHEKLETSKI C/O DAVID H STONE ESQUIRE CHECK# 39551 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO REGISTER OF WILLS DEPUTY REGISTER OF WILLS s 3 ~ N ~3 H y r~ LTJ Z :[7 y N I-' f--~ cn rn ~, ~ u, rn x N- Q. n7 ~S m rr n~ rt H rr ri lD rt w s~. rd rt F~- f--' 0 O N i 0 w O rU H d H 0 t~ H H t~] H N N ._. . ~ ..../~ _.. r_..::: ~. C~ 0 G' z H c~ [~ z C~7 r F-~ w ca N C 1 CrJ ~-3"I r O Z ~ ~ m .. .. r 1 = D , F ., o + vi ~ n r.. cn ry-G Cn ' ' , w m - ~ ~cn ~` ' - 7C , r r m 1 "'~ 'a ~„~ z ;O m ~ ,~ v -i j N :O 3 `z a ~ o m , m ~ 3 G7 _ , r to Fy 1~1 C ,~ Nmcn n ,y cn ~ _..i 7C r- r m ~ m a ~ ~ d a ° 'v - n ~ a n o0 ty O z m O H V O r.. a o C N z C w ~ A O 3 V1 ~1 m a -c 3 m z 1 -~ 0 Z ~ N d ~ ~ o c c ~ m d ~ o m = ~m~cn r ~ 0 d -N+ m m N 'O '~ a V O V O a o~ ~~ O N R1 N ~~~ = m wso ar" O ~ Z an~Cltlb azm zc°~arna ymH z m nii a m v+os ~zom ZHm 3 ~ p y Vl y a a ~ °~" _~ o X Z ~ C ~ ~ 1'I F-+ T ~ o ~-' 3 i CO p Fr ~ N r Ri N V1 ~,.,, ~ F+ N N Y~.1 a o 0 0 Z w o o t7 G N W x N r a -n ~~ ~~~ STATUS REPORT UNDER RULE 6 12 Name of Decedent: Hilda F. Fry Date of Death: November 15, 2002 Will No. 21-02-1030 To the Register: 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 X 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: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes X No (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be at~ached to this report . ,,...--_.,,,,_ , Date ~ ~-~~ DavZ H. _,~t e,, 'squire 414 Br' tre t New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative est\rel\FRYGARY IN RE: ESTATE OF HILDA F. FRY IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LATE OF THE TOWNSHIP OF UPPER ALLEN, CUMBERLAND ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA N0. 21-02-1030 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, GARY M. FRY, being one of the beneficiaries under the will of Hilda M. Fry, do hereby acknowl- edge that I have received all sums of money and property due me by virtue of the death of Hilda M. Fry, in full satisfaction and settle- ment of all of my rights ar~d claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, GARY M. FRY, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thine whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the ~_ day of,~(~t'~i, ~Y't.a 2004. Witness STATE OF ILLONOIS . SS: COUNTY OF 4~~L~ . }~~ _3 ~~ ~ cE GARY M. FRY On this, the ~ day of 2004, before me a Notary Public, the undersigned officer, personally appeared GARY M. FRY, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. ~i - _, OFFiC1ALSEAL N ~ teary Publi Mary C. Ridpath Notary Public, State of Illinois My Commission Expires 3-24-06 - 2 - est\rel\FRYSTEVAN IN RE: ESTATE OF HILDA F. FRY IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA LATE OF THE TOWNSHIP OF UPPER ALLEN, CUMBERLAND ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA N0. 21-02-1030 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, STEVAN D. FRY, being one of the beneficiaries under the will of Hilda M. F'ry, do hereby ac- knowledge that I have received all sums of money and property due me by virtue of the death of Hilda M. Fry, in full satisfaction and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies of the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, STEVAN D. FRY, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of ~~~~~~~~ ,~- 2004. ,,.,.~ ~ ,~ Witness STEVAN D. FRY i STATE OF FLORIDA SS. COUNTY OF On this, the ,~~ day of 2004, before me a Notary Public, the undersigned officer, personally appeared STEVAN D. FRY, known to me (or satisfactorily proven) to be the person whose name is subscribed to the wi'~hin instrument and ackno.,Tledgec~ that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. a so~~ Debra Rae Belle ~~~~ ~;~ _,~ ~~ ~ ~ ** My Commission CC91588d ~' N o t a r y P ub l i c ~~NK~~• Expires March O5, 200A -2-