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Home My WebLink About02-1116No.,~/- oa - ~i i In Estate of MARY R• BANDANNA, a/k/a MARY~SANDANNA Deceased DECREE OF PROBATE AND GRAIti'T OF LETTERS AND NON _ I~FC'FMRFR ~ 7' ~ n n ~ ~~ 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_ March 15, 1990 described therein be admitted to probate and filed of record as the last will of MARY R. BANDANNA a/k/a MARY BANDANNA and Letters TESTAMENTARY ; are hereby granted to Rosemary Ruggieri Baer FEES Probate, Letters, Etc.......... ~ 6 0. 0 0 Short Certificates( ) ..... , , , .. ~ 3 6 . 0 0 Renunciation ....... xtr. a 'pages' --~'.~-- Sza-~,_ TOTAL ~ »n_nn Filed ..12'?~-2002 mailed to~ ~atty~ ~12-27-2002 Regi of MichaE~l H . S ~2~~/~' mall, ~,squ~_re ~' I.D. #19212 ATTORNEY (Sup. Ct. LD. No.) 201 South Railroad St., P.O. Box 113 Palmyra pA 17n7R nii~ ADDRESS 717/838-1385 PHONE ~OS.RpS RFP 9iRC, This is to certify that the information here given is correctly copied from an original certificate of death duly tiled with me as Local Registrar. The original certificate will be forwarded to the Stare Vital Records Office for permanent tiling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Eee for this certifc)te, $~.00 _ ~' 8387603 No. Local Registrar ~'~~ SEP I ~. 2002 Date ~~z ~!~'~ 1t ~ fie. ~-C~,uLD 2L~iD AS FQLL~~1+5: ,a„ y87 COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT Of HEALTH • VITAL RECORDS CERTIFICATE OF DEATH NMrE Of DECEDENT If Irv. Middle. ~a91 ~ SEX SGCIAL SECURITY NUMBER DATE OF DEATH ~MCrxD. Day.'Rarl Mary Bandanna :female ].195 -07 -8568 ISe t.8 2002 AGI (l av Bvlnoayl UNDER I YEAR UNDER 1 DAY DATE OF BIRTH B1TfTHPUGE tCay ar'.d PLACE OF DEATH rfhxn rv~y nne -- -;ee,nsuu:l;x~v m urM~ vwi Mon,ns . Days lbws . Minuln Monm. OaV. reap Slarea fcre~yn l;aunev) HOSPITAL: OTHER: aD.ra ^ DQA ^ " '"'"'9 ~ ^ ~ ^ " ^ Ewow 87 Y~ y 21 1915 risburg PA Ha e Ra„da„~ S yy, p wpa'"' , , - COUNTY OF DEATH CfTY, BORO. TWP OF DEATH FACILf1V NAME 111 nol ~nv~Mrcxr. give vreel antl nwnoeri VVAS D CEDENT OF HISPANIC ORIGIN? RACE ~ Amenean Nbien, Black, WDXe. Nc. Na~•'A.^dyea.w.clyQ~b•n~ (~) A4TTuuff~~ Porno Rlcan. wc. per Allen f'~`)~rV11 C'tunberland U hit 4 p • ~ ~ , ,. „w e e ' ` J-+~ 4~ ~ _ . OECEOEM'S USUAL OCCUPATION VINO OF BUSINESS/INDUSTRY WNS DECEDENT EVERIN OEC DENT'S EDUCATION MARITAL STATUS-MamW SURVIVING SPOUSE ~ (s wa. g~va rnaiaen name) M ar~ U. S. ARMED fORCES? S ~ n ev cpn 1 Ns DN ~ ls (Give Marddwark Ow.e owug nio9 lils; do nd a ed) ENmenlary/Sewrwary Coesge d wpeir ^ ~ q department store "k` "'° C`O$IIlet1C saes 12 (D'Z' °Iw'~1 widowed ~~• ~~ 13. 1]. 11. 18. oECr:DENT'S MAILING ADDRESS (S1reel.Ch/T~y'n. SUr. Z4 Codel DECEDENT'S Pennsylvania WCaWnlived in Upper Allen ~Yp ,JC ~ 1704 Kathryn St. . , ad ACTUAL ,Ja. Slate ' RESIDENCE d•c•d•'e ~ b ,,. New Ctunberland,PA17070 wr niP? „d.^ ~;,,,,~„,~d ~,,,,b„o w,om"e abe',"u 1>e.Cou Ctiunberland b FRI rER'S NAME (F'vs1. Midme. Lase MOTHER'S NAME IFuv. Mxldle. Marten Swname) ,~ Samuel Rezzo ,a. Jose hine Farin 1 ' INFORMANT'S NAME (TyparPrirul I S MAILING ADDRESS (Steel. Cdylbwn, SIeN, Zip Cooe) NFORMANT ROSEMARY B71ER 301.704 Ka St N 30. METI IOOOF DISPOSITION DATE Of DISPOSITION PLACE OF DISPOSNION ~ Name of Camelery, Gemabry LOCRq ~ CirylTOwn, Sole. Zp Cade Burial Cremation ^ Rerrloval pan Slate ^ (MOnm, QaY• ~) • w Omsr Plaee Dona ^ olb« t ^ Sept.12, 2002 lly Cross Cemetery ~{arrisbur PA 17111 ~ 3L. 3 . ' SIG E FUNERAL ERYICE LICENSEE PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF TACp.RV :~013163-L FH & C5, 324 Fim[el Ave. PA17043 Iems 27at only wfan unirykq tlr Deq a my Nrow am occwred al lM ums. Dale ano pace slale0. LICENSE NUMBER DATE SIGNED IMarm+. Day. Pearl pbya~cran rs no1 available al Ume of dNID b (SiOnaluce art Teel • canny caw. a cream. 3aa. 37b. 3x. bertu 2138 must W wmpNed W TIME OF E H DATE PROM UNCE DEAD IMmm. Day, Year) YMS CASE REFER RED TO MEDICAL E%AMINERICORONER? ~ ^ • person wDO Pmrlowlces dsam. ~ No Yss M. 33. ~. 21.' 37. PART L EnW lM diseases, injuries or GOmpaCalXMa wniU roused the deem. Do not antes me nbda o1 ,sue s eardac or respualory anasl. shock or Dean failure. r Approsmau li d PART 11: 01Mr SgnilkaM eond'eiona mrllrigAerq b deem. but rot rew8ep n the wberfyeq caws 9n•n n PATiT I. l LW oily one cause on ea no. ~ orMel arM deelh IYYEOIATE CAUSE fFinal l ~ ~ arseas a coMnnn ~ ~~+~ (~ r _. J _ qn raswrn daadJ -- a. IX!E yp TOR AS A C ENCE OF): , _ Seouwviaay esl aardilions D. ' i/ env. b snnreoiaw DUE T010H AS A CONSEQUENCE OF): 1 _ cause. Eller UNOERLYBq l CAUSEID~seasea~nryry c. - yes u ~aale0 ewrea OUE 70 (rJR AS A CONSEQUENCE Oft: 1 ~eyA,nq n oeanl LAST d INAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH GATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. PERT ORMEDT AVAILABLE PRIOR TO IMonm. Day. Pearl COMPLETION OF CAUSE OF DEQM? ^ NMwal HOmiciW Vp ^ NO ^ Accbenl ^ PendnO lnvevgslion ^ Y ^ N ~ Yee ^ No ^ yacrds ^ Could na W determined ^ 30e. 70b. M. 70c. 708. PUCE OF INJURY - AI Dome. farm, vreel. factory, o,DCe L ATION ISbeM. Coy/TO'.M. Stale) o es DulOing. Mc. lSpecM) 3M. 28b. 39. ' CER l IF1ER ICDeck orgy onel $IGNATU E AN OF T IE 'c:ERTIF'YING PHYSICIAN IPDyvGan cenny+ng cause d death when angf•er oDVSK~an has prwrarrCed deem ano comryeled Item 331 t u TIN bawl of my krowNdge, deem occured due b me caufe(sl and manner ae aUled ..................................................... ^ 31b. _ ~. 'F RONOUNCIHG ANO CERTIFYING PHYSICIAN IfTyscan hul/. aror~rwncrtg dealD and cenilyug locau'.e of nealnl I L ENS U ~-'') ~ ~ DATE y.,~ , ~(L~ /, 1 ~ I ~ 71 d. `.1 y.r Ille beat o, my anowledgn, deem xcwred at lM dme, date, >rW place, and des to lM cause(s) and manner as crated ........:................. AME~~~~~~WW1lllDA ESS OF PERSON MO COMPLETEDCAUSE OF EATH • -MEDICAL E%AMINER/CORONER Item Z~ Prirg~~ ~ _ . (11~A' `~) ~J(~_ ~~~,J j/'P/ly' e.n the Delis of esaminetion antl/or investigation, in my opinion, death occurred al the ,Ime, date, and place, and due to the cause(s) soil ^ r ~~ ..annerasauted .................................................................................................. ],e 73. L Q _ ~EGISTRA/T~ SIGNATURE A/a/I~JM~FiJ-""' y -- ~ ~ / te DATE FILE (MOnm. Day, year . ..- ' :~ ~~• _.~~--.. -_; !.:!/ Ji.. dL.• r' om' / Q G Z ]~. _ aa. ,t i LAST WILL AND TESTAMENT OF MARY R. BANDANNA I, MARY R. BANDANNA, of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate as follows: A. Twenty-Five percent (25%) thereof to my sister, ROSE RUGGIERI, or to her issue, per stirpes. B. Seventy-Five percent (75%) thereof to my niece, ROSEMARY RUGGIERI BAER, or to her issue, per stirpes. ITEM II: I appoint JOHN M. BAER of New Cumberland, Pennsylvania, guardian of any property which passes either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make Page 1 payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM III: I appoint my sister, ROSE RUGGIERI, and NICHOLAS RUGGIERI, her husband, Co-Executors of this my last will. Should either my sister, ROSE RUGGIERI, or her husband, NICHOLAS RUGGIERI, fail to qualify or cease to act as Co-Executors, I appoint my niece, ROSEMARY RUGGIERI BAER, Executrix of this my last will. ITEM IV: I direct that my Co-Executors, Guardian, and their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, ~MARY~R. BANDANNA, have hereunto set my hand and seal this ~~~ day of ~Z'~=y~,c--.~a , 1990. r ., MARY SAND A SIGNED, SEALED, PUBLISHED and DECLARED by MARY R. BANDANNA, the Testatrix above named, as and for her Last Will and Testament, and in the pre- sence of us, who at her request, in her presence and in the presence of each o , have subscribed our names as witnesses. ~$ ~ ,t~~ ' it s Address Witness Address `'J Page 2 COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND . I, MARY R. SANDANNA, the Testatrix 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 this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. J L ~~ ya ~ I~y' r-' f~ Jt,~~.zt-1'L.C~--- MARY RT BANDANNA Sworn to or affirmed to and acknowledged before me by MARY R. BANDANNA, the Testatrix, this ~~day of ~ ~. 1990. ~~~~ t ~ ~~ f ,~ . ~'A~A Notary Public r~~th~;, M. R7iC~iiE, ~. r 1 "Jc~n' CUMnERf And ~ aQ. ", F. `. i ~! t~, tn,y COM,'~ ~ ;: r ~ D SCR. Cuhlii~%~LA.';n r.;', ~ 0~1 EXr ~ K~~S h. ~,RCH 24. 1993 f ---____ Page 3 COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND t _.~.. f~ /~~ t ~ and t_,~-c(d-~~~C..~ ~'-~.`~`~~^-' the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more ears of age, of sound mind and under no constraint or undue influence. s Witness Sworn to or affirmed to and acknowledged before me by ~~ ~~~ ~°~ r-, ~' )I ~~~~~~ and ~ ~~ ~~`ll ~..u I~ ~'. ~- ~ K ~ ` ~ witnesses, this I ~ day of ~~ ~ ,:~,,~ ~> , 1990. Notary Publ r:~oTAR~AL sFaL ~'? DELINDA M. RI~C`iir, N`J'"RY P;~ELiC ~ NEW CUMBERLAND DQRD. ;n ~, ,~ .. C~,, ~~d EXi~T "CH Zy, '~93 ~ Page 4 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA R E N U N C I A T I O N Estate of Mary R. Bandanna, a/k/a Mary Bandanna, Late of the Township of Upper Allen, County of Cumberland and Commonwealth of Pennsylvania, Deceased The undersigned, ROSE RUGGIERI, a surviving sibling and a designated Co-Executor of the above Decedent, hereby renounces the right to administer the estate and respectfully requests that Letters Testamentary be issued to Rosemary Ruggieri Baer, the alternate Executrix designated in Decedent's Last Will And Testament. WITNESS my hand this 10th day of Witness: .~ Y Michael H. Small, E December 2 0 0 2 . ~L ~,~ ~ ' Rose Ruggieri ~~ ~~~~~ . The Bridges at Bent Creek 2300 Bent Creek Blvd. Mechanicsburg, PA 17050 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Mary R. Bandanna, a/k/a Mary Bandanna Date of Death: September 8, 2002 Will No. ~-`_Q.~,''~~~~ Admin. No. To the Register: I certify that Notice of 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 Name Rosemary Ruggieri Baer (Rose Ruggieri Address 1704 Kathryn Street New Cumberland, PA 17070 c/o The Bridges at Bent Creek 2300 Bent Creek Blvd. Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except: none. J r,, _ ~ z. ,~' ~' f ,~ Date : r'~ ~ ~~i', ~ ~~ ' Signature Name: Michael H. Small, Esquire Address: 201/203 S. Railroad St. Palmyra, PA 17078 Tele.: (717) 838-1385 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 N0. CD 001929 SMALL MICHAEL H ESQ P O BOX 1 13 201 /203 SOUTH RAILROAD STREET PALMYRA, PA 17078 fold ESTATE INFORMATION: ssrv: 195-07-8568 FILE NUMBER: 2102-1 1 16 DECEDENT NAME: BANDANNA MARY R DATE OF PAYMENT: 1 2/09/2002 POSTMARK DATE: 1 2/06/2002 COUNTY: CUMBERLAND DATE OF DEATH: 09/08/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 525,000.00 TOTAL AMOUNT PAID: REMARKS: ROSEMARY R BAER C/O MICHAEL H SMALL ESQUIRE CHECK# 4253 SEAL INITIALS: CW RECEIVED BY: DONNA M. OTTO REV-1162 EX111-961 525,000.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OP INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002601 SMALL MICHAEL H ESQ P O BOX 1 13 201 /203 SOUTH RAILROAD STREET PALMYRA, PA 17078 fold ESTATE INFORMATION: ssrv: 195-o7-s5ss FILE NUMBER: 2102-1 1 16 DECEDENT NAME: BANDANNA MARY R DATE OF PAYMENT: 05/22/2003 POSTMARK DATE: 05/21 /2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/08/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 53,349.59 TOTAL AMOUNT PAID: REMARKS: MICHAEL H SMALL ESQUIRE CHECK#12007 SEAL INITIALS: CW RECEIVED BY: DONNA M. OTTO REV-1162 EX111-96) 53,349.59 DEPUTY REGISTER OF WILLS REGISTER OF WILLS i/ Register of Wills of ~b~lana County, Pennsylvania INVENTORY Estate of Mary R. Bandanna also known as No. 21-02-1116 Date of Death 09/08/2002 Deceased Social Security No. 195-07-8568 ROSEMARY RUGGIERI BAER, Executrix, Personal Representativels) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of tho Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.`' coon 4904 rela~g to nsworn falsifi~n to / ' authorities. ~+ e~rs~l Re esentat ~ ~~`~ ~~/ ~~~u, attorney: Michael H. Small, Esquire ~ ~ Rosemary Ruggier~~Baer, Ex__ecutrix '~ 17~ Kathryn Street I.D. No.: 19212 _New Cumberland, PA 17070 __ address: 201 South Railroad Street, P.O. Box Dated ~;f:~~~B~ 113, Palmyra, PA 17078-0113 Telephone: 717/838-1385 . Description Value 1. Allfirst Bank Checking Account #0075454092 ---------- $ 6,846.90 2. Merrill Lynch US Government Mortgage Fund Class D (3,672.234 shares X $10.26 = $37,677.12) ------------ 37,677.12 3. Verizon -Refund ------------------------------------ 9.11 4. Highmark -Premium Refund --------------------------- 190.68 cwt cwt c~ ~-, N N >-- ~.~. _. ~; ~~ 1,ti r'r'1 ~ ;- ~~ . ~ ~ "..' C.:r Total: $44, 723.81 (Attach Additional Sheets if necessary} NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of tfre personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. ~1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mary R. Bandanna, a/k/a Mary Bandanna Date of Death: September 8, 2002 Will No . 2002-01116 Admin . No . 21-02-1116 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the follow.inq with respect to completion of tl~e 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: c. Did t:he personal representative state an account informally to ttie parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orpliails' Court and may be attached tv this report. ~ ,r Date: May 20, 2003 Signature " Michael H. Small, Esquire Name (Please type or print) rya 201 South Railroad St., P.O. Box 113 w .. Palmyra, PA 17078-0113 r~ Address o< N ( 717 838-1385 Tel. No. -~? Capacity: Fersonal Representative M -= ~.~ [~ "..~~-= x Counsel for personal representative (MAH:rmt!AM3) PETITION FOR PROBATE and Estate of MARY R , BANDANNA No. also known as MARY SANDANNA To: Deceased. Social Security No. 195-07-8568 GRANT OF LETTERS ~ J' t~ ~ - //~!~ Donna M. Otto, First Deputy 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 executrix (alternate) named in the last will of the above decedent dated __ Ma_r -_ 1 , 19 90 and codicil(s) dated __ N/A; One c~esi named Co-Executor, Nicholas Ruggieri, died on 11/24/96; the other designated Co-Executor, Rose R~ggiPri} haG PXPC-,7tP~ a Renunciation ~n favor o Ro4Pmarc iPri RaPr the al +- ~'-Bu99 tern ? FYPI~Ii~r~~ ~,.,d your PPt-ttinnPr_ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C rl nd County, Pennsylvania, with her last family or principal residence at McG~i ah ti 1 1 aq~., 1 M nn+ n~ i ert--Dive Mechanicsburg, Cumberland County, Pen~ylvania (list street, number and muncipality) Decendent; then 87 years of age, died __ September 8, 2002 , p~ at Messiah V' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted P* after execution of the will offered for probate; was not the victim of a killing and was never adjudicated Upper Allei incompetent: None. Township 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 Pen N ylAvania $ situated as follows: / 25.000.00 WHEREFORE, petitioner(s) respectfully reqguest((s)) the robate of the last will and codicil(s) presented herewith and the grant of letters TESTAMENTARYp theron v G D .-. vv x~ ~ o ~ '~ H0. v ~... ~ o m C ' m --, (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) /1 _ ~`; 4- _ Rasemary Ruggieri Baer 1704 Ka hrvn StrPPt ~iPw t'>>m1-~r],.~-~~_~&--~7A-79 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF ctml~FRLAND ss 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 beligf of petitioner(s) and%that as personal represen- tative(s) of the above decedent petitioner(s) will well ~hd truly administeF the estate accord}~ig to law. _/ ~ -~' " Sworn to or affirmed and s;rbscribed ~'`~-t~~ t~'--~- `` c~-< ~~ ~:~,__ - ~'`>~-"L~, before me this _ 2 7th day of osemary ~ ggieri aer ~' DECEMBER _ ~~ 2002 a ~ ~ egister y R~V_15()oEX+(6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 /7 - /t77- // REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT t:/" OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 1 1 1 6 coumC56E ---YEA~ - - NUMBE:R- - .... Z W C W U w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SANDANNA, MARY R. DATE OF DEATH (MM-DD-Year) 0910812002 SOCIAL SECURI1Y NUMBER 0512111915 DATE OF BIRTH (MM-DD-Year) 195-07-8568 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) NIA W I- ::.::::$(1) V"''' wG.V ",00 ufffi G. " 00 1. Original Return o 4. limited Estate [KI 6. Decedent Died Testate (AttachcopyofWiH) o 9. Litigation Proceeds Received D 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82} o 7. Decedent Maintained a Living Trust {Atl.atlltall'l mTrust} o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) o 3. Remainder Return (dateofde81h prior to 12.13-82) o 5. Federal Estate Tax Return Required Q... 8. Total Number of Sate Depo" Boxe, D 11. Election to tax under Sec. 9113(A) I_h Soh OJ I- Z W C Z o G. '" W '" '" o V tHISSECTlONMUStllEOMPLETEIl,AlL CORRESPONDENCE AND ONFIDENTlAL tAX.I/llFORMATlON SHOUll) BE OIRECTlED TO: NAME COMPLETE MAILING ADDRESS Michael H. Small, Esquire 201 South Railroad Street FIRM NAME (Ii Applicable) FARRELL & SMALL P.O. Box 113 TELEPHONE NUMBER 717/838-1385 Palm ra PA 17078-0113 z o i= < ..J :) .... ii: < u w 0:: z o ~ :) c.. :e o u ~ .... ,. Real E,tete (Schedule A) 2. Stock, end Bond, (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgage, & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (totel Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabiliies, & Liens (Schedule I) t t. Total Deductions (total Line, 9 & 10) 12, Net Value of E'itate (Line 8 minus Une 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) OFFICIAL USE ONLY (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) po ,_" (f' :3 :?- \.,.i' r, 44'b'23.81 8 :JJ ell (1 () ,~ rj" ~ N N " N I.). 169;265.24! ~ 213,989.05 14,253.01 466,92 (11) (12) (13) 14,719.93 199,269.12 14. Net Value Subject to Tax (Une 12 rn'lnus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 199,269.12 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)lt .2) 16. AmountofUne 14 taxable atlinea\ rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due x _(IS) X (16) 7,500,97 X .12 (17) 900.12 191,768.15 X .15 (18) 28,765.22 (19) 29,665.34 20. [8] CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BEl SURE TO ANSWER AlL. QUEStlONSON REl\IERSElSIDE! AND RECHECK MATH << Decedent's ComDlete Address: STREET ADDRESS . Messiah Village 100 Mt. Allen Drive CITY' . I STATE PA I ZIP 17055 Mechamcsburg Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Cred',t 8. Prior Payments C. Discount (II 29,665.34 25,000.00 1.315.75 Total Credits (A + 8 + C) (2) 26,315.75 3. InteresUPenalty if applicable D. Interest E. Penalty T otallnteresUP6l1alty ( 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) 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) 8. Enter the total of Line 5 + 5A This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 3,349.59 3,349.59 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; ........................................................................... 0 IZl b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IZl c. retain a reversionary interest; or m................................................................................................... 0 [Zl d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IZl 2. If death occurred alter December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................................... ........................,... 1KI 0 3. Did decedent own an "in trustfo~ or payable upon death bank account or security at his or her death? ................. 0 IZl 4. Did decedent own an Individual Retirement Account, annuity, or other non.probale property which contains a beneficiary designation? ............ ............................................. ._........,...... ._,............... .......,... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. h~ "3 " 0..3 Michael H. S , Esquire, Attorney for the state 201 South Railroad Street, P.O. Box 113, Palmyra, PA 17078-0113 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate impcsed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 <aJ (1.I){i)]. For dates of death on or after January 1, 1995, the tax rate impcsed on the net value of transfers to or for the use of Ihe surviving spouse is 0% [72 P.S. ~9t 16(a) (\.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spcuse is the only beneficiary. For dates of death on or alter 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. ~9116(al(I.2)]. The tax rate imposed on the nel 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(1.21 [72 P.S. ~9116(al(I)]. The tax rate imposed on the net value oftransfers to or for the use of the decedent's siblings Is 12% [72 P.S. ~9116(a)(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. LAST WILL AND TESTAMENT OF MARY R. SANDANNA I, MARY R. SANDANNA, of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate as follows: A. Twenty-Five percent (25%) thereof to my sister, ROSE RUGGIERI, or to her issue, per stirpes. B. Seventy-Five percent (75%) thereof to my niece, ROSEMARY RUGGIERI BAER, or to her issue, per stirpes. ITEM II: I appoint JOHN M. BAER of New Cumberland, Pennsylvania, guardian of any property which passes either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make Page 1 --.._'--_._._._..._----~._~- payment for these purposes, without furt.her responsibility, to the rainor or to the minor's parent or to any person taking care of the minor. ITEM III: I appoint my sister, ROSE RUGGIERI, and NICHOLAS RUGGIERI, her hus':land, Co-Executors of this my last ",ill. Should etther my sister, ROSE RUGGIERI, or her husband, NICHOLAS RUGGIERI, fail to qualify or cease to act as Co-Executors, I appoint my niece, ROSEMARY RUGGIERI BAER, Executrix of this my last will. ITEM IV: I direct that my Co-Executors, Guardian, and their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. I and seal IN WITNESS WHEREOF, ~ this / ~ day of I, MARY R. SANDANNA, have hereunto set my hand ),~~ , 1990. " / in MARY " , \ , L I 'h, ,0 ,{ " V SANDANNA ,{ (/;()( Il~ SIGNED, SEALED, PUBLISHED and DECLARED by MARY R. SAND ANNA , the Testatrtx above named, as and for her Last Will and Testament, and in the pre- Bence of us, who at her request, in her presence and in the presence of each ~ have s~bscribed our names as (l \ct" , I-,,~~ ~'., ( ~~/?f( f(~ ' Witness witnesses. 1) i /... ".' ";, I ((, (CJi~""'''\'' \,( Address ' )Iuu~ Address ~~)4- '-.J' Page 2 COMMONWEALTH OF PENNSYLVANIA: :3S: COUNTY OF CUMBERLAND I, MARY R. SANDANNA, the TestatriK whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and eKecuted this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. /7./ Ii: !\' "_ / / i L ,'r ~ J 1/-' ,.. ..~_,/ '- c-t- /1 .J f.... rL.t'<-- MARY R.JSANDANNA Sworn to or affirmed to and acknowledged before me by MARY R. SANDANNA, the Testatrh, this /S*day of q'~C:L'LQJ\ ,1990. ,- , (" , , Notary Public t~L r ' ... --_.,~-----_.- ,.., ,mIAr;'" (.:_ ': :: 1 j h...f1~tfi t'1 RT'(",;~ "{"r;'. I ;';;:t~ :"';I'.'Q[O,'^,," 'r~"'.-'-' ';-..' ., - '- '..".. 1\ . D ,'.. ,'(,' , . ..,~ L~ CG."~~j_ ~','~ ;-0,:,: 'E,;?~ ,~':'~, I:'_:,;~~~ \,~,';'-' I -_ _____.__~___. ;:":"2_! Page 3 COMMONWEALT~ OF PENNSYLVANIA :3S: COUNTY OF CUMBERLAND C)tl/) ~ J~ Wet /J vJ ' and (~:iJ-~ A {~, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more ears of age, of sound mind and under no constraint or undue influence. \ /' '\ wN~ ( l~O~ ;;t:!(~. Witness Sworn to or \Xl \\r\hl c_' :\TnG this It;' ''''~;;y of ; ( CUtQ affirmed to and acknowledged before and (cns,\(U'IC l L. Kcv\ \ , IDe by witnesses, , 1990. Ih..((~ I , ~,,'C;~f.R~:\l ,"~;\L 1 I ..P?~W~l; ~'1. Rn.'d:> .,~, ..' ,',"" <,~ ' 11;,-'..,' CU~BERLM:D 80:;:; rll"~ - 'I '~'- ," j "',' (""......_ ',d ,,_ ;," 'J' I.~ .~..~ _'.:.:.:~~~;~~:.~~ ..:.'..:~_' ~! Page 4 REV.1508EX+(1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF SANDANNA. MARY R. FILE NUMBER 21 02 1116 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointry.owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Allfirst Bank Checking Account #0075454092 - See Verification attached VALUE AT DATE OF DEATH 6,846.90 2. Merrill Lynch US Government Mortgage Fund Class D (3,672.234 shares X $10.26 = $37,677.12) - See Verification attached 37,677.12 3. Verizon - Refund 9.11 4. Highmark - Premium Refund 190.68 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 44,723.81 iii allflrst January 22, 2003 Farrell & Small Attn: Michael H. Small, Esq. 201/203 South Railroad Street P.O. Box 113 Palmyra, Pennsylvania 1707B-o 113 Allfirst Financial Center N.A. p.o. Box 900 Millsboro, DE 19966 RE: Estate of Mary R. Sandanna Date of Death: September 8, 2002 Sodal SecuritY Number: 195-07-8568 Dear Mr. Small: In response to your request, please be advised of the following account the above-named decedent had with this bank and the balance on the date of death. Account Type........................... Golden Age Checking Account Account Number....................... 0075454092 Ownership................................. Mrs. Mary r. Sandanna, Owner; Rosemary Baer, POA Opening Date........................... 07/28170 Balance on Date of Death...........$ 6,846.90 Accrued Interest...................... 00.00 Total......................................$ 6,846.90 This response does not apply to any assets held with A/lfirst Brokerage, where AJlffrst Bank;s serving as a trustee, not' to any cl'Od/t carris owned by Bank of America bearing Ai/first Bank's name. For further account information, closures and/or reimbursement of funds refer to below branch. 344 South 10111 Street, lemoyne, PA 17043, telephone 717-737-3322. Sincerely, '7tt:cf ~. Mary Anne Macielag Associate l/elS (302) 934-2240 I-II I . i~_~__1 Duane E. Herman, CPA Financial Consultant ('1'1'1 l.'.O\I", lhi,-,-. \\\\h 1(\1 . \h'~l),mi,'\"')l':, 1'.-\ \-\)-',; . "1-,-',--21nll . 111111-1-1"_SII'11I . !'.!X -:'17-7.~7"5002 F:'<\'.' '1,\1. .C:i"\\ ,.' February 25, 2003 Michael H. Small, Esquire Farrell & Small 201/203 South Railroad Street Palmyra, P A Re: Mary R. Sandanna Dear Mike, Pursuant to your request for the value of the mutual fund listed below, the following is provided: Merrill Lynch US Government Mortgage Fund Class D Estate value on September 8, 2002 (Sunday) is determined by the closing value on September 6, 2002. Closing value September 6, 2002: $10.26 per share Total value: 3,672.234 share x $\0.26 = $37,677.12 If you require additional intiJrmation, please feel tree to contact me. Best regards, r" /,;')'/",,1", ,/ //<-< ",,(/ (.' / I~' Duane E. Herman, CPA , / " I,insco/Private I.edger i\1emhcr NASD/SJPC REV_'510EX+('_97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF SANDANNA. MARY R. FILE NUMBER 21 02 1116 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OFTHETAANSFEREE,THEIRFlELATIONSf-IIPTO DECEDENT AN OTHEDATEOFTRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATIACH A COPV OF THE DEED FOR REAL EST/l.IE VALUE OF ASSET INTEREST (IFI\PPlICABLE) 1. L P L Financial Services 172,265,24 100, 3,000,00 169,265,24 Investment Account #63883596 - See Verification attached TOTAL (Also enter on line 7, Recapitulation) $ 169,265,24 (If more space is needed, insert additional sheets of the same size) Dated: //d.(1)(7"1 I TO: Michael H. Small, Esquire 201/203 S. Railroad Street P.O. Box 113 Palmyra, Pa. 17078-0113 RE: Estate of Mary R. Sandanna Mary R. Sandanna, deceased The information which you requested on the account(s) of (Social Security No. 195-07-8568 is as follows: Accoun t Number( s) 6388 3596 Type of Account Investment Account Date Opened 3IoZ4"/(/;Z Principal Balance I Accrued Interest r 4Lt j ,1 t~l!M ,"L'f/ Balance at Date J of Death: 9/8/2002 Acct. Ownership - - -JOIi\.) i Name of Joint Owner, if any -€ n (I;; IF/f'iif:4' bi;eR Date Ownership was Established 3/.2.5/11 ;J.. Additional Infor- mation Requested L P L Financial Services By: ~//d/7?? ~ d~/_ v IJPL Duane E. Herman, CPA Financial Consultant 'i')')'} LnUlle Drl,'e. SUtre 101 . :--1e~h.lninhllrg, 1'/\ 170)) . 717.::':-17-2100 . 800.]49-8090 . Fall: 717-737-5002 F1X-\."\C1AL SER\'ll 'ES January 20, 2003 Michael H. Small, Esquire Farrell & Small PO Box 113 Palmyra, P A 17078 Re: Mary R. Sandanna Dear Mr. Mike: The account maintained by Mary R. Sandanna had a total value at the date of death of $172,265.24. The details of the account is as follows: Money market account Accrued dividend on above $54,724.13 13.44 PIMCO GNMA fund (5.144.995 class C shares @ $11.l7) 57,469.59 PIMCO Real Return fund (5,324.298 class C shares @ $11.28) 60,058.08 $172,265.24 Total value If you need additional information regarding this account, please contact me. Yours very truly, / C2J~P-~/~ /~Mr~~ Duane E. Herman, CPA Linsco/Privare Ledger Member NASD/SIPC REV_1511EX+(1_97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF SANDANNA. MARY R. FILE NUMBER 21 02 1116 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman Funeral Home, Inc. - See attached 8,893.80 B. AOMINISTRA TIVE COSTS: 1. Personal Represen1a1ive's Commissions Name of Personal Representative (s) So~al Security Numbe~s) I EIN Numberot Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Farrell & Small 5,000.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees (Initial probate costs - $120.00; Add'!. probate costs - $20.00) 140.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. The Sentinel - legal - Estate Notice 119.21 8. Cumberland law Journal - Estate Notice 75.00 9. Register of Wills - Filing fee re: Inheritance Tax Return 15.00 10. Register of Wills - Filing fee re: Inventory 10.00 TOTAL (Also enter on line 9, Recapitulation) $ 14,253.01 (11 more space is needed, insert additionai sheets of the same size) . r [ "" j '.,f I ,;7, i,-'~ j.- Established 1895 Brian C. Musselman. FO. Supervisor William G. Pegan, F 0 P.O. Box 137 324 Hummel Avenue Lemoyne, PA 17043-0137 (717) 763-7440 . . r" FiJn81a' Expenses at MARY SANDANNA Resernary Baer 1704 Kathryn Street New Cumberland, PA 17070 2002 Sept. 1 2 PROF. SERVICES RENDERED,FACILITIES,AlJIDS Stainless Steel "Centura" Casket Cameo Rose lined vault Cash Expenditures: Flowers Copies of certificate Newspaper death notice Tent & grave servicing st. Theresa's Church Organist bench fee Cantor Altar servers TOTAL ':' :,PPO'lm.IENT PHONE 717.763.7440 Oct. 7 , 2002 $3,300.00 3,150.00 1,950.00 $8,400.00 180.20 16.00 57.60 100.00 100.00 75.00 50.00 15.00 ,$493.80 $8,893.80 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. Lori Saylor, Classified Advertising Manager of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or pUblication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication -ESTATE NOTICE .... Notice is h~teby given ttlBt 4ttte~Testal1\entary ':onthe I;state bfMARY ., R.l!....ItQANNA. """. ! Mary S.ndal'i".Jate 'of ~echanicsburg. Upper Allen Township, Cumbertand County, Pennsylvania. deceased, havs: been granted to the'undersigned Executrix. , All persons, therefore Indebted to said estate are requ8stedto make 'mmedlate'payment, and those having lust claims; win please present the,same, duly authenticated, forsenle. trI~~t...~lthouldelay. R~'emary ~uggi8ri B~er ~:.1704 KathryolStreet .. New Cumberland, PA 17070 , . .... . .' ...<Exec~triX Michael H. Small, EsqUire 2011203 South Railroad Street. P.O. Box 113 Palmyra. PA 1707g..0113 Counsel January 29 & February 5 & 12, 2003 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegatiot1s in the foregoing statement as to time, place and character of publication are true. ~~ ~f~ February 12, 2003 Sworn to and subscribed before me this 12th day of February, 2003. c~vJ.L</ 0 C-:OU.ZJCtFl Notary Public My commission expires: I PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYL VANIA : ss. COUNTY OF CUMBERLAND : Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, ofthe County and State aforesaid; being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2,1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: FEBRUARY 7,14,21,2003 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter ofthe aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Sandanna. Mary R.. a/k/a Mary San- danna. dec'ct. Late of Mechantcsburg. Upper Allen Township. Executrix: Rosemary Ruggieri Baer. 1704 Kathryn Street. New Cumberland. PA 17070. Attorney: Michael H. Small, Es~ quire. 201/203 South Railroad ORN TO AND SUBSCRIBED before me this 21 day of FEBRUARY. 2003 Street. P.O. Box 113. Palmyra. PA 17078-0113. ~jOTAA LOiS E. SNYDER Nolaly PullQc C::.1!Jb ""'rO, CU;7ibe!t3.'1d COunty '~'j I"A"~"~' ''''~n "~";l& MllIl:h5. 2005 1..'l,.A,.l..........,...."'-u"""^".... I REV.1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS EST ATE OF SANDANNA. MARY R. FILE NUMBER 21 02 1116 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. Holy Spirit Hospital - Medical Bill 25.44 2. Pinnacle Health Hospice - Medical Bill 441 .48 TOTAL (Also enleron nne 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 466.92 REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~...~...,. 'R NUMBER I. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec, 9116 (al (1.2)] Rose Ruggieri c/o The Bridges at Bent Creek, 2300 Bent Creek Blvd. Mechanicsburg, PA 17050 Rosemary Ruggieri Baer 1704 Kathryn Street New Cumberland, PA 17070 FILE NUMBER ?1 O? RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 111R AMOUNT OR SHARE OF ESTATE Twenty-Five (25%) Percent of Residuary Estate Seventy-Five (75%) Percent of Residuary Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-I 500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE Sisler 2. Niece 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space Is needed, Insert additional sheels of the same size) v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 MICHAEL H SMALL FARRELL & SMALL PO BOX 113 PALMYRA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ~ ' ,.. .. ~ •, ;~ - t. _ ESQ PA 17078 REV-1547 E% ~FP (01-03) DATE 07-07-2003 ESTATE OF BANDANNA MARY R DATE OF DEATH 09-08-2002 .,FILE NUMBER 21 02-1116 COUNTY CUMBERLAND ACN 101 Amount Remitted 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 BANDANNA MARY R FILE N0. 21 02-1116 ACN 101 DATE 07-07-2003 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) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 44,7 23.8 1 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 169,265.24 989.05 213 8. total Assets (81 , APPROVED DEDUCTIONS AND EXEMPTIONS: 14,253.01 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule Hl (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 466.9 2 (11) 14.719.93 11. Total Deductions 199,269.12 12. Net Value ofi Tax Return (121 00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . 199,269.12 14. Net Value of Estate Subject to Tax (141 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: 00 00 .00 15 (15) Amount of Line 14 at Spousal rate . X = . 16 Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 . .00 . 17 Amount of Line 14 at Sibling rate (17) 7,500.97 X 12 900.12 . 18 Amount of Line 14 taxable at Collateral/Class B rate (18) 191,768.15 X 15 28,765.22 . 1191= 29,665.34 19. Principal Tax Due AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-l 12-06-2002 CD001929 1,315.79 25,000.00 05-21-2003 CD002601 .00 3,349.59 TOTAL TAX CREDIT 29,665.38 BALANCE OF TAX DUE .04CR INTEREST AND PEN. .00 TOTAL DUE .04CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, 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.)