HomeMy WebLinkAbout01-0314
Estate of
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
,JJ./-O/-j I c.J
SARAH J. CARROLL
No.
To:
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 182-22-8342 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
rix
Your petitioner(s), who is/are 18 years of age or older an the7 e'l.eS::!It.
in the last will of the above decedent, dated 2 2 ~ / ~ 1
and codicil(s) dated
named
,19_
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cu be r land
h er last family or principal residence at'
P.^. 17050
County, Pennsylvania, with
41 Lilac Drive, Mechanicsburg,
~~"1~
(list street, number and muncipality)
Decendent, then 74 ye~rs of age, died March 16, 2001,.. , l~ '
at ~.~~ ~) D~A..: ~~ , ~^,('A.JlAA^-j, ~. .
Except as follows, decedent di not marry, was not <;hvorced and dId not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: 41 Lilac Dr.. Mechanicsburg, PA
20,000.00
$
$
$
$100,000.00
17050
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentary
(testamentary; administration c.I.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ~ ~
COUNTY OF _ CUMBERLAND J ~.:s
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
S",om 10 0< affi,m,d aod sub",dbed f '.)"OJ )fi. ~ ~,e So
before me this day of ~
19 ~
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No.
21-2001-314
Estate of
SARAH J. CARROLL
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
March 23rd, 2001
AND NOW 1'J!L..-, 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 28, 1991
described therein be admitted to probate and filed of record as the last will of
Sarah J. Carroll
and Letters Testamentary
are hereby granted to Janice L. Page, Executrix
FEES
P b L E $ 235.00
ro ate, etters, tc..........
Short Certificates( 6) . . . . . . . . .. $ 18.00
Renunciation ................ $
Bond $ 15.00
x-Pages (1) j.UU
JCP TOTAL - $ 5
.uu
Filed t:1ax:ch. 23r200.1 . . . . . . . . $. .276.00 .
Douglas, III, Esquire
61886
AlTORNEY (Sup. Ct. I.D. No.)
27 W. High St., Carlisle, PA 17013
ADDRESS
"
717-243-1790
PHONE
CALL ATTORNEY
q'n"..Q{\C:; ~l:"Y <;/.0(.,
This is to certify that the information here given is correctly copied from an original certificate of ~ath duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
,
Fee for this certificate, $2. 00
p
7285712
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,
Date
21-2001-314
H105. t43...... 2117
COMMONWEALTH OF PENNSVLVANIA . DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
-
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.... Of DICEOIHT IF.... MldcIe. r...,
I. Sarah J. Carroll
tWI"'I~
SEI SOCIAL SECuAln HUYlER
I. Female I. 182 - 22 - 8342
DIiIEO#O€RHro....-. I
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74
UHOIflI 1 YEAR
- Doys
....HPUCE,c... _
SUlM or fcr'9'CouwVl
Dauphin, PA
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COUNtY OIF OERH
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Carroll
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LAST WILL AND TESTAMENT
OF
SARAH J. CARROLL
21-2001-314
I, SARAH J. CARROLL, presently residing at 41 Lilac Drive
Mechanicsburg, Cumberland County, Pennsylvania, being of
sound mind and memory, do hereby make this my Last Will and
Testament, revoking and making void all wills, codicils, and
other testamentary dispositions, by me at any time here-to-
fore made.
First, I direct my Executor to pay all of my just debts, the
expenses of my last illness, and interment, of suitably
marking my place of interment, and the costs of
administration of my estate as promptly after my decease as
may be convenient.
Second, all the rest, reS1aue and remainder of my estate,
real and personal property, of whatever nature and wherever
situate, I direct my Executor to distribute equally among my
three (3) children, Janice L. Page, of Indianapolis, Indiana,
Paul L. Sheaffer, of Dauphin, Pennsylvania, and Karl B.
Sheaffer, of Dillsburg, Pennsylvania.
In case any of my said three (3) children shall fail to
survive me for a period of thirty (30) days, the gift to that
child shall lapse and shall be taken, share and share alike,
by the remaining children surviving me for a period of thirty
(30) days.
Lastly, I make, nominate and appoint Janice L. Page,
Daughter, to be the Executor of this my Last Will and
Testament.
This document has been prepared and executed in duplicate,
and either one of the identical copies shall be considered an
original. Furthermore, the disappearance of either copy
shall not be construed as a destruction, modification,
cancellation, termination or revocation of this document, and
it is my intention that this document shall not be destroyed,
modified, cancelled, terminated or revoked except by actual
destruction of both copies or by another document in writing.
One of these copies shall remain in my possession with my
personal papers and the other shall remain in the possession
of the Executor.
.
IN WITNESS WHEREOF, I the said SARAH J. CARROLL have to this
my Last Will and Testament, hereunto set my hand and seal,
this __;L'1_~' _ day of February, in the year of our Lord, One
Thousand Nine Hundred and Ninety One (1991).
__~--:~. (...),.,~ SEAL
Sarah J Carroll
Signed, sealed, published and declared by the said SARAH J.
CARROLL, as and for her Last Will and Testament, in the
presence of us, who, in her presence, and in the presence of
each other, have hereunto set our hands as attesting
witnesses, we believing her to be of sound mind and memory.
NAME
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ADDRESS
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REGISTER OF WILLS OF ~ COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will 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 signed as a witness at the
request of testat in h presence 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
")--1 19_
(Name)
(Address)
Register
(Name)
(Address)
-:; .~-:-:
21-2001-314
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
T::lni (,P T. P::lEP ::lnil T.::lrry P::lEP
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
they are familiar with the signature of Sarah J. Carroll
~){x
testat~ of (one of the subscribing witnesses to) the will
that
they
presented herewith and
eolfieifx
believes the signature on the will is in the handwriting of
Sarah J. Carroll
their
to the best of knowledge and belief.
Sworn to or affirmed and subscribed before
me this 22nd day of
March 192001
olis, IN 46240-3627
7255 Dean Road, Indianapolis, iN 46240-3627
(Address)
-:.
BOND
REGISTER OF WILLS OF CUMBERIAND COUNTY
BOND AND SURETY FOR PERSONAL REPRESENTATIVE
21-2001-314
KNOW ALL BY THESE PRESENTS, That
7255 Dean Rd. Indianapolis, IN 46240
Janice L. Page
as principal(s) and
Pennsylvania National Mutual Casualty Insurance Company of Harrisburg, PA
as surety (sureties) are held and firmly bound unto the Commonwealth of Pennsylvania in the sum of
One hundred twent)dollars ($ 120,000) to be paid to the Commonwealth, for which payment we
thousand
do bind ourselves, jointly and severally, our heirs, executors, administrators and successors, the
condition of this obligation being that if
l:mi rp T PR8/"
as (state fiduciary capacity) executrix
of the estate of
Sarah J. Carroll
, deceased,
or any of them, shall well and truly administer the estate according to law, then this obligation shall
be void as to the personal representative or representatives who shall so administer the estate and his
or their surety or sureties; but otherwise it shall remain in full force.
Signed and sealed this
)1 ~t
day of MR"t:(' n
,x~ 2001 , each
intending to be legally bound hereby.
-t" Hi If, tl9~
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(Seal)
(Seal)
_(Seal)
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Att~ey- -Fact .
(Seal)
WI
PENNSYLVANIA NATIONAL MUTUAL CASUAL TV INSURANCE COMPANY
Harrisburg, Pennsylvania
POWER OF ATTORNEY
Know All Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE
COMPANY, a corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint
PATRICIA K. ARBEGAST, DAVID W. HOPCRAFT AND JEFFREY L. SCOTT, ALL OF CARLISLE,
PENNSYLVANIA (EACH)
its true and lawful Attorney(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed:
ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING
EXCEEDS THE SUM OF SEVEN HUNDRED FIFTY THOUSAND DOLLARS ($750,000.00)---------------
ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT
NOTICE AT MIDNIGHT OF THE 30TH DAY OF SEPTEMBER 2002, AS RESPECTS EXECUTION SUBSEQUENT
THERETO.
and the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to
all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company
at its office in Harrisburg Pennsylvania, in their own proper persons.
This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company
on October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full
force and effect.
In Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these
presents to be signed and its corporate seal to be affixed on SEPTEMBER 20, 2000
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PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY
By t;;.~/d(f,~.-;w
. "Kenneth R. Shutts-Secretary
Commonwealth of Pennsylvania, County of Dauphin - ss:
On SEPTEMBER 20,2000 ,before me appeared Kenneth R. Shutts to me personally known, who being by me duly sworn,
did say that he resides in the Commonwealth of Pennsylvania, that he is Secretary of PENNSYLVANIA NATIONAL MUTUAL
CASUALTY INSURANCE COMPANY, that he is the individual described in and who executed the preceding instrument, and
that the seal affixed on said instrument is the corporate seal of said Company, and that said instrument was signed and sealed
on behalf of said Company by authority and direction of said Company, and the said officer acknowledged said instrument to
be the free act and deed of said Company. ..' ...;.....;.....
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Nnt<lnT Public
NOTARIAL SEAL
CHRISTINA ENCK, Notary Public
Harrisburg, Dauphin County
My Commission Expires Jan. 27. 2003
I, Thomas L. Vehar, Vice President, Surety of the PENNSYL VANIA NATIONAL MUTUAL CASUALTY INSURANCE
COMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certifY that the above and foregoing is a true
and correct copy of a Power of Attorney, executed by the said Company, which is still in full force and effect.
".r
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Commonwealth of Pennsylvania, County of Dauphin - ss:
In W;tness Whereof, I have hereunto set my haod and affu.-ed the corporate seal of said Company on March 21~
~vl Jj
Vice President, Surety
IMPORTANT NOTICE: This border must be RED in color. If it is not RED, this is not a certified copy. Telephone us at Area Code 717-255-6870. ..
78-190(Rev 1/99)
RESOLUTION
adopted by the Board of Directors of
Pennsylvania National Mutual Casualty Insurance Company
on October 24, 1973
RESOLVED, that (1) the President, any Vice President, the Secretary, or
any Department Secretary shall have power to appoint, and to revoke the
appointments of, Attorneys-in-Fact or agents with power and authority as
defined or limited in their respective powers of attorney, and to execute
on behalf of the Company, and affix the Company's seal thereto, bonds,
undertakings, recognizances, contracts of indemnity and other written
obligations in the nature thereof or related thereto; and (2) any of such Of-
ficers of the Company may appoint and revoke the appointments of joint-
control custodians, agents for acceptance of process, and Attorneys-in-Fact
with authority to execute waivers and consents on behalf of the Company;
and (3) the signature of any such Officer or of any Assistant Secretary or
Department Assistant Secretary and the Company seal may be affixed by
facsimile to any power of attorney or certification given for the execution
of any bond, undertaking, recognizance, contract of indemnity or other writ-
ten obligation in the nature thereof or related thereto, such signature and
seal when so used whether heretofore or hereafter, being hereby adopted
by thee Company as the original signature of such Officer and the original
seal of the Company, to be valid and binding upon the Company with the
same force and effect as though manually affixed.
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PENNSYLVANIA NATIONAL
MUTUAL CASUALTY INSURANCE COMPANY
Harrilburt, P.nn5ylvaftla
21-2001-314
SB 305175
. In the Matter of the Estate of: SARAH J. CARROll
7255 Dean Road
KNOW ALL MEN BY THESE PRESENTS, that we, Janice 1.. Page Indianapolis, IN 46240;-3627
as executr; X
of the Est"te of
Sarah J. Carroll
and Pennsylvania National Mutual Casualty Inllu~ncc Company, a Pennsylvania Corporlltion, of lIarrisburg,
Pennsylvania, as SIlJety, arc beld and firmly bound unto the Corrmonwealth of Pennsylvania
One hundred twenty thousand -------------------- DOLLARS,
in the full and just sum of
($ 120, QOO. --- J for tbe payment of which, well and truly to be made, we bind OUrselves, OUr heirs, oxe.
cutors, administrators, lIUCC(lSsor. and assigns, jOintly end severally, firmly by these presents,
Sealed with our seals, and dated this 21s t day of March
, 4GQ01
WHERF.AS,
Janice L. Page
, has been, 01 is about to be, appoinled
Exe~utrix
of the estate of
Sarah J. Carroll
, by the
Orphans
Court of
Cumberland
County.
NOW, THEREFORE, the condlllon of this obligation is such, that iethe said . TAn; ~e 1.. Page
snail weU and truly dischareE: the duties of said trust according to law. then thlJ; obllg~llon
is void. otherwise to remain in full force and effcet.
.~~M-
1~;1l:J. A~
(SEAL)
PENNSYLVANIA NATIONAL MUTUA1~
CASUALTY INSURANCE COMPANY
,"orm 18-168
" ~
PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY
Harrisburg, Pennsylvania
POWER OF ATTORNEY
Know All Men By these Presents, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE
COMPANY, a corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint
PATRICIA K. ARBEGAST, DAVID W. HOPCRAFT AND JEFFREY L. SCOTT, ALL OF CARLISLE,
PENNSYLVANIA (EACH)
its true and lawful Attorney(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed:
ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING
EXCEEDS THE SUM OF SEVEN HUNDRED FIFTY THOUSAND DOLLARS ($750,000.00)---------------
ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT
NOTICE AT MIDNIGHT OF THE 30TH DAY OF SEPTEMBER 2002, AS RESPECTS EXECUTION SUBSEQUENT
THERETO.
and the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to
all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company
at its office in Harrisburg Pennsylvania, in their own proper persons.
This appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company
on October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full
force and effect.
In Witness Whereof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these
presents to be signed and its corporate seal to be affixed on SEPTEMBER 20, 2000
. '-'-"~,.
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PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY
t;4~/-d (j?, ~~7tY7
. / Kenneth R. Shutts-Secretary
By
Commonwealth of Pennsylvania, County of Dauphin - ss:
On SEPTEMBER 20,2000 , before me appeared Kenneth R. Shutts to me personally known, who being by me duly sworn,
did say that he resides in the Commonwealth of Pennsylvania, that he is Secretary of PENNSYL V ANlA NATIONAL MUTIJAL
CASUALTY INSURANCE COMPANY, that he is the individual described in and who executed the preceding instrument, and
that the seal affixed on said instrument is the corporate seal of said Company, and that said instrument was signed and sealed
on behalf of said Company by authority and direction of said Company, and the said officer acknowledged said instrument to
be the free act and deed of said Company. . ......,;;::;.ifJ~. ::'"
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Nnt~1'V Public
NOTARIAL SEAL
CHRISTINA ENCK, Notary Public
Harrisburg, Dauphin County
My Commission Expires Jan. 27, 2003
I, Thomas L. Vehar, Vice President, Surety of the PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE
COMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certifY that the above and foregoing is a true
and correct copy of a Power of Attorney, executed by the said Company, which is still in full force and effect.
\. '''. ~~.1 ..~?'
...<:;.:.:r~::..:/:..,
Commonwealth of Pennsylvania, County of Dauphin - ss:
In Witness Whereof, I have hereunto set my hand and affixed the corporate seal of said Company on . March ..~
~yl ;ji
Vice President, Surety
IMPORTANT NOTICE: This border must be RED in color. If it is not RED, this is not a certified copy. Telephone us at Area Code 717-255-6870. ~
78-190(Rev 1/99)
RESOLUTION
adopted by the Board of Directors of
Pennsylvania National Mutual Casualty Insurance Company
on October 24, 1973
RESOLVED, that (1) the President, any Vice President, the Secretary, or
any Department Secretary shall have power to appoint, and to revoke the
appointments of, Attorneys-in-Fact or agents with power and authority as
defined or limited in their respective powers of attorney, and to execute
on behalf of the Company, and affix the Company's seal thereto, bonds,
undertakings, recognizances, contracts of indemnity and other written
obligations in the nature thereof or related thereto; and (2) any of such Of-
ficers of the Company may appoint and revoke the appointments of joint-
control custodians, agents for acceptance of process, and Attorneys-in-Fact
with authority to execute waivers and consents on behalf of the Company;
and (3) the signature of any such Officer or of any Assistant Secretary or
Department Assistant Secretary and the Company seal may be affrxed by
facsimile to any power of attorney or certification given for the execution
of any bond, undertaking, recognizance, contract of indemnity or other writ-
ten obligation in the nature thereof or related thereto, such signature and
seal when so used whether heretofore or hereafter, being hereby adopted
by the> Company as the original signature of such Officer and the original
seal of the Company, to be valid and binding upon the Company with the
same force and effect as though manually affixed.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Sarah J. Carroll
Date of Death:
March 16, 2001
Admin. No 21-01-0314
Will No.
TO THE REGISTER:
I certify that notice of (beneficial interest> estate administration required
by Rule 5.6 (a) of the Orphans' Court Rules was served on or mailed to the
following beneficiaries of the above-captioned estate on March 26, 2001
Janice L. Page
7255 Dean Road
Indianapolis, IN 46240
Paul L. Sheaffer
1917 Linglestown Road
Harrisburg, PA 17110
Karl B. Sheaffer
700 Salem Road, Lot 27
Regent Acres
Etters, P A 17319
Notice has now been given to all persons entitled thereto under Rule 5.6(a)
except: None.
Capacity:
~ P. ~'lli"
George F. Douglas, III, Esq.
27 W. High St.,
Carlisle, P A 17013
717-243-1790
Personal representative
X Counsel for Personal Representative.
Date: March 26, 2001
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NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND,
PENNSYLVANIA
IN RE: ESTATE OF SARAH J. CARROLL, DECEASED
NO. 21-01-0314
TO:
Janice L. Page
7255 Dean Road
Indianapolis, IN 46240
Paul L. Sheaffer
1917 Linglestown Road
Harrisburg, P A 17110
Karl B. Sheaffer
700 Salem Road,' Lot 27
Regent Acres
Etters, P A 17319
Please take notice of the death of decedent and the grant of letters to the
personal representative named below. You may have a beneficial interest in
the estate under the Last Will and Testatment of Sarah J. Carroll.
See attached copy of Will
Name of decedent: Sarah J. Carroll
Last known address of decedent: 41 Lilac Drive, Mechanicburg, PA 17050
Date of Death: March 16, 2001
Place of Death: Harrisburg Hospital, Dauphin County, P A
County of Grant of Original Letters: Cumberland
Decedent died Testate, and a copy of the Will is attached hereto
Name, address and phone number of all personal representatives:
Janice L. Page
7255 Dean Road
Indianapolis, IN 46240
317-841-7909
.,
,
Name, address and phone number of counsel:
George F. Douglas, Ill, Esquire
27 W. High St.
Carlisle, Pa. 17013
Phone: 717-243-1790
Additional information may be obtained from the undersigned:
Dated: March 26,2001
-""---
<<5-)~
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LAST WILL AND TESTAMENT
OF
SARAH J. CARROLL
21-2001-314
I, SARAH J. CARROLL, presently residing at 41 Lilac Drive
Mechanicsburg, Cumberland County, Pennsylvania, being of
sound mind and memory, do hereby make this my Last Will and
Testament, revoking and making void all wills, codicils, and
other testamentary dispositions, by me at any time here-to-
fore made.
First, I direct my Executor to pay all of my just debts, the
expenses of my last illness, and interment, of suitably
marking my place of interment, and the costs of
administration of my estate as promptly after my decease as
may be convenient.
Second, all the rest, residue and remainder of my estate,
real and personal property, of whatever nature and wherever
situate, I direct my Executor to distribute equally among my
three (3) children, Janice L. Page, of Indianapolis, Indiana,
Paul L. Sheaffer, of Dauphin, Pennsylvania, and Karl B.
Sheaffer, of Dillsburg, Pennsylvania.
In case any of my said three (3) children shall fail to
survive me for a period of thirty (30) days, the gift to that
child shall lapse and shall be taken, share and share alike,
by the remaining children surviving me for a period of thirty
(30) days.
Lastly, I make, nominate and appoint Janice ~. Page,
Daughter, to be the Executor of this my Last Will and
Testament.
This document has been prepared and executed in duplicate,
and either one of the identical copies shall be considered an
original. Furthermore, the disappearance of either copy
shall not be construed as a destruction, modification,
cancellation, termination or revocation of this document, and
it is my intention that this document shall not be destroyed,
modified, cancelled, terminated or revoked except by actual
destruction of both copies or by another document in writing.
One of these copies shall remain in my possession with my
personal papers and the other shall remain in the possession
of the Executor.
...
.
,
IN WITNESS WHEREOF, I the said SARAH 3. CARROLL have to this
my Last Will and Testament, hereunto set my hand and seal,
this i2 ~ ~. _ day of February, in the year of our Lord, One
Thousand Nine Hundred and Ninety One (1991).
S~J~t~SEAL
Sarah 3 Carroll
Signed, sealed, published and declared by the said SARAH 3.
CARROLL, as and for her Last Will and Testament, in the
presence of us, who, in her presence, and in the presence of
each other, have hereunto set our hands as attesting
witnesses, we believing her to be of sound mind and memory.
NAME
7I~~/
J2Mk
ADDRESS
~y 4~-&t, flu~.;f.
t??// ~~ J!.. ~4,;, ~.
, " /7'/ Y
"J.
l/~
.........
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
DOUGLAS GEORGE F III ESQ
27 W HIGH ST
CARLISLE, PA 17013
___un. fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: SSN: 182-22-8342
FILE NUMBER: 21-2001- 0314
DECEDENT NAME: CARROLL SARAH J
DATE OF PAYMENT: 08/30/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 03/16/2001
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
REMARKS: JANICE L PAGE
C/O GEORGE F DOUGLAS ESQUIRE
CHECK#1025
SEAL
INITIALS: SK
RECEIVED BY:
REV-1162 EX(11-96)
NO. CD 000212
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
AMOUNT
$4,811.00
$4,811.00
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
1.
J
55:
being duly
sworn
George F. Douglas. III. Esquire
according to law, deposes and says that he
Sarah J.
of the Estate of
is the attorney for
Carroll
late of -S-ilve-r-S'fH.;.i-ng-l'ownship-,----- , Cumberland County, Pa., deceased and that the
within is an inventory made by him _, the said attorney
of the entire estate of said decedent. consisting of all the personal propo!rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
Sworn to
and subscribed before me,
~ ~. ~1!r
August 30
2001
Executor. Administrator Attorney
19
George F. Douglas, III, Esquire
Notanal Seal
Anne M. Coll, Notary Public
CamsIe Borough. Cumberland County
. My commiSSIon eXl>lres July 14. 2005
27 W. High St.
Carlisle, PA 17013 Address
Day
M.G..("' ~'"
Month
2.00
Date of Dsath
\'-
Year
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.
...
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Inventory of the real and personal estate of
SARAH J. CARROLL
deceased
,.,,;" \.
...~"
. .
.
t,.
Boscov's paychecks
Prudential Ira check
Teamster pension check
Waypoint Savings Acet.
Waypoint Checking Aeet.
Prudential Ira check
Boscov's paychecks
Boseov's paychecks
United Airlines, refund
Patriot News, refund
Teamsters pension check
1992 Bonneauville, blue book value
Personal Property
U.S. Treasury, 2000 income tax refund
Com cast refund
Sale of personal property, Glenda Bostdorf
PA state income tax
Comcast refund
Verizon refund
Erie Insurance refund
U.S. Treasury, tax relief check
Real Estate-41 Lilac Dr., Mech.,PA
Mutual Fund - Prudential- IRA
/I
356.65
101.94
230.00
5,970.90
1,119.82
101.94
362.18
357.09
314.22
22.85
230.00
1,920.00
2,000.00
216.00
12.19
45.00
84.001
20.89
19.43
202.00
188.70
119,641.04
10.742.84
144,259.68
~ /6-~/9'- ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REY-15Q7 EX AFP (12-00)
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
10-22-2001
CARROll
03-16-2001
21 01-0314
CUMBERLAND
SARAH
J
ACN 101
DOUGLAS ETAL I Allount Rellitted I
27 W HIGH ST
CARLISLE PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is'4j-i3f-AFP-fi2'=oOY-NOTici--OF-YNHiifiTii.fCE-TAX-A-PPRA-isiMENT~--Ai:.l-owiNCE-(fR-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CARROLL SARAH J FILE NO. 21 01-0314 ACN 101 DATE 10-22-2001
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) 119 ,641. 04 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 subllit the upper portion
4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this forll with your
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 13.875.80 tax paYllent.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 10.742.84
8. Total Assets (8) 144.259.68
APPROVED DEDUCTIONS AND EXEMPTIONS: 37.353.78
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) 37.353 78
12. Net Value of Tax Return (12) 106.905.90
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 106.905.90
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15) .00 X 00 = .00
16. Allount of Line 14 taxable at Lineal/Class A rate (16) 106.905.90 X 045 = 4.811.00
17. Allount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Allount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= 4.811.00
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
08-30-2001 CDOO0212 .00 4.811.00
TOTAL TAX CREDIT 4.811.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
lIE IF PAID AFTER DATE INDICATED. SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
GEORGE F DOUGLAS III ESQ
[)'/.)J
~J '
I,. /
~f
c::.."\Ili FORM
ESTATE OF 5" /J-1Z 4// J. c:! /1 R-,k!.,t) L L
8o:s~vl 5
in the amount 0 f S / .....1b.6'_ / S-
ORPF..ANS' COrmT DIVISION O~
COURT OF COMMON p~~ OF
t!t<.1H Df.RL/f/l"lJ COUNTY PA
NO. c2/-cr/~:9/fL
,
Not:i.c:e of c:.la:i.m by
f~.lea pursuant tc sec::i.on 3384, Probata, Estatas and
Fi.duc:i.ari.es C~de Laws or 1972, Ac: No. 104 effec:ive July 1, 1972 as amended.
Date
//--5-<:0/
/
9441 LBJ FREEWAY
Lock. Box 30
Dalfas~ TX 75243
TO THE~mc OF THE
ORPHANS' COURT DrvISION:
!3b5' ~?Jt/I' S
(C.l~t: ana Address)
/,;?,?J~ r /5
against t.h.e above enti.t.led Estate _ The decedent:
Enter the claim of
in the amcunt of S
who resided at
.Ih cie//r1-McPsJ3<<~G-/ p~
(Address) "
died on :3 -It, .-...d) I
(Date)
Wri.tten notice of said claim wasmailedt~
see ~-ttacned
(Personal Represencati.ve or C~unsel)
at:
on
(Address)
The basis of aforesai.d c.la~ i.s as follows:
(Dat:e)
(Itemi=e fully tc enable persona.l representati.ve
to make proper i.nvestigation).
J1fJc/ # t:f/J ft33 5~/~O
(Name)
1 LBJ FREEWAY
ock Box 30
Dallas. TX 75243
(Address)
972-644-6360
Claimant's C~unsel
(Address)
PROBATE CDURT
CUmber land County, State of Pennsylvania
Sarah J. Carroll, Deceased
Case #21-01-314
Proof of Modling
I ma.iled the creditors claim to the fiduciary (and attorney, if applicable) as
follows:
I deposited a copy/copies of the claim with the United States Postal Service
in a sealed envelope with the postage fully pre-paid. I used first-class
ma.il. I am employed in the county where the ma.iling occurred. The
envelope (s) was/were addressed and ma.iled as follows:
Ms. Janice Page
c/o George F. Douglas, Esq
27 W. High Street
Carlisle, PA 17013
Date of Mailing:
County of Mailing:
'lIh~/
Dallas, Texas
I declare ~~ty of perjmy that
Date: 11/7 '0/
~t
the foregoing is true and correct.
for
Boscov's
P.O. Box 741026
Dallas, TX 75374
Page: 1 iocument Name: BARBARA
\RIQ (
ORGANIZATION 100 LOGO 110
SHORT ~AME CARROLL ESTATE
TOT CR LMT 0
CA CR ~~T 0
CASH BAL .00
CASH NIAL . 00
O-T-B **********0
PCT LEVEL / ID S PA
CURR BAL 1,206.15
BOSCOV'S CREDIT DIVISION
ACCOUNT INQUIRY
ACCT 0000000000003356140
STATE PA HOME PHONE
EMPL CD STATUS Z
CSH AUTH .00
TOT DISP 0 .00
CASH DSP 0 .00
CYCLE DB 0 .00
CYCLE CR 0 .00
CYCLE PMTS .00
;&.)
PAGE 01
REL
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DATE OPENED
CARD FEE DATE
DTE LST BILL
09/21/2001
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09/06/1985
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Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/07/2003
DOUGLAS GEORGE FIll ESQ
27 W HIGH ST
CARLISLE, PA 17013
RE: Estate of CARROLL SARAH J
File Number: 2001-00314
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 3/16/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~?:ollzar~p
DEPUTY REGISTER OF WILLS ~
cc:
File
~ersonal Representative(s)
Judge
Q~
Will No.:
STATUS REPORT UNDER RULE 6.12
'-~ J C~ 1)J)
3 1'<-/0 J
I ·
Q.-Do I - 00 ;''f-
Admin. No.:
Name of Decedent:
Date of Death:
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 wh~; administration of the estate is complete:
Yes 0' No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Ye~ No 0
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 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date:Wo~ ~ 'L L.d!L
~ignature ~'
~ r 7e. F. ~11o-1 7iL
de7 tv. <tJ-l V S- T:
~ p~ t,Ot3
Address
1/1 z-y-.3 171l)
Telephone No.
Capacity: 0 Personal Representative
~ounsel for personal representative
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNA.
ORPHANS' COURT DIVISION
NO. 2101-0314
FIRST AND FINAL ACCOUNT
OF JANICE L. PAGE, EXECUTRIX OF THE LAST WILL AND TESTAMENT
OF SARAH J.CARROLL, DECEASED, LATE OF SILVER SPRING
TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA.
DATE OF DEATH: MARCH 16,2001, NO. 21-01-0314
LETTERS GRANTED: MARCH 23,2001
FIRST COMPLETE ADVERTISEMENT OF GRANT OF LETTERS:
MARCH 30, APRIL 6, 13, 2001
DEBITS
PRINCIPAL: REAL ESTATE
Real Estate-41 Lilac Dr., Mech.,P A
TOT AL PRINCIPAL REAL ESTATE
119,641.04
$119,641.04
PRINCIPAL: PERSONALTY
Boscov's paychecks
Prudential Ira check
Teamster pension check
Waypoint Savings Acct.
Waypoint Checking Acct.
Prudential Ira check
Boscov's paychecks
Boscov's paychecks
United Airlines, refund
Patriot News, refund
Teamsters pension check
1992 Bonneauville, blue book
value
Personal Property
US. Treasury, 2000 income tax
refund
Comcast refund
Sale of personal property, Glenda
Bostdorf
P A state income tax
Comcast refund
Verizon refund
356.65
101.94
230.00
5,970.90
1,119.82
101.94
362.18
357.09
314.22
22.85
230.00
1,920.00
2,000.00
216.00
12.19
45.00
84.00
20.89
19.43
Erie Insurance refund
U.S. Treasury, tax relief check
Mutual Fund - Prudential- IRA
Water company refund
TOTAL PERSONALTY
INCOME PERSONALTY
TOTAL PRINCIPAL
CREDITS
The Accountant herein credits herself with the following:
J esse Geigle Funeral Home
Comcast
AT&T
PP&L
Hopcroft, Hockley & O'Donnell, estate
bond
H & R Block, 2000 tax preparation
Repairs to 41 Lilac Drive
New Life Remodeling, install new door
United Water
Debra B. Wiest, tax Collector, real estate
Verizon
Comcast
PP&L
Evening Sentinel, advertising
Cumberland Law Journal, advertising
Register of Wills, Letters
Register of Wills, filing
inventory / appraise
Comcast
AT&T
Verizon
United Water
Romberger Memorials
Reserved for First and Final Account
Essis & Son, new carpeting for 41 Lilac
Dr.
Erie, homeowners insurance
Silver .Spring Water Authority
PP&1
2
202.00
188.70
10,742.84
2.22
$144,261.90
NONE
$144,261.90
7,063.72
20.89
20.01
193.60
540.00
98.00
500.00
165.00
11.36
265.53
22.60
33.08
125.70
90.59
75.00
276.00
25.00
12.19
41.79
22.10
19.96
134.25
200.00
2,270.00
272.00
80.75
87.01
AT&T
AT & T wireless
United Water
Verizon
Verizon
Settlement costs in sale of 114 Lilac Dr.
M & T Bank charges
AT&T
PP&L
Lutheran Church, funeral donation
Readers Digest
P A inheritance tax
Janice Page, executors fee
Douglas, Douglas & Douglas, attorney
fee
TOTAL CREDITS
49.03
25.67
39.05
19.43
5.86
12,166.61
56.00
9.38
71.80
200.00
23.82
4,811.00
6,667.00
5,300.00
42,110.78
RECAPITULATION
TOTAL DEBITS
TOTAL CREDITS
BALANCE FOR DISTRIBUTION
$144,261.90
$ 42,110.78
$102,151.12
~iJ~' f~
JA CE L. P A E
(SEAL)
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
JANICE L. PAGE being duly sworn according to law, deposes and says
that she is the Executrix of the Estate of SARAH J. CARROLL, and that the
averments of the within First and Final Account are true and correct to the
best of affiant's knowledge, information and belief.
~J' Y;/MjL (SEAL)
Sworn to and subscribed
b~iore me this day of~ 2001
/
Notanal Seal
Anne M. Cox. Notary Public:
Carlisle Borough. Cumberland County
My commISSion expires July 14. 2005
4
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNA.
ORPHANS' COURT DIVISION
NO. 2101-0314
STATEMENT OF PROPOSED DISTRIBUTION
OF JANICE L. PAGE, EXECUTRIX OF THE LAST WILL AND TESTAMENT
OF SARAH J.CARROLL, DECEASED, LATE OF SILVER SPRING
TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA.
I, Janice L. Page, the accountant herein, propose to distribute the said
estate in accordance with the Last Will and Testament of Sarah J. Carroll, as
follows:
"Second, all the rest, residue and remainder of my estate real and
personal property, of whatever nature and wherever situate, I direct my
Executor to distribute equally among my three (3) children, Janice L. Page, of
Indianapolis, Indiana, Paul L. Sheaffer, of Dauphin, Pennsylvania, and Karl B.
Sheaffer, of Dillsburg, Pennsylvania."
AMOUNT TO BE DISTRIBUTED $102,151.12
Distribution
Janice L. Page
Mutual Fund - Prudential IRA, beneficiary $10.742.84
Balance for distribution $91,408.28
Janice L. Page
1/3 share
1992 Bonneauville, blue book value
Personal Property
Cash to Janice
$30,469.43
$ 1,920.00
$ 1,400.00
$27,149.43
Paul L. Sheaffer
1/3 share
Personal Property
Cash to Paul
$30,469.43
$ 600.00
$29,869.43
Karl B. Sheaffer
1/3 share
Cash to Karl
Total Distributed
$30,469.42
$30.469.42
$102,151.12
~)~. ~~
Ja e L. Page .
(SEAL)
5
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
JANICE L. PAGE being duly sworn according to law, deposes and says
that she is the Executrix of the Estate of SARAH J. CARROLL, and that the
averments of the within Statement of Proposed Distribution are true and
correct to the best of affiant's knowledge, information and belief.
~i~)jJE Il~ (SEAL)
Sworn to and subscribed
be!Q!"e me this "2.LP. day of C9-it 2001
~0-~ Ur
Notary
Notarial Seal
Anne M Cox, Notary Public
Carlisle Borough. Cumberland County
My commiSSion expires July 14, 2005'
6
~c~p
.
6)<{
<Cv(Q)~
LAST WILL AND TESTAMENT
OF
SARAH J. CARROLL
21-2001-314
I, SARAH J. CARROLL, presently residing at 41 Lilac Drive
Mechanicsburg, Cumberland County, Pennsylvania, being of
sound mind and memory, do hereby make this my Last Will and
Testament, revoking and making void all wills, codicils, and
other testamentary dispositions, by me at any time here-to-
fore made.
First, I direct my Executor to pay all of my just debts, the
expenses of my last illness, and interment, of suitably
marking my place of interment, and the costs of
administration of my estate as promptly after my decease as
may be convenient.
second, all the rest, residue and remainder of my estate,
real and personal property, of whatever nature and wherever
situate, I direct my Executor to distribute equally among my
three (3) children, Janice L. Page, of Indianapolis, Indiana,
Paul L. Sheaffer, of Dauphin, Pennsylvania, and Karl B.
Sheaffer, of Dillsburg, Pennsylvania.
In case any of my said three (3) children shall fail to
survive me for a period of thirty (30) days, the gift to that
child shall lapse and shall be taken, share and share alike,
by the remaining children surviving me for a period of thirty
(30) days.
Lastly, I make, nominate and appoint Janice L.. Page,
Daughter, to be the Executor of this my Last Will and
Testament.
This document has been prepared and executed in duplicate,
and either one of the identical copies shall be considered an
original. Furthermore, the disappearance of either copy
shall not be construed as a destruction, modification,
cancellation, termination or revocation of this document, and
it is my intention that this document shall not be destroyed,
modified, cancelled, terminated or revoked except by actual
destruction of both copies or by another document in writing.
One of these copies shall remain in my possession with my
personal papers and the other shall remain in the possession
of the Executor.
- -
.
.NESS WHEREOF, I the said SARAH J. CARROLL have to this
-'Last Will and Testament, hereunto set my hand and seal,
tKis ;2~ ~'_ day of Febr~ary, in the year of our Lord, One
Thousand Nine Hundred and N~nety One (1991).
S~~:~ SEAL
Sarah J Carroll -
Signed, sealed, published and declared by the said SARAH J.
CARROLL, as and for her Last Will and Testament, in the
presence of us, who, in her presence, and in the presence of
each other, have hereunto set our .hands as attesting
witnesses, we believing her to be of sound mind and memory.
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REV-1SlJO EX(~-OO)
/to-oi/l- c:,
REV.1500
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
coilNTY c!oE - {}- veJ- -{)- NOtaER+ -4- -
SOCIAL SECURITY NUMBER
w
,..,
:x:::$tI)
,,"''''
w""
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,,"''''
....
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DECEDENT'S NAME (LAST, FIRST, ANO MIDDLE INITIAL)
I-
Z Carroll, Sarah J.
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
W March 16, 2001 May 7, 1926
o
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MiDDlE INITIAL)
o
None
[::J 1. Original-Return
o 4. Limited Estate
o 6. Decedent Died Testate (AlIach copy 01 Will)
o 9. Litigation Proceeds Received
OFFICIAL USE ONLY
J
5f-
c.
FILE NUMBER
182 - 22
- 8342
THIS RETURN MUST Ilf FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise Jda!e of death after 12-12-62)
D 7. Decedent Maintained a living Trust (Attach copy olTrusl)
o 10. Spousal Poverty Credit ((Il1le of (\Qath betm.en 12-31-'~1 ane 1-'-95)
o 3. Remainder Return (date: of (\eatl\ priortG 12-1:!.-t2\
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
NAME
George F. Douglas, III, Esquire
FIRM NAME {II Applicabl&)
COMPLETE MAILING ADDRESS
27 W. High St.
Carlisle, PA 17013
OFFICIAL USE ONLY
(8)
144,259.68
,..,
z
W
Q
Z
o
..
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W
'"
'"
o
"
TELEPHONE NUMBER
717-243-1790
(11) 37,353.78
(12) 106.905.90
(13)
(14) 106,905.90
x.Q_ (15)
,,04-5- (16)
x .12 (17)
x.15 (18)
(19)
4.811 nn
".R!! 00
z
o
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ii:
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0::
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6, Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8, Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11, Total Oeductlons (loIaI Lines 9& 10)
12. Net Value of Estate (Line 8 minus Line 11)
(1) 119,641. 04
(2)
(3)
(4)
(5) D,S75.SQ
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(6)
(7) 10,742.84
(9) 17,1'\1 78
(10)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election 10 tax has not been
made (SChedule J)
14. Net Value Subject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES
z
o
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:ii:
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15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
16. Amount of line 14 taxable at lineal rate
106.905.90
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
20.0
, . .
Decedent's Complete Address:
STREET ADDRESS 41 Lilac Drive
CITY Mechanicsburg, I STATE PA I ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credil
B. Prior Payments
C. Discount
(1)
4,811.00
Tolal Credits (A + B + C ) (2)
3. InteresUPenalty if appiicable
D. Interesl
E. Penalty
TolallnteresUPenalty ( D + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAVMENT.
Check box on Page 1 Line 20 to request a refund (4)
A. Enter the interest on the tax due.
(5)
(SA)
4,811. 00
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE.
B. Enter the tolat of Une 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
4.811. 00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Ves
a. relain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. ildeath occurred after December 12, 1982, did decedent transfer property within one year of death
wlthoul receiving adequate consideration? .............................................................................................................. 0
3. Did decedenl own an 'in trust for' or payable upon death bank account or security at his or her death? .............. 0
4. Did decedenlown an Individual RetirementAccounl, annuity, or other non-probate property which
contains a beneficiary designalk,"? ........................................................................................................................ 0
Under penaltieS of perJury, I declare that \ have examined 1his return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Dedaratioo of preparer other than the personal representative is based on all infonnation of which preparer has any knowl6dge.
SIGNATURE OF P ON RESpONSIBLE F FILING TURN
F. '5
DATE
8/30/01
Geor e F. Dou las
I
ADDRESS
27 W. High St., Carlisle, PA 17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
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. 99116 (a) (1.1) (i)].
For dales of dealh on or after January 1, 1995, the lax rate imposed on the nel value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) Qi)].
The stalute does nol exemol a transfer to a surviving spouse fiom tax, and tl1e statutory requirements for dis~osure of assets and filing a tax retum are stiil applicable even if
the surviving spouse is the only beneficiary.
For dates of dealh on or after July 1, 2000:
The lax rate imposed on the net value of transfers fiom a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parenl,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J.
The tax rale imposed on the net value of lransfers 10 or for the use of the decadent's lineai benefi~aries is 4.5%, exceptas lIOted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)).
The lax rale imposed on Ihe net value of transfers 10 or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibiing is defined, under Section 9102, as an
individual who has al ieasl one parent in common with the decedent, whether by blood or adoption.
P"''''''''''''~''..
COMMONWEALTH OF PENNSYlVAN1A
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
SARAH J. CARROLL 21-01-0314
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defu\ed as the price at which property would be exchanged
beVNeen a willing buyer and a willing seUer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jointly-owned with
right of
survlvorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
>
DESCRIPTION
VALUE AT DATE
OF DEATH
Real Eslate-41 Lilac Dr., Mech.,PA
119,641.04
~
-"
OMB NO 2502-0265 ~
A.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.egFHA Z-DFmHA
,0'0 "'1"L21:.54 I :
SETTLEMENT STATEMENT
8. MVl<II.>,.,I.>I:.IN:>
B. TYPE :
3. QCONV. UNINS. 4. OVA
17. 615593901
5'OCONV. INS.
UMBER:
r-c:- NUTf::.: This form is furnished to give you a statement of actual settlement'cos(s. Amounts paid to and by the settlement agent ate shown.
Items merl<ed "[pOCr were paid outside the closing; they are shown here (or in(onnatione' purposes and are not Included In the totals.
1.0 3IQ6 I012M.prdK)12541.25)
rO:
iOF
1:..
Kerry C. Danner and
Lany S. Britcher
Estate of Sarah J. Carroll
G. PROPERTY LOCATION:
41 LIlac Drive
Mechanlcsburg, P A 17050
Cumberland County, Pennsylvania
H. SETTLEMENT AGENT:
Keystone Land Transfer, LId.
PLACE OF SETTLEMENT
3425 Market Street
Camp Hili, PA 17011
J.
:0"
..
1100. ..
1101. " :>alos Pilce
lU~. ersona' .. rcpertY
lU~. :>etuemeOfChargeSlollorrowei (!Jne 1400)
104.
TOO.
11~.ouu.UU
O.
-
Adjusltmltits For. Items Paid By sellsr In aCl-vanCB
1106. .CllVrrown Taxes to
1107. c.;ountv Taxes to
110b. :;Choo' Tax '0
I1U~.
I11U.
rm:
1112.
120. GROSS AMOUNT DUE FROM BORROWER
"0."
o.r'
124,971.97
1200. II:> PAID BY OR IN , 'OFI
f20"[LJ9posll or eames money
1202. PrincIpal AmoUnt of New Loan 5)
1203. ~isting loan s) taken SUbject to
1LU4.
[205:
[205:
f2OT.
ILUb.
1209. Clos,ng COSIS trom :;eller
Adjustments For lIems Unpaid By seller
f2W. "'t'l1 ownTaxes to
1~11. t;OUnlV axes to
1L1~. :;cnool lax 10
1~.
"4.
/1b.
/1ti.
/17.
m.
2W.
220. TOTAL PAID BYIFOR BORROWER
IJUU. . :>1:., "
f301.-GiosSAmounlDue From llorrower (Line l~ul
1302. Less Amount Paid By/For Borrower (une 220)
303. CASH ( X FROM) ( TO) BORROWER
<,
11 ,tiO~.UU
~,
123.153.00
I<~,>".",
. I<O.IO,.UU
1,816.97
IF. NAME
;ut-
ABN AMRO Mortgage Group,
Inc.
2600 Wesl Big Beaver Road
Troy, MI 46064
25-1676915
I. SETTLEMENT DATE:
June 29, 2001
K
"
40U.
~VI. ,t~ales nee
~u~ ersonal .. ropenv
~u,.
~"".
~uo.
11 ~.OUU.UU
At1jUsunems t or Items", aia Hy ~ell8r In aOvance
4UO.I."t'lIIOWnTaxes to
4ur. <;Qun Taxes 16 UlIUlIU~
4UO. .ax 0
4U>. .
~IU. .
~II.
412.
420. GROSS AMOUNT DUE TO SELLER
500. :
OVI. E:XC8SS uepOSIt(tiee Instructions}
:>0" t>eUlemeilf'Clfarges to :>eller (une 14UUJ
auo. ng loanlSllalfen st.i6jecllO
01.14. rayon of first Mortgage
ouo... e
ouo.
. OUI. lueposll dlsb. as proceeds)
ouo.
au~. "'oslng\:os~om""lIer
~ustments or lIems Unpal(1 By Seller
01U. "'lYn own Taxes to
011. l.AlUnlyTaxes to
. 01~. ax t6
,01'.
,014.
,010.
.010.
1011.
1010.
1010'
520. TOTAL REDUCTION AMOUNT DUE SELLER
"0.0'
5.73
119.641.04
0._.01
. Ji
12,166.61
I au'. brass Mounf DueiOSeIledI,ne420r
'QU":::. Less :eCluctions Uue Seller [line '~20}
603. CASH ( X TO) ( FROM) SELLER
119.641.04
1l.10o.01
107,474.43
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this stalement & any attachments referred to herein.
Borrower
I/t, ) () ,nil VI :)/1;1 .t
~i, ] I i (
~~llAr
~A .
,I)
(D
I' L. SETTLEMENT CHARGES
fOU. 'V'AL' I D3sea on t"nee $ 119,500.00 @ 6.0000 % 7,170.00 PAlO FROM PAlO FROM
vJV/s/on OT U)mmlSSlon (Jlna IVU) as rOllOWS: BORROWER'S SELLER'S
fUl.~ f,llU.UU 10 ".fMax MallY ASSOClale', mc. FUNDS AT FUNDS AT
IU.. . '" SETTLEMENT SfT11.EMENT
IU.. ,-omm",lon ~~Iu al",'Uemelll ',IIU.UU
fU'. "ansacuOn cee \U MIM~X ,,"allY as, me. '...vu
800. I fEMS
~Ul. Loan unglnatloo t"ee V.UUW 70 \0
ou~. Loan ul.coum 7. \0
ou.. ",,~r.,.a, rua W Clr' aga "arvlce., 100 ,_.wo
oV"t. l,...reyh "e~H 10 C'rsl unlleo Man ,~g. ".Mces, mo. ,(0... '-V\,o
ou;.!. I-t:nue. S Inspe....uou tD r-lrSl unHeo MOn age ~ervICClS. 10(,;. ,.(."".-V\,o ,....
ouu. MOIIOaO' In.. Al'P. e.a 10
oUl. ASsumpuon cea .0
OUO. ,
OU'.
OlU.
,011.
I 01.L. LJOCUmeOll repalauun "' CtrSI u",lea Monga, e ;:)srvlC8S, mc. 1fO.W
IO'~. VvemlWln IVlall "' rJn;1 unllea Monoa, e ..,8TY1ce:.. 1"'-'. ...UU
101~.C1~~" "'".. UlUIOU' ,10"- ,u.uu
1010. cnNV" cunon'o r.a 'u '''>I'M'''.... a uruup, ,,,_. "UU.UU
1010. .-ramlum "om "CD lUr"""" , OL_'.uur...."
01/, ",reon lor tjanK reas , 10 'lI1;jlVIIUeU I e ~rvl~:;" In.... -4.".uu
0'0.
0'..
OLU.
.UU. 'IlY 10
901. Intarest From 06120/01 to 07/01/01 @ $ 24.180000/day ( 2 days %) 48.36
Il:1U"". Mongage inSurance rrellllum,or manu I~ age roup, n . l,f.O,{.
I ~U,j. nazare Insurance ,...remlum tor 1.U yaars '0
1>IU4.
SUO.
IUUU. 'VVIlH
lUU1. Mazaro Insurance ~.UUU monms ~u."~ par monm ..,...
1 UU"" Mong~ge Insurance mornns 4U.;.1U per momn
ltJl.I'" l.,.;ItY/IOWn laxes monm. per monm
lU\J4l.. VOU01Y Taxes Q.UUU momns a.l. par monm I...(e
-I uuo. i)I;llOOI I ax 1..UUU monm. ol.~U par monm ,144.'O'oJ
,VUO. momns . par monUI
lUUf. mon $ per montn ,
I uue. "Ogragalll AOJu.tman monms . per monm -,.,..,
11UU.IIIL'"
1101. SeWament or Closing Fea to
""~. ,,"SU"VI or flUa "earen W
"U3. litis Exam naUon 10
1104. IIlIa msurance '>lnoer 10
11 UQi, uocumem I""reparatlon 10 ,
1 1 Vb. NOtary I""ees 10,"","" U.UU
11 U f. Alwmay. . aes 10 uouglas, uoug",. & uouglas
(/nCfUaeS BOOVfJ icBm numOBrs: )
nut). 1 me Insurance to Keystone Land Hans er, Ltd. POlicy "1;f131 , 1,UIi ;.10
(mCluoa. SDOve lIem numoe=noorsamams lUU, .UU, 0.1 )
, "". Lenoar. ","v.raga . 1-I/.OO".uv
I"'U, uwner. ","v.raoa . 1111.0VU.uv
: 1111. '-,losIng .-'O,eCuOn L'Ua' '~I 10 ".y"o"a ...n. ,r.n.,." LIU. (v.vu
: rl1~ uVernlgm '0 "ay.,"". ...". "a"..a., L<~. ".UU
""..
,UOO.
1201. Racordlng Fea.: Oaed $ 25.50; MOItgaga $ 33.50; Releases $ 50.00
I'"U". '-IlYfyoumy ,aJU"",mps:u.au -1,-Il:JO.UU; MOngage " '"'.uu
I ,"U.. ""'la I axf"",mps: ~evenue~Ulrnps 1.1l:JO.UU, Mongage I,'.O,UU
l;tU.q.. ASSignment OJ Mongage 10 Ulmoenand ....ounty Recorder 01 uaeOS ,..UU
,"U'.
1300. ALSt11
1301. Survay to
l,JU.o::::, t'eSl Inspecuon 10 ~Iacnlar & IlIlery PV<;
,.u.. clOa. ".w.r J;Ullj .lj/L" 10 "liver "prlOg I wp. MUnc. Aumorny IUO.Ol
1304. ,
'.UO.
"UU. 'VIAL (t:nter on Lines llJ.J. .:::tectlon.J ana :>U"-. :>>ectlon K) 5.330.93 .8,060.6'
5~ & g,r"flg piOl)$ 1 ollhl$ .lawmenl. lh.. 5.gIlllI0<1... f'8(:lIlipt or. comoJ..1ad I'nn.... nI ""'''''' u,;.. ....~ ~~__ .'_'~_u'
Page 2
RlN.l50SEX.. (l.gn
'*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA .
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SARAH J. CARROLL
FilE NUMBER
21-01-0314
Include the proceeds of litigation and the date the proceeds were received by the estate. All property joinUy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Boscov's paychecks
Prudential Ira check
Teamster pension check
Waypoint Savings Accl.
Waypoint Checking Accl.
Prudential Ira check
Boscov's paychecks
Boscov's paychecks
United Airlines, refund
Patriot News, refund
Teamsters pension check
1992 Bonneauville, blue book value
Personal Property
U.S. Treasury, 2000 income tax refund
Comcast refund
Sale of personal property, Glenda Bostc or!
P A state income tax
Comcast refund
Verizon refund
Erie Insurance refund
U.S. Treasury, tax relief check
"
VALUE AT DATE
OF DEATH
356.65
101.94
230.00
5,970.90
1,119.82
101.94
362.18
357.09
314.22
22.85
230.00
1,920.00
2,000.00
216.00
12.19
45.00
84.00
20.89
19.43
202.00
188.70
TOTAl (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
13,875.80
.11 ~!!.~~
~Street~Office
CURRENCY ~
u~
ADDITIONAllISTING~CHECKS ...
BE SURE EACH ~
PROPERLY EN~~~
IOTAL OEMi
i
~
.
DEPOSIT TICKET
DATE fd'u II> I
CHEClGANOOlliEAITEMSAAEAECEIVEO OROE~UBJECTTOTHEPAOVISIONS
OF Tl1E UNIFORM COMI.EFIcIAl.. COOE OR AN( APPl.ICABlE COlllCTlON AGRl:EI.lENT
OEI'OSITSMAYNOTBEAVAIl..AtllEFOFllMMEDlATEW'llllllAAWAl
ESTATE OF
ESTATE OF SARAH J CARROLL
JANICE L PAGE, EXECUTRIX
27 W HIGH STREET
CARLISLE, PA 17013
$
T8i.t~rf~~ ...
':0 3 ~ 30 2"l 5 5':
BB"l2t.t. ~"lbB"" b
~022oooBbB~bB~t.00?~3 bB333~"l2S
Prudential
Investments
Mutual Fund Servfces LlC
P.O. Box 7968
Philadelphia, PA 19101-7968
State Street
Quincy, Mass 02171
Pay:
DIVIDEND
*************ONE HUNDRED ONE AND 94/100
DOLLARS tAR 20 2001
Void after One, Year
Tolhe SARAH J CARROLL******************************
Order 01, .41 LILAC DR
MECHANICSBURG PA 17055-3190
LIST CHECKS SINGLY OR ATTACH LIST
11/1f2.
fO/9Lf
"3"2 Us
3 S-7 o{
/1LfI.D3
53-283
113
)*******101*94
Dollars Cents
~'" o.c..-'Yt
lI"oBb 2B 3B ~ 5 ~"" 1:0 ~ ~ 30 2B 3 bl: BB ~ 30 5BB""
~ Prudential Mutual Fund Services lL~ .
~ P.O. Box 7968
Investments Philadelphia, PA 19101-796'
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State Street
QuIncy, Mass 02171
08627al3W( -
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DIVIDEND
**********
*9NEHUNDRED ONE AND 94
53~283
1ff
Pay:
DOLLARS rEB 20
2001
To the SARAH ARROLL**********
Order 0" 1/1'LILAC DR
MECHANICSBURG PA 17055-3190
Void
**********
Dollars Cents
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CENTRAL PEN/IISYlVAIjI!\ TEAMSTERS
PENllfON~
READING, PA 1!l6f?-522a
O.B. BENEFIT ACcOUNT
FIRST UNION NATIONAL BANK
REAOING, PA
_PAY
TCiTHE OADE~,OF
SAR1\Jj ~, C\RROtL ',',
- 41 r,!LAC'lIlt '
MEClllINiCSBUR.C;- P,A 17055,~3190
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Boscoy's Department Store. ~
PO Box 4505
Reading PA 19606
~
311
THE BANK OF NEW YORK (DELAWARE)
Newark. Delaware
0300970753
0001218315
Date 0~/08/0]
Payable AmolDlt
$*iUl331.74
Pay
Three Hundred Thirty-One and 74/100 Dollars
To The
Order
OJ
0001~ 0701 02/08/01
SARAH J CARROLL
41 LILAC DRIVE
MECHANICSBURG PA 17055
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Authorized Signature
1I'000~2~B:I~511' l:o:l~~00:l5~1: 0:100'17075:111'
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Pay
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Order
Of
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Ilosco.'s lIepartlnent StOre. u.c
PO !lox 4505
Reading PA 19606
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TIlE BANK OF NEW YORK (DELAWARE)
Newl\fl!.D<!laware
030097075~
Date 03/29101
Three Hundred SIXty. Two and .18/100 Dollars
00l!12 070L 0349/01
Il5TATEOP SARAHCARRQLL
4'1 LILAc DRIVE
MECHANICSBURG PA 17055
'000.2???b'irr' 1:00l.l.OO0l5.1: 00l00'i?0?501rr'
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Pay
To The
Order
Of
, .
, ,
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1losco."~tStore.u.c
1'0 !lox 4505
Reading P A 19606
Payable Amount
$"'362.18
"22.,-",,; q ~~
~.. ' Authorizec:! Signature
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~
311
TIlEIlAN~oFmY~~WWJ
Newarlt;lllllaWMe . .
0300970153. .
!late 03/22/01
Three Hundred Fifty- Seven and 09/100 Dollars
00012 0701 03l~2/01
~A~ OF SARAH CARROLL
41 LlL:AC DRIVE
MECHANICSBUIlG PA 17055
1'000.2(;'i0l0l.rr' 1:001..00015.1: 00l00'i?0?501rr'
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$""357.09.
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AulbotUed Signature
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SARAH J. CARROLL
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
FilE NUMBER
21-01-0314
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 NAM~ OF THE TRANSFEREE, THEIR RELATIONSHIP TO oeceoENT.AAlD Tl1E DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSI~~ TAXABLE VALUE
ATTACH A COf"(OFTHE DEEO FOR REAl ESTATE.
NUMBER VALUE Of ASSET INTEREST IF APPliCABlE
1. Mutual Fund - Prudential- IRA
10,742.B4 10,742.84
TOTAL (Also enteron line 7, Recapitulation) $ 10,742.84
(If more space is needed, insert additional sheets of the same size)
Prudential Mutual Fund Services LLC
PO Box 7387
Philadelphia, PA 19101-7387
~ Prudential
-
Investments
CLIENT CONFIRMA nON
Your Account Number Is: 02808148373
ACCOUNT OWNERfS):
PRUDENTIAL BANK AND TRUST CO.
CIF THE IRA OF
SARAH J CARROLL DEC'D
FBO JANICE L PAGE
7255 DEAN RD
INDIANAPOLIS IN 46240-3627
1.1"1.11""1".1"111.",.11,,1,,,,.1,11...1,,.1,,1,1..11,.1
Page I of I
. 'WeCqnfirm Your Mutual FundActivity oii 4117/2~~IFoT:rh~f()llo~j*gl..........'.'... .
Pru~ential High Yield Fd: Fnll Transfer from 03800186202 $10,742.84 $6.14 1,749.648 1,749.648
CI A Fd #0087
Distribntion Due to Death-Chic ($9,656.56)
Federal Withholding ($1,Q74.28)
Anoual Fee ($12.00)
Total Transaction ($10,742.84) $6.14 (1,749.648) 0.000
Dividend Close Out-Cash $85.76 $0.00 0.000 0.000
Remtered RepresenlaUve(s): For Prndential m.h Yield Fd: Cl A Fd # 0087
BRIAN KENNEDY LUTCF (717)774-7080
PRUCO Securities COIl'oration, member NASD, SIPC, acted as agent in this transaction.
Prudential Mutual Fund Services LLC strives for quality processing. Was this transaction executed to your satisfaction?
Please caD onr toll-free Customer Senice number _ (800) 22S-1852
Please refer to the reverse side for additional infonnation. Retain this copy for your records.
~----------------------------------------------------------------------------------------------------------------
Additional Investment Form Please use this fonn 10 make an additional inveslment 10 your mutual fund account(s).
Please indicate the dollar amount you wish to invest on the line below, next to your fund/class.
ACCOUNT OWNER(S) List the total amount of your investment and make your check or money order payable to PMFS.
PRUDENTIAL BANK AND TRUST CO.
CIF TIIEIRA OF
SARAH J CARROLL DEC'D
FBO JANICE L PAGE
Your Retirement Account Holdings
PRUIllGHYIEW:A
Fund
Number 2001
I 0087 Is
I
Total Invesbnent
I 1$
Your Account Number is. 02808]48373
Your SSNrrax ID is. 312-62-45]2
, ,J1i:l',
/\ J-\V \ ~ i/lI1/Pp\vnr L. 0'/1 if1:\ J \~
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0280814837360087000000000000000000001302
Fee Amount
1$
~
REV-1511 EX+ (12-99) _
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
SARAH J. CARROLL
FILE NUMBER
21-04-0314
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
Jesse H. Geigle Funeral Home 7,063.72
B. ADMINISTRATIVE COSTS:
1. Personal Aepresentallve's Commissions
Name of Personal Represen\at\....e(s) Janice Page, executors fee 6,667.00
Social Security Number{s}/EIN Number of Personal Representative(s)
Street Address 1'l.S,5 lJ.e~" ~
City ]:(\d1a.nap"tt S. IN Stater (I./ Zip 4(.2.1(0-31.2..1
Year(s) Commission Paid:
2. Attorney Fees Dooj"-'> I !::bu~'as, & Douglas, atty. Fee 5,300.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ~ Zip
Relationship of Claimant to Decedent
4. Probale Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Comcast 20.89
AT&T 20.01
PP&L 193.60
Hopcroft, Hockley & O'Donnell, estate bond 540.00
H & R Block, 2000 tax preparation 98.00
Repairs to 41 Lilac Drive 500.00
New Life Remodeling, install new door 165.00
United Water 11.36
TOTAL (Also enter on line 9, Recapitulation) $ 37,353.78
(If more space is needed, insert additional sheets of the same size)
. .
Debra B. Wiest, tax Collector, real estate
Verizon
Comcast
PP&L
Evening Sentinel, advertising
Cumberland Law Journal, advertising
Register of Wills, Lelters
Register of Wills, filing inventory/appraise
Comcast
AT&T
Verizon
United Water
Romberger Memorials
Reserved for First and Final Account
Essis & Son, new carpeting for 41 Lilac Dr.
Erie, homeowners insurance
Silver Spring Water Authority
PP&l
AT&T
AT&T wireless
United Water
Verizon
Verizon
First United Mortgage, sale of home
Seller's closing cost, sale of home
Realtor's commission
Keystone Land Transfer, sale of home
Recorder of Deeds, transfer tax
Recorder of Deeds, recording mortgage assign
Silver Spring Water Authority
M & T Bank charges
M& T checkbook charge plus check charge
AT&T
PP&L
Luthern Church, funeral donation
Readers Digest
265.53
22.60
33.08
125.70
90.59
75.00
276.00
25.00
12.19
41.79
22.10
19.96
134.25
200.00
2,270.00
272.00
80.75
87.01
49.03
25.67
39.05
19.43
5.86
28.00
3,500.00
7,295.00
84.00
1,195.00
14.00
106.61
27.92
26.08
9.38
71.80
200.00
23.82
37,353.78
.
RfV_1513 EX + (1.97)
'*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDE T DECEDENT
ESTATE OF
Sarah J. Carroll
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (Include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not list Trustee(s)
1.
Janice L. Page
7255 Dean Road
Indianapolis, Indiana 46420
Daughter
2. Paul L. Sheaffer
1917 Linglestown Road
Harrisburg, PA 17110
Son
3. Karl B. Sheaffer
700 Salem Road, Lot 27, Regent Acres
Etters, PA 17319
Son
21-01-0314
AMOUNT OR SHARE
OF ESTATE
1/3
1/3
1/3
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II . NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON liNE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheels of the same size)