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Home My WebLink About01-0322i ~' I W I I D I I +~ I ~I f I~ Q ~I 0 III Z I ~ a ~ ~,,., I ~ a as w W a W 1 ~° ~ Na ~ W ~ W Z V a~ ~ ~ 11 ? i a z a J fp ~ X z W Q O z~~ o W z J OD ajQ N w r O¢o xw> a ~O~ d ate? ~ W W LL O W 0 ~ ~ ~ ~ Q N _ ~a¢~a¢ O W ~ W Q U O m ~ 2 ~ '~- z T O a .- ~ H W ~ W ~ m Q ~ ~ Z Q O LL W w U W __ _. . ,_ 0 0 4 r^K ~ :~~ O ;'U U 't" i v~ ~ .-a ,Y ai E- ~ u: ~.i~ .~ .~ 1~ ~ „'~ ~ L: .., Y .-t w 3 ! t3 w :x t-- u`5 y~ 2 t:.i ~?. !.:! t1. ~ L:,. ,^~ *-~ .~ e-~e ~1 ,J fJ ~~ w x 0 0 r ~~ '~\ ~ ~~ I ._, ~ «~ ~ ~ `. r _1 \`ti ~' r~ `~./ ~~ i ~~= t` ~ ~. ~. :` '..~ ', F ` Z } ^~ ~, ~ m:~ ~ w ~ u.. o W Fu ~, ~.,~ ~_ t~.; w ui G'~ il{ ~S Z ° `~ (n Q € ~ U ~J ti °~> Q ~~ oW wF~3 F.^~ ~,s1 x ~--~ ~ ~ u U~~ ~~ a0~ 1~ Q~% L LI ~ `-., o~ a t~7 ¢ ~ .~1 o CJ L L r ~ i. U ¢ O G. O Q ~ 4,...i Q i Q ~ Z w w ~ w ~ ~ cn z x w ~ W a ~ o ~ z o i i f .} :i --Y .1 t.% i. ^ 1 ~ i~ :~ 's ~ ~ Q W J J W c~ w REV-1500 EX+ (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA V N REV-1500 /~ J ~J /~,+ / v~ DEPARTMENT OF RE E UE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17126-0601 RESIDENT DECEDENT 21 2001 0322 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Moose, A. 201-18-3889 DECE- DENT DATE OF DEATH (MM-OD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE 12~30~00 08~21~1925 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK 1. Original Return 2. Supplemental Return (date of death prior to 12-13-82) APPRO- 48. Future Interest Compromise 4. Limited Estate `(date of tleath attar 14-13-a4) 5. Federal Estate Tax Return Required PRIATE 6. Decedent Died Testate 7. becedent Malntainstla Living Trust (Attach copy of Will) f 0 8. Total Number Of SffiB De OSIf Bores ~ BLOCKS 10. Spousal Poverty Credlt(date of tleath between it. Election to taz under Sec. 91t A 0. Litigation Proceeds Received ~ ( ) 14_31-91 and 1-1-95) (Attach Sch O) 7F1[$ $E4"t'lpN MUST BE ~glu~l„~TE4~ AF.1. ~OEiRi;SPQfI d #.+7t#P.I.DI~TUkI,n'IYf7i If>IR#JRMlTlON sH4ul~,t WE OfREG3'RD TO NAME COMPLETE MAILING ADDRESS coR- Je A. Wei le, Es 're 126 Fast King Street RE- FIRM NAME (If Applicable) Shi~TR}x 1Yg, PA 17257 SPON DENT Wel le, Perkins & Associates TELEPHONE NUMBER (717) 532-7388 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) NOIle 3. Closely Haltl Corporation, Partnership oraole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) NOIle 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (s) 14, 099.79 6. Jointly Owned Property (Schedule F) Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) None 8. Total Gross Assets (total Lines 1-7) (6) 14, 099.79 9. Funeral Expenses & AdminisVative Costs (scnaaple H)(9) 1, 567.00 10. Dabis of Oacadant, Mortgage Liabilities,BLiens (Schatlule p(l O) 2,055.82 11. Total DeduMlons (total Lines 9 & t0) (11) 3, 622.82 12. Net Value of Estate (Line 6 minus Line 11) (12) 10, 476.97 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tar (13) None has not been made (Schedule J) 14. Net Value Sub)eet to Tax (Una 12 minus Une 13) (t4) 10, 476.97 TAX COMPU- TATION SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Lina 14 tazable at the spousal taz rate, ar transfers under Sec. Bt ls(aNf ~~) x.0 (15) i6. Amount of Llne t4 taxable at lineal rate 10,476.97 x.0 45 (16) 471.46 17. Amount ai Line 141azable at sibling rate 0.00 %.12 (17) 0.00 16. Amount of Line 141azableat collateralrate 0.00 X.15 (18) 0.00 ts. Tax Due (t B) 471.46 20. ~ CHEOK HERE IR YOU ARE t3E0UE$TiNG A REFUND'.bF AN OYERRAYMENT- 0 PA15001 NTF 09)55 Copyr,ght 2000 Greatlantl/Nalco LP-Forms Software Only Estate of: Ruby A. Moose SUDM~]ARY OF ALJACATIONS Tl~ Taxable at lineal rate Gilbert P. Moose Nancy J. Ccx[g~ Johnny A. Moose Gregory D. Moose 3,492.33 3,492.32 1,746.16 1,746.16 10,476.97 21-2001-0322 PA REV-1500 EX (6-00) Panc ~ Decedent's Com lets Address: -' - STREETADDRESS Outlooke Pointe Nursin Home 129 Walnut Bottan Road CITY STATE ZIP Shi PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 1s) (1) 471.46 2. Credits/Payments A. Spousal Poverty Credit e. Prior Payments 450.00 C. Discount 23.68 Total Credits (A + B + c) (2) 473.68 3. Interest/Penalty if applicable p, Interest E. Penalty Total InteresVPenaOy (D + E) (3) 0.00 4, Ii Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Llne 20 to request a refund (a) 2 , 22 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS. AGENT 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 : ...................................... . b. retain the right to designate who shall use the property transferred or its inwme : ................ . c. retain a reversionary interest; or ....................................................... . d. receive the promise for life of either payments, benefits or care? ............................. . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate considers[ion7 ................................................... B 3. Did decedent own an "in trust tor' or payable upon death bank account or security at his or her death? .. . a. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation7 ........................................................ IF THE ANSWER TO ANY OF THE ABOVE OUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and ballet, It is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which preparer has env knowledge. SIG TUBE OF PERSON RESPO/NSIBLE FOR FILING RETURN GATE DATE A-/~-d 126 East King Street, Shipp~.sl-9,~, PA 17257 For tlates of tlea:n on araRer July 1, 1994 antl before January 1,1998,thetaz rate imposed an thanetvalue of transfers to ortpr the use of the surviving spouse is 8% (]2 P.S. ®911fi Ia)(1.11 (,)]. For Oates pf tlea:n on or after January t, 1995, th a tax rate is imppsetl on the net value of transfers to or for the ass of the surviving spouse is 0 % I]2 P.S. 8 9118 (a) (1.1) (ii1]. The statute dnA "oie mntabansfer toasurvrving spouse irpm[az, antl the statutory requirements for disclosure of assets antl filingataz return are still appl¢able evanrt th a surv,wng spcpse is'[he poly beneficiary. For dates pt tlea'n on or alter July 1, 2000: The taz rate i mp gsetl on the net value pf transfers from a deceased child twenty-one years of ago or younger at death 10 or f or th a use of a natural parent, an atlppbve parent, or a stepparent c' [he child is o% P2 P.S. fi9216(aN2.21]. The tax rate impcsetl on the net value pf transfers to or for the use pf iha tlecetlent's lineal beneficiaries is 4.5%, except as notetl in 12. P. a.6 9 f 26(1.21 I]2 P.S. i 92 t6(ax2)]. The tax rate ,mpcsetl on the net value pt Iransters to or for the use of the tlecedent's siblings is 12% (]2 P.S. f 9128(ax 1.6)]. A sibling is OehneQ antler Secbon 9201, as an md,mdual woo has at leas: one parent ,n common wdh the tlecedent, whether by blood or atloption. 0 PA15002 NTF 19]56 GppyngM 2000 Greatland/Nalco LP-forms Software Only Estate of: Ruby A. Moose 21-2001-0322 The following person(s) are signing the return as representative(s) of the estate: Gilbert P. Noose 6 Broad Street Shippensbusg, PA 17257\ REV-~ 508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN pERSONALPROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ruby A. Moose 21-2001-0322 IncluEe proceeds of litigation a data proceeds were receivetl bytha estate. Ali OI -owned Vdtll N M Ot 8UfVIVOfehl must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIP710N DATE OF DEATH 1 IAllfirst Bank Checking Accrount #00386-0725-5 ~ 14,099.79 (If more space is needed, insert additional sheets of the same size) 14,099.79 7 CPA81 +-F ~;eoe Copw~gnt For.= L •..are Cnly, i99] Nelco. Inc. REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-0322 ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Eby Granite Works - trornmtent 1,001.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Stree[ Address City State Zip Year(s) Commission Paid: z. Anorney Fees Name: Weigle, Perkins & Associates 3. Family Exemption: (If decedent's address is not the same as claimant's, aaach explanation) Claimant 0.00 450.00 0.00 Street Address City State Zip Relationship of Claimant to Decedent a. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0 , 00 7 Register of Wills, Clunberland County - filing PA Inheritance Tax 15.00 Return 8 Register of Wills, Cumberland County -filing Family Settlement 75.00 Agreement 9 Weigle, Perkins & Associates -reimbursement for postage, xerox 18.00 copies, and long distance telephone calls 10 Linda K. Klein -notary fee 8.00 TOTAL (Also enter on line 9, Recapitulation) S 1, 567.00 (If more space is needed, insert additional sheets of the same size) 7 CPA71 NTF io9n :oovngnt p.,,rms Software OnIY, X99) \ec... -c. REV-7572 EX+ (7-97) SCHEDULEI PENNSYLVANIA DEBTS OF DECEDENT, EDE TRN MORTGAGE LIABILITIES. & I ESTATE OF FILE NUMBER Ruby A. Moose 21-2001-0322 Include unreimbursed medical ex enses. ITEM NO. DESCRIP170N AMOUNT 1 I1rew J. Stoker, M. D. - 01/12/01 statement 2 Masland Associates, Inc. - 01/08/01 statement 3 Choice Critical C are, Inc. - 01/31/01 statement 4 Chambersburg ALS - West ShoreFMS - 3 calls 5 Cumberland Valley FMS - 03/05/01 statement 6 Carlisle Hospital - 02/24/01 and 04/10/01 statements 7 Carlisle Hospital - 04/30/01 statement 8 Carlisle Hospital - OS/18/O1 statement 9 Carlisle Hospital - 05/30/01 statement 10 Pinnacle Health - 06/14/01 statement TOTAL (Also enter on line 70, Recapitula 7 CPA72 NTF 10912 (If more space is needed, insert addillonal sheets of the same size) Cppyng~t Forms Software Only, t99] Nelc o,lnc. 4.00 47.00 738.93 240.85 368.00 100.00 250.00 32.04 250.00 25.00 055.82 REV-1513 EX + (1 -97) COMMONWEALTH OF PENNSYLVANIA I SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Ruby A. Moose 71 _9nn1 _n4O0 RELATIONSHIP TO DECEDENT YAMOUNT ORS` No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributrons) 1 Gilbert P. Moose Son 3,492.33 6 Broad Street Shippensburg, PA 17257\ 2 Nancy J. Comp Daughter 3,492.32 R. D. 2, Box 57 Loysville, PA 17047 3 Johnny A. Moose Grandson 1,746.16 R. R. 1, Box 246-AD Blain, PA 17006 4 Gregory D. Moose Grandson 1,746.16 R. R. 1, Box 246-AF Blaiin, PA 17006 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THRO UGH /7 AS APPROPRIATE ON RE V 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S 0.00 7 CPA73 NTF 10913 (If more space is needed, insert additional sheets of the same size) Cop YngM forms Spitware Only, 1991 Nelcp, Inc. LAST WILL AND TESTAMENT I, RUBY A. MOOSE, of 511 First Street, Carlisle, Cumberland County, Pennsylvania 17013, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my children, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint Kenneth E. Moose, Nancy J. Comp and Gilbert P. Moose, or the survivors thereof, to be the co-personal representatives of my estate, to serve without bond. 5. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this «~ day of October, 1996. /~ ,/ ~, J~iiL~-t~ ~ Jam/ / =""_z_(SEAL) RUBY A. OOSE Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ~7 ~ i ~- ACKNOWLEDGMENT AND AFFIDA VIT WE, RUBY A. MOOSE, JOY S. ZERANCE and GAY L. IRWIN, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: Subscribed, sworn to and acknowledged before me by RUBY A. MOOSE, the testatrix herein, and subscribed and sworn to before me by JOY S. ZERANCE and GAY L. IIiWIN, witnesses, this 1 ~ "~ day of October, 1996. Notaria; oe>~ Harold S. Irwin III, Notary Public ~ Carlisle (3oro, Cumberland County My Commission Expir=c SeFt. 7 ~ , 1S^" Memher, Pennsylvania Avcaation of ~~car. allfirst RUBY A MOOSE C/O GILBERT P. MOOSE, POA 6 BROAD STREET SHIPPENSBURG PA 17257-9414 ffflllffflfflfiflflflftfllflfffltfifffllflfflllffffllffflffli Page 7 0l 3 Direct Deposit Checking Decemoer 76, 1000 mru January i7, 2001 Ruby A Moosa Acct NO 00386-0725-5 ® allfirst.com A Z4-hour Customer Serviee 1-600-533-4630 Activity Summary Balance on 12/15 514,099.79 Deposits and additions 388.45 Checks -1,039.10 Other activity -13,418.14 Fees and credits -62.00 Balance on 01/17 -31.00 Deposits and additions Date Desctlpfro^ Amount 01/04 CREDIT OVERRIDE 5357.45 01/08 CREDIT MEMO 31.00 5388.45 Checks • Denotes missing sequence number Number Date Amount Number Date Amount 952 01/04 S357.45 953 01/03 S162.10 952 01/02 357.45 953 01/10 162.10 51,039.10 Other activity Date Demripfio^ Amount 01/02 CLOSING WITHDRAWAL - y,0~q,79 01/04 DEBIT REVERSAL -NSF 162.10 01/05 DEBIT REVERSAL -NSF 35J.45 01/11 DEBIT REVERSAL -NSF 162.10 -13,418.14 We are safekeeping your checks for your convenience. 031662 2 0000-00000000044 050 Allfirst $ank ISSUED BT: TRAVELERS E%PRE55 DOMPANV, INC. DRAWEE: FIRST INTERSTATE BANK HELENA. MT - - ~ DA7E PAY TO THE 01/OZ/01 Drax~er: Allfirst Bank ORDER OF RI19Y A. HDdSE################ 114099.79 M Fourteen Thousand Ninety Nine and 79:100 - 7uRE Dollars AFB176 The Du¢hase of an I~CeT BME may fu ~¢OUire6 Delore IDis check will Ee replacstl or refunGeO in the evenl it is lost misplacee or smlcn. N'22220771B11' ~:09200541i40i600i03330i311' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMDEPARTMENT OFPREVENUEAN A NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-3547 EX AFP (12-00) DATE 09-24-2001 ESTATE OF MOOSE RUBY A DATE OF DEATH 12-30-2000 FILE NUMBER 21 01-0322 COUNTY CUMBERLAND JERRY A WEIGLE ESQ ACN 101 WEIGLE ETAL Amount Remitted 126 E KING ST SHIPPENSBURG PA 17257-1102 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 (12-00)DiSALLOWANCENOFRDEDUCTIONS ANDRASSESSMENTAOFOTAXCE 0 ESTATE OF MOOSE RUBY A FILE N0. 21 01-0322 ACN 101 DATE 09-24-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN .Op NOTE: To insure proper (1] 1. Real Estate (Schedule A) ,00 credit to your account, 2. Stocks and Bonds (Schedule B) (2) .00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 ofi this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) 14.099.79 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) ,00 6. Jointly Owned Property (Schedule F) (6) (7) .00 7. Transfers (Schedule G) (8) 14, 099 .79 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 1,567.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 2,055.82 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) - (11] 3.622.82_ 11. Totai Deductions (12) 10,476.97 12. Net Value of Tax Return .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule Jl (14) 10,476.97 14. Net Value of Estate Subject to Tax NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount ofi Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class 8 rate 19. Principal Tax Due 03-23-2001 AA4/ZSL 09-17-2001 REFUND .00 .00 X 00 _ - .00 (15) 10,476.97 X 045 = 471.46 (16) .00 X 12 _ .00 (17) .00 X 15 .00 (18) 471.46 (19)= AMOUNT PAID 450.00 2.11- TOTAL TAX CREDIT 471.46 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Name of Decedent: Date of Death: REGISTER OF WILLS, CIIAiBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 RUBY A. MOOSE December 30, 2000 Wi 11 No . 21-01-0322 Admin . No . The Will was not probated. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be-filed with the Cerk of the Orphans' Court and may be attached to this repgrt. '~ ,, Date : ~ ~;~ ~ ` Sig~~ture i` Jerry A. Weigle, Esquire ~~ Name (Please type or print) WEIGLE,.PERKINS & ASSOCIATES 126 East King Street . Address Shippensburg, PA 17257 ( 717) 532-7388 Tel. No. Capacity: Personal Representative x Counsel for personal representative (MAH:rmf/AM3) ESTATE OF RUBY A. MOOSE File No. 21-01-0322 FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT made this ~ ~ -' day of t!~e^- , 2001, BETWEEN: GILBERT P. MOOSE, NANCY J. COMP, JOHNNY A. MOOSE, and GREGORY D. MOOSE, being the legatees under the Last Will and Testament of Ruby A. Moose, late of the Township of Shippensburg, Cumberland County, Pennsylvania. WHEREAS, Ruby A. Moose died December 30, 2000, testate, and under her Will left her estate to the parties herein; and WHEREAS, there were no probate assets in the estate so that it was unnecessary to present the Last Will and Testament or Ruby A. Moose for formal probate in Cumberland County, PA; and W[ IERf:AS, all assets of the late Ruby J. Moose have been liquidated or distrihutcd and all her debts paid in full, the said parties hereto desire to waive the duty of the thins: of a First and Final Account with Proposed Schedule of Distribution t~~r purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTI-IER desire that a Family Settlement .A~reement be executed, which Family Settlement will be duly recorded among the deed records in and for Cumberland County. NOW, THEREFORE, WITNESSETH, that the parties hereto, in consideration of the premises above stated, and of the Accounting and Proposed Schedule of Distribution attached hereto and made a part hereof, and the receipt of their distributive shares as therein shown, do mutually bind themselves to the said Distribution and Accounting as set forth and further mutually release each other from all claims and demands whatsoever arising out of settlement of the Estate of Ruby A. Moose. The parties hereto do further agree that should any liability come due to the estate of the said decedent after the signing of this agreement, we and each of us do hereby covenant and agree with each other that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate after the signing, sealing and delivery of this family settlement agreement and final release. IN Wfl'NI~.SS Wl I[;RLOF, the parties have hereunto set their hands and seals the day and year first ahuve written. dl /~.c~~(,~-r~ ~ (SEAL) Gilbert P. Moose r ~~ ~' ~, , ~ ~ .~~ (SEAL) Nancy J. C p ~` (SEAL) J nny A. oose ~~ (SEAL) Grego , .Moose COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS On this, the ~ ~ r~ day of ~c;~"- 2001, before me, the undersigned officer, personally appeared GILBERT P. MOOSE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~,~~,,.~. ~ /~~-t~v~ (SEAL) Notarial Seal Linda K. bein, Notary Public Shippensburg, PA Cumberland-County MY Commission Expires August 15, 2004 COMMONWf;AL'rII OF PENNSYLVANIA SS COUN'T'Y OF CUMBERLAND On this, the ~ ~ _ day of ~ Ci~-~r-2~-~ ?001. before mc, the undersigned officer, personally appeared NANCY J. COMP, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN Vl"ITNESS WHEREOF. I hereunto set my hand and official seal. ~~~_ (SEAL) NOTARIAL SEAL GLORIA A. SMITH, Notary Public Spring Twp„ Perry County, Pa. My Commission Expires Jan. 3, 2002 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF On this, the day of lr'~c,~a n -~ ` 2001, before me, the undersigned officer, personally appeared JOHNNY A. MOOSE and GREGORY D. MOOSE, known to me (or satisfactorily proven) to 'oe the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. (SEAL) ~~a2P sworn and Subscribed itrict urt 41.05 PertY ~h L"oycville, PA 17047 Commission Expires Jan. 2, 2006 FIRST AND FINAL ACCOUNT FOR ESTATE OF RUBY A. MOOSE, DECEASED Date of Death: Accounting for the Period: December 30, 2000 December 30, 2000, to October 14, 2001 Purpose of Account: The Estate of Ruby A. Moose offers this account to acquaint interested parties with the transactions that have occurred during the estate administration. The account also indicates the proposed distribution of the estate. [t is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Jerry A. Weigle, Esquire Weigle, Perkins & Associates 12G East King Street Shippensburg, PA 17257 717-532-7388 S[~RY OF ACCC~LJNI' Estate of Ruby A. Noose For Period 12/30/00 Through 10/14/01 Proposed Distribution to Beneficiaries Principal Receipts Net Gain (or Lass) on Sales or Other Dispositions Other Receipts Less Disbursements: Ac~ninistration F~cpenses (Frio) Fees and Commissions (Frio) Funeral ExperLSes (Frio) Other Expenses (Frio) Balance before Distributions Distributions to Beneficiaries Principal Balance on Hand Income Receipts Less Disbursements Balance before Distributions ' Distributions to Beneficiaries Income Balance on Hand Combined Balance• on Hand Page 5 1 2 2 2 2-3 $ 566.00 450.00 1,001.00 2,055.82 4 Fiduciary Acquisition Value $10,029.08 $14,101.90 0.00 0.00 $14,101.90 4,072.82 $10,029.08 0.00 $10,029.08 $ 0.00 0.00 $ 0.00 0.00 $ 0.00 $10,029.08 RECEIPTS OF PRINCIPAL Estate of Ruby A. Noose As of 10/14/01 Assets Listed in Inventory (Valued as of date of death) Checking Accounts Allfirst Banc Checking Account #00386-0725-5 Refunds Cocrrronwealth of PA - refund of PA Inheritance Tax received 10/04/01 'IC7I'AL INVF'[~TIC~RY Page 1 Fiduciary Acquisition Value $ 14,099.79 2.11 $ 14,101.90 DISBURSII~TTS OF PRINCIPAL Estate of Ruby A. Noose For Period 12/30/00 Through 10/14/01 Administration F~cperLSes (Prin) 03/23/01 Register of Wills, Cumberland County - PA Inheritance Tax payment at discount 07/11/01 Register of wills, Cumberland County -filing PA Inheritance Tax Return 07/11/01 Weigle, Perkins & Associates - reserve for , filing Family Settlement Agreement with Register of Wills, Cumberland County 07/11/01 Weigle, Perkins & Associates - reimbursement for postage, xerox copies, and long distance telephone calls 07/11/01 Linda K. Klein - notary fee Fees and Coamissions (Prin) 07/11/01 Weigle, Perkins & Associates - attorney fee Funeral E~cpetLSes (Prin) ~03/16/O1 Eby Granite Works - rtbnurnent Other Expezlses (Prin) 02/15/01 Drew J. Stokers, M. D. - Ol/~2/Ol statement 02/15/01 Masland Associates, Inc. - 01/08/01 statement 02/15/01 Choice Critical Care, Inc. - 01/31/01 statement 02/21/01 Charnbersburg ALS - West Shore EMS - 3 calls 03/16/01 Cuumberland Valley FMS - 03/05/01 statement 03/28/01 Carlisle Hospital - 02/24/01 and 04/10/01 statements 05/08/01 Carlisle Hospital - 04/30/01 statement 05/30/01 Carlisle Hospital - 05/18/01 statement 06/07/01 Carlisle Hospital - 05/30/01 statement $ 450.00 Page 2 15.00 75.00 18.00 8.00 $ 566.00 450.00 1,001.00 $ 4.00 47.00 738.93 240.85 368.00 100.00 250.00 32.04 250.00 DISgURSII~T!'S OF PRINCIPAL Page 3 Estate of Ruby A. Noose For Period 12/30/00 Through 10/14/01 06/27/01 Pinnacle Health - 06/14/01 statement $_- - 25_00 $ 2,055.82 'IC7I'AL DISgURSII~]'TS OF PRINCIPAL $==4, 072-82 PRINCIPAL BALANCE ON ~~,l~ID Estate of Ruby A. Noose As of 10/14/01 Checking Accounts Weigle, Perkins & Associates Clients Account PRINCIPAL BALANCE ON HAND Page 4 Current ~"rY~g Value Value $ 10,029.08 $ 10,029.08 ----------- ----------- $ 10,029.08 $ 10,029.08 Page 5 PROPOSED DISTRIBUTIONS TO B~T~'FICIARIES Estate of Ruby A. Noose For Period 12/30/00 Through 10/14/01 To : Gilbert P . Noose Cash 10/02/01 The beneficiary will receive a 33.3333% interest in the estate's residue, representing a Portion of the following assets: $ 3,343.02 Cash $ 3,343.02 Total To : Nancy J . Cocr~ Cash 10/02/01 The beneficiary will receive a 33.3333% interest in the a portion of the tin g estate's residue, represen following assets: 3,343.02 Cash $ 3,343.02 Total To: Johnny A. Moose Cash 10/02/01 The beneficiary will receive a 16.6667% interest in the nting a portion of the estate's residue, represe following assets: 1,671.51 Cash $ 1,671.51 Total To: Gregory D. Moose Cash 10/02/01 The beneficiary will receive a 16.6667% interest in the a portion of the tin g estate's residue, represen following assets: 1,671.53 Cash $ 1,671.53 Total $ 10,029.08 'IC7TAL PROPOSED DISTRIBUTIONS TO BE[~F'ICIARIFS ________=_ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 JERRY A WEIGLE ESQ WEIGLE ETAL 126 E KING ST .. SHIPPENSBURG PA 17257 COMDEPARTMENT OFPREVENUEAN A INHERITANCE TAX STATEMENT OF ACCOUNT REY-107 E% RFP (12-00) DATE 10-01-2001 ESTATE OF MOOSE RUBY A DATE OF DEATH 12-30-2000 FILE NUMBER 21 01-0322 '~ COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fore with Your tax payment. RETAIN LOWER PORTION FOR YOUR RECORDS ~ --------------------------------- CUT ALONG THIS LINE ---------°----°---- ~~(* --------------- ---------- ----------------------------- **~ INHERITANCE TAX STATEMENT OF ACCOU REV-1607 EX AFP (12-00) DATE 10-01-2001 ESTATE OF MOOSE RUBY A FILE N0. 21 01-0322 ACN 101 THIS STATEMENT IS PRORINCIPAL TAXIDUE,FAPPLICATIONTOFTALLSPAYMENTSSTTHEDCURRENT BALANCEEDANDTAIF.APPLICABLEOW IS A SUMMARY ~F THE P A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-24-2001 471.46 PRINCIPAL TAX DUE :.......................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 23.57 450.00 03-23-2001 AA478201 00 2.11- 09-17-2001 REFUND TOTAL TAX CREDIT 471.46 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF TNIS FORM FOR INSTRUCTIONS. )