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HomeMy WebLinkAbout01-0345 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Sara K. Noss also known as No. 4 J- () 1- ~'I~ , Deceased Social Security No. 209 - 28 - 9272 Archie A. Noss, Jr. Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) 00 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or named in the last Will of the Decedent, dated 02/22/1980 and codiciKs) dated None Archie A. Noss, named Executor under the Will, died February 20, 1986. Archie A. Noss, Jr., Petitioner hereunder, is named as successor Executor. State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: n/a D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationshi ;;..: =- 'Residetie (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania with hislher last family or principal residence at 1821 Fisher Road, Upper Allen Township (list street, number, and municipality) Decedent, then ~years of age, died 03/18/2001 at Upper Allen Twp., Cumberland Co., PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania $ $ $ $ 6,000.00 50,000.00 situated as follows: 1821 Fisher Road, Mechanicsburg, PA Wherefore, Petitioner(s) respectfully request{s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a ro riate form to the undersi ned: Si nature rinted name and residence Archie A. 1790 Orrs Enola, PA 17025 Prepared by the Pennsylvania Bar Association Copyright (e) 1996 form software only CPSystems. Inc. /~ - ~c2/-D Form RW-1 (1991) 21-01-345 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumber land The Petitioner(s) above-named s_ar(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 representative(s) of the Decedent, Petitioner(s) will weD and truly administer the estate according to law. Q-.t; C. .rJ1~~ Archie A. Ness, Jr. ~ Sworn to or affirmed and subscribed ~ before me this 80 day of WJd~ , ,Jilt? J 'm24ft! KuLM "YA.e./I. ~Zi:Uh4"/di, . I For the Register ~. r No. 21-01-345 Estate of Sara K. Ness Deceased Social Security No: 209-28-9272 Date of Death: 03/18/2001 AND NOW, APRIL 2, 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [!J Testamentary 0 Of Administration (c.I.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Archie A. Ness, Jr. t_" in the above estate and that the instrument(s) dated 02/22/1980 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . . . . $ 115 . 00 Short Certificate(s). .3. $ 9.00 ~ll"""~n. $ Affidavits ( $ Extra Pages ( 1 ). $ 3.00 Codicil. . $ JCP Fee. . . . . . . . . . $ 5.00 Inventory. $ Other . . $ 'TlJay-C!. 0/-//to' ,~A. e//. ~~~/J /.4J~//h'7~ Register of Wills, . TOTAL. . . . . . . .. $ 132.00 MAILED LETTERS TO ATTORNEY APRIL 2, 2001 Prepared by the Pennsylvania Bar Association Copyright (e) 1996 form software only CPSystems, Inc. Form RW-1 (1991) . Hl "<;..Q:/)<; R,FV CY'P" This is to certify that the information here given is correctly copied fran: an original certificate of death dull: filed with Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~ ~~ Local Re~ Fee for this certificate, $2.00 p 7294712 tlt'\l\ 2. 1 LuLll Date ; 43 Rev 2/87 COMMONWEALTH Of PENNSYLVANIA. OEPARTMENT Of HEALTH. VITAL RECOROS CERTIFICATE OF DEATH .. AGE (L,"IlOMa,) Sara UNDER 1 YENl _ 0.,. K. Noss SEX zfemale STATE FilE NUMBER SOCIAL SECURITY NUM8ER NAME OF OECEOENTtFI'SI. M~. Lu:) -------- 3209 -28 - 9272 DATE OF DEATH ,McnIn. Da.,. .'eat, .March 18, 2001 87 v... . cOuNTY Of' DERH Cumberland UHIlER I 0IIt Houra Minutee ! BIRTHPlACE (C.ty and PlACE OF OERH fCN!ck Dr1ly fYIe -- ioN lOtlruch0n8 on othet SlOeI Slaoe '" ."'_ CourwYIP A HOSPITAL Mechanicsburg _0 ERiOlApaU.nt 0 7. Ie. FACIUTY NAME (If f'IOt If\IiIoMlOn. ONe street and numberl Messiah Village ~IO DECEDENT'SUSUAl~ (<r-=:__:O~:::2,::r seamstress RACE . Amencan 1ncMn. 1IKk, Whit.. _. I_I white ... 17055 A. 17". MARfTAL STAruS._ -........-. ~tsPoc.." widowed 1.. ~ Al1pn -- "" irll Cumberland -....;p? 17..0 ~""=,,=of MOT~ff'.M"""".Ma_Sulnam.1 Wise 1. INfORMANT'S MAIlING AODAESS (St,ee.. CIly/i)wn. s.e.. Zip Codel 1790 Orrs Bridge Road, Enola, PA 17025 PlACE Of' DISPOSITION. _ofCemelety. c,_ LOCRION .~. _.. ZilI~ '" au.. PIoc:e 2001 Trindle Springs Cemetery Mechanicsburg,PA 1~ 21. SURVIVING SPOUSE (If..... gMI tnaIOen namel 1821 Fisher Road ,.. Mechanicsburg, PA FRHet:~m~f: ~<l<Ie L...) 1.. INFOAMANT'S NAME IT '001"'''' Archie METHOOOf' IlIS~ O _-QlXc......... 0 ~ au.. tsPocIyl 21.. _U ...... "",,-... Kapp _......SIa..o 17055. A. LICENSE NUMIlEfI 22.. FD 013340 L the bNI of my knowledge, death occurred at the lIme. dale and p~ silled. . ,. and Title) NAME AND AOOReSS Of' AAClll 220. PO BOX 431, New Cumberland, PA 17070 LICENSE NUMBER ORE SIGNED (MonOI. Dov. -, 311. . WOoS CASE REFERRED TO MEDICAl EXAMINERiCORONEfI? ....0 ~ :K. I ApproxUnaJe : inl..... bMweIn I 0ftMl and death I I I ....,rg PART H: au.. ~_canriluIinglO"'I.. ... not~irtlM~cauHgiyeninPJUn I. E DUE 10 (OR AS A CONSEOUENCE 0Fl: DUE 10 (OR I>S A CONSEOUENCE 0Fl: WERE AUltlPSV FINllINGS MANNEA Of OEATH .#MUlA8LE PRtOA 10 COMPlETION 0#' CAUSE ..liSJ 0 OF DEATH? ......... Homoade _nt 0 Pending lnveaIigalion 0 Yeo 0 .... 0 - 0 Coukj no( be detenT\lned 0 DATE OF INJURY (~onlh. Day. ~) TIMe OF INJURY INJURY 1J v.oAK? DESCRIBE HOw INJURY OCCURRED. .... 0 NoD -- .... CERT.wlIChocl< only..... *CERTIFYING IIHYSICIAN (PhySICIan Cefbl)'lf\9 cause ~ de81h when another phy$lCoan has pronounced dealh ana Completed lIem 231 To Ihe... of m, knowledge, de.... OCCUfNd due.. the caUU(l) and manner.. MatH. _ . . . . . .. ................ ... 300. PlACE OF INJURY. AI home. farm, SIr.... factory. olftc. buikIinQ, Me. l$pec!tv) 300. M. .II'flK)NOUNClNG AND CERTIPYINO PHYSICIAN tPhysDan bolh j)l'OI1Qu(lclfl9 oeartl Mld t;;endytng 10 cause of ONlh\ To 11M..... of my kno~., death occun8d at .....1Ime. dille, and piKe. ..net due 10 the UUMtl. and mann.r.. I'aled LOC"'ION (Sb-.... C1y1TOwn. SIeJ.1 OIlEDlCAL EXAMINER/CORONEfI ~~'.:,~~t::=.~.I~~'.~...~~~~~~~I~~I.~~: ~~ ":.Y. ~~j.~i:~: ~~~~~ ~~~~..~;~ ~~~ ~I~,.~~t~: ~~.~I~~~: ~~~.~~~ ~~ ~~~ ~~~~~).~~ 0 31.. REG~STRAR'S S~URE AND NU; ~ ~ r'c '?"a..t. ~II ~I/ 1/ I ~ J4 o I . I . . . ", . ~ . 21-01-345 1lIa5t IIi!! aub illt5tamtut OF SARA K. NOSS hereby revoking FIRST: my last illness may be done. SECOND: I, SARA K. NOSS, of Upper Allen Township, Cumberland County, Pennsyl- vania, make, publish and declare this as and for my Last Will and Testament, all other Wills and Codicils heretofore made by me. I direct the payment of all my just debts and the expenses of and funeral from my estate, as soon after my death as conveniently I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate unto my husband, ARGilE A. NOSS, provided he survives me by sixty (60) days. lHIRD: Should my husband, Archie A. Noss, predecease me or die on or before the sixtieth (60th) day following my death, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate unto my children, ARCHIE A. NOSS, JR., LARRY E. NOSS, WAYNE E. NOSS, MARY K. LANTZY and SARA M. SANDERS, or the survivor or survivors thereof, in equal shares. Should any of my children predecease me, I devise and bequeath that child's share under this, my Last Will and Testament, to such of that child's children who survive me, in equal shares. FOURlH: My Executor and personal representative shall have the following powers in addition to those vested in them by law and by other provisions of this Will, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as are deemed proper. (B) To compromlse any claim or controversy. FIFTH: I direct that any and all inheritance, estate and transfer taxes imposed upon my estate passing under my Will or otherwise shall be paid out of the principal of my residuary estate. SIXTI1: I nominate and appoint my husband, ARCHIE A. NOSS, Executor of this, my Last Will and Testament. In the event of the death, resignation or inabil ity to serve for any reason whatsoever of the said Archie A. Noss, I nominate and .. I . ... .... " : appoint, ARCHIE A. NOSS, JR., Executor of this, my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties as such in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last " Will and Testament, this t( ~ day ofg;"kw'~1 ' 1980. ~/2~ ;r-!:;) MXJ/ Sara K. Noss (SEAL ) Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~".<~ 12 il2~ ~L,.z.wJ C ~ Address Address I ,t . .: 21-01-345 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS James D. Bogar IllDdicN (euh) a subscribing witness to the will presented herewith, ~ being duly qualified according to law, depose(s) andsay(s) that np ~A1;:l c:: present and saw Sara K. Noss the testatrix , sign the same and that he signed as a witness at the request of testat rix in}1 er 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 ~ .t- day of '7J:lt:VU/J 2001 ~~~. 1.tu4, do. ~ ---zJ;;udj / . / Register /' C ,. J es D. Bog One W. Main ame) t , Shiremanstown, PA 17011 (Address) (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Archie A. Noss, Jr. (~ a subscriber hereto, ~~ being duly qualified according to law, depose(s) and say(s) that he is familiar with the signature of Srlrrl K No",,,, ~ will testat r i x of (BlX'fK m xtlhI xsuEseIdIliRjJ: X'aliincSGO!SX ~ the presented herewith and oacIic:it x believes the signature on the will is in the handwriting of that he Sara K. Noss to the best of hi s knowledge and belief. Sworn to or affirmed and subscribed before O~ (). 4l~ me this &J'=" day of Archie A. NO~ilmilrf' ~ ' 20~ 1790 Orrs Bridge Road, Eno1a, PA 17025 '-ff)~ c!', ~ /UA. Ii! d. ..d--IG~.llR~.6j (Address) Register (Name) (Address) - E - CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Sara K. Noss Date of Death: March 18, 2001 Will No. 21-01-0345 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 25, 2001: Name Archie A. Noss, Jr. Larry E. Noss Wayne E. Noss Mary K. Lantzy Sara M. Sanders Address 1790 Orrs Bridge Road Enola, PA 17025 602 West Keller street Mechanicsburg, PA 17055 2845 Morningside Drive Camp Hill, PA 17011 116 Winston Drive Mechanicsburg, PA 17055 1938 Chatham Drive Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: April 25, 2001 oar, Esquire One West ai street Shiremanstown, PA 17011 (717) 737-8761 capacity: Personal Representative X Counsel for Personal Representative JAMES D. BOGAR ATTORNEY AT LAW ONE WEST MAIN STREET SHIREMANSTOWN, PENNSYLVANIA 17011 e-mail bogarlaw@ezonline.com TELEPHONE (717) 737-8761 FACSIMILE (717) 737 -2086 June 14, 2001 Via Certified Mail 7099 3220 0009 6896 0534 Mary C. Lewis Register of wills cumberland County Courthouse One Courthouse square Carlisle, PA 17013 RE: The Estate of Sara K. Noss No. 21-01-0345 Date of Death: March 18, 2001 Dear Mrs. Lewis: I represent the Estate of Sara K. Noss. Enclosed is a check made payable to the Register of wills in the amount of $4,146.75, same constituting a prepayment at discount on account of Pennsyl- vania inheritance taxes in the above-captioned estate. The prepaYment is determined as follows: $97,000.00 multiplied by 4.5% or $4,365.00, less discount in the amount of 5% or $218.25, resulting in paYment of $4,146.75. Please provide me with the appropriate receipt in this matter. Your time and consideration in this matter is greatly appreciated. L?1~n JJJES D. JDB/jeb Enclosure cc: Archie A. Noss, Jr. r ~ ~ I ~ o ~ Ul :;.! ~ ~ ~ ~ A ~ ; ~ ~ E-o I<l ~ 0 ~ ~ ~ ~ ~ ~ ~ 0 ~ z ~ I<l el ~ Ul ... ~ o <<> . ... ... o ~ ... - ~'i' -. 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(j) <( LL ~ W o ~ (j) w ~ ..... w C3 a: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 000634 BOGAR JAMES 0 1 W MAIN STREET SHIREMANSTOWN, PA 17011 ACN ASSESSMENT CONTROL NUMBER AMOUNT u______ fold 101 $815.42 ESTATE INFORMATION: SSN: 209-28-9272 FILE NUMBER: 21-2001- 0345 DECEDENT NAME: NOSS SARA K DA TE OF PAYMENT: 12/12/2001 POSTMARK DATE: 12/11/2001 COUNTY: CUMBERLAND DATE OF DEATH: 03/18/2001 TOTAL AMOUNT PAID: $815.42 REMARKS: ARCHIE A NOSS JR C/O JAMES 0 BOGAR ESQUIRE CHECK# 1308 SEAL INITIALS: DO RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS JAMES D. BOGAR ATTORNEY AT LAW ONE WEST MAIN STREET SHIREMANSTOWN , PENNSYLVANIA 17011 e-mail bogarlaw@ezonline.com TELEPHONE (717) 737-8761 FACSIMILE (717) 737-2086 December 11, 2001 Mary C. Lewis, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Sara K. Noss No. 21-01-0345 Dear Mrs. Lewis: Enclosed for filing concerning the above-captioned matter are the following documents: 1. An original and one (1) copy of the PA Inheritance Tax Return. Also enclosed is a check in the amount of $815.42 for paYment of the PA inheritance tax that is due. Kindly provide me with the appropriate receipt. 2. An original copy of the Inventory. A check in the amount of $28.00 is also included, same representing payment of the filing fee for the above documents. Kindly time-stamp the additional copies of the above documents that are enclosed and return same to me in the enclosed self-addressed, stamped envelope. Your time and consideration in this matter will be greatly appreciated. y truly yours, D~~- r or; .-- """.'''' :=C't' :::S ;:;:. 0'" ,~, '" ' ~ :o~ (0<'"1 C\J. Q :'_t';t Ci ''':i~~ ,~(: JDBjjeb Enclosures Certified Mail 7000 1530 0001 0192 1909 c::::J c-::l --- N ;;E -"" p;. \0 o ...., r ,L w :l0- t:; .x z ;; t-- ~_. .- (/)0 _.z ~.......;;;o_=> ([:2:1'--0 .a..'l:-u~ (.11 E u.J ~ ~ 0 I :/) <D o ~OO C"'-I~ .00 LO~ i:A- :5 ~' 'I~~ 0 ~ $15 C) ~~ 0 c... 0 w" it; :>f IT" C IT" ~ n.J IT" ~ C ~ c::I C c::I C ITl LI'I ~ C C T C ('- ~ o I'- " ... rJ) r- [;I;:l ~ U ... H ... ~ ~) o -< ~I~'d H z ~ .... z ':l~~ I """ Po._ o ~ _ () o ~ z ~ ~ ~ , . rtJ ~ Z -< ~ II: ~ rtJ rJJ ~ ~ ~ " Cf) H H H :s: !i..~ OCf) ::J 0::0 ~::c: 88 M Cf) 0:: ()I.-l H::JCf)Q (.90 r- ~U~.-l 0::0Cf) Cf)U::J..:c: H 0 :s:p::c:p... ~:Z8~ H..:c:O::H H ::J '" 0:: 0 VJ U~U~ ><J:O I-i O:::S~~ ..:c:::JOU :su o I- " t <!. Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Sara K. Noss No. 21-01-0345 also known as Date of Death 03/18/2001 ,Deceased Social Security No. 209 - 28 - 9272 Archie A. Noss, Jr., Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I /We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Name of Attorney: James D. Bogar Esquire Signature: ~. C /lz~) Archie A. Noss, Jr. I.D. No.: 19475 Signature: Address: One West Main Street Address: 1790 Orrs Bridge Road Shiremanstown, PA 17011 Eno1a, PA 17025 Telephone: 717 /737 - 8761 Telephone: 717 /732 - 0488 Dated: 12/11/01 Description Value (See continuation page(s) attached) o CJ d .... '3J'i? (l)O a:>,Q &~ ~;! .... N c..' ;:g --- ~~!J C' .. w 0) (Attach additional sheets if necessary) Total: 69 , 377 . 04 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. FormtlRW-7 (1992) .. INVENTORY Estate of: Date of Death: County: Sara K. Noss 03/18/2001 Cumberland CASH: Blue Cross/Blue Shield - Refund 166.80 PNC Brokerage Corp. - Account No. 63343444 consisting of 491.719 shares of Liberty Colonial Federal Secs Fund Class A, date of death value per share $10.59 5,207.30 PP&L - Refund 2.94 5,377.04 PERSONAL PROPERTY: Contents of home and personal property 1,000.00 1,000.00 REAL ESTATE/PA: All that certain piece or parcel of real estate having erected thereon a dwelling house being known and numbered as - 1821 Fisher Road, Mechanicsburg, Pennsylvania. 63,000.00 63,000.00 TOTAL RECEIPTS OF PRINCIPAL....... ... ..... 69,377.04 ---------------- ---------------- \ /6--D2c:2/-)? COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP <12-001 RecorCtc, Hep;:- of DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-29-2002 NOSS 03-18-2001 21 01-0345 CUMBERLAND 101 SARA K JAMES D BOGAR ESQ 1 W MAIN ST SHIREMANSTOWN '02 FEB-1 P 1 :42 PA llOluh ClImbEJ. . ,tic ( F'A Allount Rellitted 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 ~ REV=is4j-E3f-AFP-fi'2=oOY-NoYicE--OF-YNHERYrAifcE-YA'X-APPRAisEirENT~--AL1-owAiicE-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NOSS SARA K FILE NO. 21 01-0345 ACN 101 DATE 01-29-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks end Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 63.000.00 .00 .00 .00 6 . 377 . 04 64.607.17 .00 (8) NOTE: To insure proper credit to your account. subllit the upper portion of this forI! with your tax paYllent. 133,984.21 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) nO) 16,761. 90 2.101.79 nl) (2) (3) (4) 18.863 69 115,120.52 .00 115,120.52 NOTE: .00 X 115,120.52 X .00 X .00 X 00 = 045 = 12 = 15 = (9)= .00 5,180.42 .00 .00 5,180.42 RECEIPT NUMBER AA496725 CD000634 SC T (+) INTEREST/PEN PAID (-) 218.25 .00 AMOUNT PAID 4,146.75 815.42 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 5,180.42 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~~/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Sara K. Noss Date of Death: March 18, 2001 Will No.. .21-01-0345 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal . representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did t.he pers.onal 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 report. Date: 03/28/02 ,.- ('"', James D. r, Esquire Name (Please, type or print) One West Maln St. Shiremanstown, PA 17011 Address C./\ N (717) 737-8761 Tel. No. LV 6: '~ Capacity: Personal Representative c...J p J ~-: .-. I' ~""lI -' "..... x Counsel for personal representative (MAH:rmf/AM3) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500EX +(6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST,AND MIDDLE INITIAL) Noss Sara K. DATE OF DEATH (MM-DD-YEAR) c.. OFFICIAL USE ONLY It:, - d ~/-y FILE NUMBER 21-01-0345 NUMBER COUNTY CODE YEAR SOCIAL sECURITY NUMBER 209-28-9272 THiS RETURN MUST BE FilED IN OUPUCATEW1THTHE REGISTER OF WILLS SQC1Al SECU IT NU SER 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a UvingTrust 0 (Attach cCP'! ci Trust) 010. Spousal Poverty Credit D {date of death between 12-31-91 and '-1-95) ,trim!:~~~:!tlli!e' '!i!IW'/~1' i NiII'iiJiifa COMPLETE MAILING ADDRESS 3. dilote of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Retum RequIred 8. lotal Number of Safe Deposit Boxes d :o~ OFF[~ ~E ONLY ~~, C ,'" 'i> ~ r"; One West Main Street Shiremanstown, PA 17011 ;)0 ::(1) 63,001,,'. 0 bne ,".ne -8 6 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule S) 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 (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule l) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus line 13) DATEOF BIRTH (MM-DD-YEAR) X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate (Attach copy of Wlll) o 9. litigation Proceeds Received . DISIlIiC:,TION:ftA. lli.reO NAME James D, Bo ar Es uire FIRM NAME<<f Applicable) TELEPHONE NUMBER (1) (2) (3) N,me 6,3Ti.04 -~" , u. 64,601\7 None 16,761. 90 2 ,101. 79 x X X X .0 0 .045 .12 .15 o c-:l - N ;E - w CX> (8) 133,984.21 (11) 18.863.69 (12) 115,120.52 (13) (14) 115,120.52 (15) (16) (17) (18) (19) 0.00 5,180.42 0.00 0.00 5,180.42 R E C A P , T U L A T I o N (4) (5) (6) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 115,120.52 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. Copyright (c) '2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1821 Fisher Road CITY I STATE I ZIP Mechanicsburl?' PA 17055 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,180.42 4,146.75 218.25 Total Credits ( A + B + C) (2) 4,365.00 3. Interest/Penalty if applicable O. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) Make Cheek Payable to: REGISTER OF WILLS, AGENT ""i'i'in"',!"!,"i!:j::!i!,jjjj.WW:W!:iWiWii,Wiij.j.iWWI!':Wmm!W!!!mmm!!!!m!im!!!::'!!W!!iiW!Wii!iiii:!li!i!liii!i!!:mi"'ii.W:WI!!!I!I!!II!ill!!mmmWWi!!IWliiWWWiiiWW:WWWIWililiiiWiiiWii!IW!!!!!iiWWW:W W!!!I!II!IIIIWWiil:WlliIWWiW!!!!Iliii!lli:!IIII!i!!Wii' 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; ~ ~ix b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . . d. receive the promise for life of either payments, benefits or care? . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 [!] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? 0 [!J IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 815.42 0.00 815.42 Under penalties 01 perjury, I declare that I have examlned. thIs return, IncludIng accompanyIng schedules and statements, and to the best of my knowledge and belief, It Is true, correct and complete. Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIGNA.TURE OF PERSON RESPONSIBLE FOR FlUNG RETURN Archie A. Noss, Jr. _ _ _1. ?~9_ _()",,-,,- _13,,_~~g~_ }~9!':<! _ _ _ u - - - _. - - - - - - - - - - - - -- Eno1a, PA 17025 James D. Bogar Esquire One West Main Street - - -Shi,:';ma~stow:r;; - if" - -li6il- - - - - - - - - - - - - - - - - - - -- DATE 12/11/01 DATE 12/11/01 For dates of death on r a r 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% P.S. 9116 (a) (I.l) (;)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116{ 1.2) (72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116{a){1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECE:DENT ESTATE OF FILE NUMBER Sara K. Noss SS# 209.28-9272 03/18/2001 21-01-0345 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is de1ined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant 1acts. Real property which is jointly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 All that certain piece or parcel of real estate having erected 63,000.00 thereon a dwelling house being known and numbered as - 1821 Fisher Road, Mechanicsburg, Pennsylvania. The property was acquired by Archie A. Noss and Sara K. Noss, husband and wife, b) Deed dated May 28, 1955 and recorded in the Cumberland County Recorder of Deeds Office, a copy of which is attached hereto and incorporated herein. Archie A. Noss died February 29, 1986, whereupon title became vested solely in Sara K. Noss, the decedent herein. The real estate was sold pursuant to an Agreement dated July 19, 2001, a copy of which is attached hereto and incorporated herein. Final settlement took place on August 28, 2001. A copy of the Deed conveying the real estate, along with a copy of the Settlement Statement, are attached hereto and incorporated herein. The sale price of the real estate was $63,000.00. SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recaoltulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. S 63,000.00 Form REY..1502 EX (Rev. 1.97) ," BOOK16 L. fAlil4UZ t!C4ts irrb Made the cP-fth in the year day of May one thousand nine hundred and fif'tf'"fi.... (1966). Betweell SAMUEL J. RIFR and EDITH S. RIFE, h1a wite, of the Township of Upper Allon, County of Cwnberlard and State of Pennsylvania, Grantors, AND ARCHIE A. NOSS and SARAH K. NOSS, his wife, of the Township of Upper" Allen, County ot Cwnberland and State of Pennsylvania., Grantees, Witnesseth, that in consideration of "'*F'i ve Thousand in hand paid. the receipt whereof il hereby adc:nowledged, the laid Grantor 8 hereby grant and convey to the .aid GranteeS : Five Hundred Dollars, do ALL that oertain pieloe or paroel of land situate in the 'l'ownship of' Upper Allen, County of Cumberland and State oE Pennsylvania, bounded .nd desoribed in aaoordanoe with a survey mad8 by W.. G.. Reohel, Registered Surveyor on May 23, 1966, as tollows, to wit~ BEGINNING ..t... stone in the publio road leading trom Meohanlosburg to the Gettysburg Pik&. whioh stone is .lso the southwestern oorner of the larger traot or land at whioh thiB 'paroel was rormerly a part, thence by land or Clare Hopple north 13 degrees 30 minutes east one hundred fifteen and one-halt (-116.5) feet to a pin,: thenoe by land of the grantors herein south 69 degrees east one hundred ritty-five (156) reet to a pin,; thenoe by the same south :_13 degrees 30 minutes west one hundred ri1'tee.n am one-haIr (115.6) reet to a pin in the af'ore.. mentioned publio road, thenoe along said road on a line parallel to and at a dhtanoe or rive and one-halt (5.6) roet south of' the fence.. line on the north side of sald road, north 69 degrees west one hWldred fi1'ty-rive (166) feet to a stone, the place of nBGINNING. HAVING thereon ereoted a frame dwelling houee. BEING part or the same premises whioh the First Bank &: Trust Company of Meohaniosburg, Pennsylvania, Guardian of the Estate of Mary E.. Holstine, by its deed dated November 24, 1954, and recorded 1n the Cumberland County Reoorderls Offioe in Dee~ Book C, Vol. 16 .b page 490, oonveyed to Samuel J. Rire and Edith S. Rife, his wife, grantors herein. ,.. ijlUl'~'.\n:_"~',iln.1 ~;;!<:J';;';< 1\-"1,./\:.;0 i, ", ':'I:!--' ."!' '1,,\ '..,;~ ').' ;f}:~,,":-..~ /~\ '~~~~!D_' I.'?':_'l 'i"PJ.~'I'.\'il:;'-, II ~-r..~~ ~", :lIl1:_'~~' I l""I...,q~I'; LI,'.~ ~,,!!;, ':~'\~ I !"~,_';' ~_;~f~~~~;:~~~:~~". .)/'! ....... 'Ie' ::1,7),.,'.' ,.,1,1"..." ".." 1(\;'1 i;\' ~'\~r;-~'t'~.;.y;'l 1;'.,'1'.'11.: t,:i:~\1 .lln,.I"\,),:;nll:, i Il';'I~'c~J:..~(~[f)jl II ~ : ~ ~. ~ .. "" BDO~JLti L- PAGf41():) AND the .~id GrantorS Will Warrant generally the property hereby ~onveyed. IN WI~ESS WHBREOP, the laid Grantor II haW the day and year -first above written. hereunto set the lr hand s Signed, Sealed and Delivered .m..~h~e'e~_... \~...........:~a;+m (~!tl~~m ........ ~ ......, J COMMONWEALTH OF PENNSYLVANIA COUNTY OF cm.\BERLAIID .p.fih ~ ~ " ~ ... ~ ~ Recorded on this Recorder', Office of the .aid County in Deed Book day of SS, ~ ... .~ ss, . on on '" .... --: C'( ,t 'J /7?7 L-' Volume I' and Ical (SEAL) (SEAL) (SEAL) (SEAL) (SEAL) ... .... I & Il:LC~" ~ rl CfI,--cr ~ ] nJ: {~\~: ~~~f:r~~ tHE '" h '. DfFC'S IllY.lllJ 'I' J ~ III '6;... 8.0 I h t- ~v:"l/j. . .~ ~'NJ,~;:'fJ COlJNlr -! co 'I JlA.y14 I . t. I i o i. ~ I ~ i 8 ,; o on ~. . o .. ~ ." 'ij t3 A. D. 1943' "; in the Page /.,LD.:l- Given undu my hand and the seal of the .aid Office, the date above written. R(GUIW(l).utfICE Of THE tU:Rl'. Uf \:,OUinS .. RECORDER Of ptEDS o _ll' ~ . .,.., ~~ '" - -i &- -~ _ 0 o U ~~ ~ .<:l ~ llA . ." -" E :: '" l:: '" WI a .t COMMONWHALTH OF PBNNSYLVANIA COUNTY OF~.--I , .II,y~ ft~/ . ~ ~ f _ ~ .d ~~.~---.. I{>~ '1~ 'I''''. CUMBERlAltD COUNTY 'ENNSyt'MI~ Recorder Prlllte<l aIId~~t~~~.}eb:-Vl':...."::~t:!lIa~~~. Wlll1emsl'orI1'.. m4ili i\gr.etmtttt MADE and Concluded this ...gi.ng.tl:.~n.t.b_.._.._....... day of m."'''''''';~' ._..~~.~r.. ........mn:k%.. 2001 Kf;AY;~~_~~~.~_~.~:'~~:r.:::i.~:~~::~~~:;'=~~~:=~~:~_~=~::'i;~:~~=::::::~::=~~::~:=::::::=::~:::::"""""""~.::~".:::.._..... hereby agrees to sell to ......._.............._...n._..J.1mQ.thyJ~._.....Mg.'i!.~.........n......_.._......_......_......................_..'" who agrees to buy premises ..........._...............m...._......_....~.............m......m.........m._............... 1821 Fisher Road, Mechanicsburg PA 17055 :::::::::=::::::~::=::=::::::=::::::=::::::~::::::=::::::~::r.:t2;~!:f.y:::!:~:::!~~~:f.;:~::i~~:v.Pp.~:~:::A!:i:~~::!:?~g~~i.P.:_.. '._mm___ ...._.........._.........._......_......_......_..........~.1f.!I}.I?~E.!~.~~...~~.~E.~.Y._.~~.r!..!~...!:~~~E~.~.~...~~...~.?~E~..~~.~~_~...~.?~.~...~6 ......._......_.._.._......_,....._..............~..........~.?:~.t;:..~.Q.?....................._._............_....._..n.._......................_.........._.......... __.for the price or sum of .m......~J~.~y....~.!~E~~....~.i.'_~.~~~.~~.___..........mm..__.... ..... ._..m.m Dollars. free and clear of alltiens and incumbrances, excepting existing restrictions and easements, if any, The said sum of ..m.mm........m.m.........~.l!.~.{)_Q....._........m..hmmn. ...m.._......_................m.m...........m._...........m_;?QQ....'n'" Dollars, part .Dollars to be paid as follows thereof at the execution of thi~ agreement and the balance or sum of m....~.__m_...~.?!.~g_\lm..... mm.............. ~~~e 0~~..:~4.;~er;.~~~~r~~~~~..~~..~.~.~..~~.~!~.~t&9~ shall t<lke pl<lce on or before the TITLE is to be good and marketable; otherwise the buyer shall he repaid hi.!! deposit money paid on account. Gas and electric hxtures. heating and plumbing systems, mnges and laundry tubs annexed to said Buildings are..... m...included in this sale. TAXES, Water Rent. House Rent and Interest on incumbrances are to be apportioned to date of settlement. POSSESSION to be delivered, subject to existing leases, if any, on . ...A\l.&.1!~!;..J...I._l9.QJ . ......._...._ Dollars at the ..._.n...~~.y.~~~.~_e:E.~!?___._. FIRE INSURANCE POLICIES to be purchased by buyer at pro nta value. or cancelled by seller 'I'his agreement not to be lodged in any public office for record. Formal tender of deed and tender of moneys is hereby waived. Should the buyer fail to make settlement as herein provided. and the said time is hereby agreed to be the essence of this agreement, sum or sums paid on account arc to be retained by the seller, either on ac- count of the purchase money, or as compensation for the damages and expenses he has been put to in this behalf, as the seller shall elect, and in the latter case this contract shall become null and void apd all copies to be returned to seller ior cancellation. It is understood that ._..... .".._nm'''.' .._"_.m.' ....m................ is acth'lg as Agent only and will in no case whatsoever be held liable to either party {or the performance of any term or covenant of this agreement, or for damages for non.performance thereof. It is understood that thil'l ~ale is made subject to the written approval of the owner, which must he obtained within.m..... "__m.._nm._' mdays. This agreement to extend to and be binding upon the heirs, executors, administrators and assigns of the parties hereto. IN WITNESS WHEREOF the said parties have hereunto set their hands and s('als the day and year first above written. SEALED AND DELIVERED l in tbe presence of .::::~::::::~::::::~::::::::::::::::::~::~::::.:~::: ...-......-..-......-......-......-....................,........._......_.~ ~~e~.~t_~;:. .....___...~_-#____...._____._._._m~ ._.. ... ._.__dM:__'2zt.~_!m-::::..__m___.___~ .___ . m .__C.{!l~~".._~f:..~ ________._he<eby 'pp,oved the .bove eont..et.-.::::~::~::~::::::~::::::~::~!Jl?2~/~._______om. -~~ '~J .. . ~ -- - ,.~ _'~... . =1=~,~:;:: p: (\ ", - ',-~, '-, ,- ,', ,- -, ...... ......Vl...."...;..... '_'r o):.:.cD.::> "U1.jQ::"L''''1 ~"'I"TY p' .." I 1,,0....:\ .1-0.1..... vU\. il - io\ '01 RUG 29 ArJ 8 2S Tax Parcel No. 42 10 0644 032 THIS INDENTURE, MADE THE ~~~ day of i~L~ in the year two thousand one (200if~ BETWEEN ARCHIE A. NOSS, JR., Executor of the Last Will and Testament of SARA K. NOSS, late of Upper Allen Township, Cumberland County, Pennsylvania, party of the first part, and TIMOTHY W. NOSS, single person, of Mechanicsburg, Cumberland County, party of the second part: WHEREAS, the said Sara K. Noss, by her Last Will and Testament, duly proved and recorded in the Cumberland County Register of Wills Office, Carlisle, Pennsylvania, in Docket Book 21-01-0345, Let~ers Testamentary being issued on April 2, 2001, provided, in pertinent part, as follows: FOURTH: My Executor and personal representative shall have the following powers in addition to those vested in them by law and by other provisions of this Will, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as are deemed proper... SIXTH: I nominate and appoint my husband, ARCHIE A. NOSS, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason wha~soever of the said Archie A. Noss, I nominate and appoint, F~CHrE A. NOSS, JR., Executor of this, my Last will and Testa- ment.. . NOW THIS INDENTURE WITNESSETH, that the said party of the first part, by virtue of the power and authority aforesaid, in said Will contained, and in consideration of the sum of Sixty-three Thousand and No/100 Dollars ($63,000.00) paid to him paid by the said party of the second part, at and before the ensealing and delivery of these presents, the receipt whereof is hereby acknowledged, granted, bargained, sold and conveyed, and does hereby grant, bargain, sell and convey to the said party of the second part, his heirs and assigns forever: ALL THAT CERTAIN piece or parcel of land situate in Upper Allen Township, Cumberland County, Pennsylvania, bounded and described in accordance with a survey made by W.G. Rechel, Registered Surveyor, on May 23, 1955, as follows, to wit: BEGINNING at a stone in the public road leading from Mechanicsburg to the Gettysburg Pike, which stone is also the southwestern corner of the larger tract of land of which this parcel was formerly a part; thence by land of Clare Hopple north 13 degrees 30 minutes east one hundred fifteen and one-half (115.5) feet to a pin; thence by land of the grantors herein south 59 degrees east one hundred fifty-five (155) feet to a pin; thence by the same south 13 degrees 30 minutes west one hundred fifteen and one-halt (115.5) feet to a pin in the aforementioned public road; thence along said road on a line parallel to and at a distance of five and one-half (5.5) feet south of the fence- line on the north side of said road, north 59 degrees west one hundred fifty-five (155) feet to a stone, the place of BEGINNING. F~J1ING ERECTED THZRZON a frame dwelling house being known a~d numbered as 1821 Fisher Road, Mechanicsburg, Pennsylvania. BEING the same premises which Samuel J. Rife and Edith S. Rife, husband and wife, by deed dated May 28, 1955, and recorded May 28, 1955, in the Cumberland County Recorder of Deeds Office i~ Deed Book "L", Volume 16, Page 402, gra~ted and conveyed unto Archie A. Noss and Sara K. Noss, husband and wife. The said Archie A. Noss died February 29, 1986, whereupon full and com- plete title became vested solely in Sara K. Noss, the decedent . herein. The said Sara K. Noss died March 18, 2001. TOGETHER with all and singular the rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging or in anywise appertaining, and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of the said Sara K. Noss at and immediately before the time of her decease, in law or equity or otherwise howsoever, of, in, to or out of the same: TO HAVE AND TO HOLD the said granted premises to the said party of the second part, his heirs and assigns forever. AND the said party of the first part, does covenant, promise, grant and agree, to and with the said party of the second part, his heirs and assigns, by these presents, that the said party of the first part, has not done, committed, or knowingly or will- ingly suffered to be done, any act, matter or thing whatsoever, whereby te premises aforesaid, or any part thereof, is, are, shall or may be charged or incumbered, in title, charge or estate, or otherwise howsoever. IN WITNESS WHEREOF, the said Grantor has hereunto set his hand and seal the day and year first above written. Signed. Sealed and Delivered /ithe Pre.e~fe of . L... f)l~~,~. ( - (j {2g: c- /J~?,_ Qk. Archie A. Noss, Executor of Estate of Sara K. Noss (SEAL) the COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this, the [).&fI.-.day of AUjI.AS+- , 2001, before me, the undersigned officer, personally appeared Archie A. Noss, Executor of the Estate of Sara K. Noss, known to me (or satisfac- torily 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. -:Bcnt10 cf LJJ.QlLJ"rA,O Notary Public My Commission Expires: (SElI.L) " :.. ~ :l.J " NOTARIAL SEAL B01l1tlE L WILLIAMS. NOTAR'f MllC SHIREMANSTOWN BORa.. CUMBERlAND CO MY COMMISSION nPIRES APRil 18 Z005 "" ,. )} ,.' t., '1 CERTIFICATE OF RESIDENCE I do hereby certify t~at the precise residence a~d complete post office address of the withi~ named grantee is 1821 Fisher Road, Mecha~icsburg, PennsYlvania, 17055. , 1 /1 '11 'lr. ." ., '~r--.,t)>f , 200l-w{ cr.,; Y I<-;~tz....., , ~ James D. Bo~ r, Esqulre Attorney for Grantee COMMCNWElI.LT:: OF PENNSYLVlI.NI.n. 55. COlJNTY OF Cl.,11BERLlI..L'lD RECORDED on this in the Recorder's Office Page day of of the said County, , 2001, in Deed Ecc~ Given under my hand and the seal of the said office, the date above written. , Recorder. 'f,~;:~tij:""'h~;W~:~'!J';'P') >,:I..":t',(~OMB NO,2S02~2". E P'LOAN:I.",'" ,,'...~.,.. .:' ,,.,,,.~,.,.',. ,.', " I'i'" "".. ",..' CONV.UNINI;.ll("., 4,DvA s.DCONV.'IHS. 7.' .LOAN NUMBER: 4151807 C. NOTE: This form Is fumishedfo vve)'O&l' SfetemMt oIecrull sen:llHMntcosrs. Amounts pMllo and b)'1he seMtment.,. eN shown. /lems merked "[POCr were paid outside lbe cIoslnQ; lhey ere shown harelorlnformellone' purpose. end ere not Inclurad In lbe totels. 1,0 31811 (HOSS. T.,PFOf3.ler.1112) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SelLER: F. NAME AND ADDRESS OF LENDER: Timothy W. Noss 5120 Simpson Ferry Road ~han~s~g,PA17050 SarlI K. Nos. Estale Archie A. NOH, Jr., Executor 1790 Orrs Bridge ROlId Enols, PA 17025 Counlrywlde Home loans 4830 Csrtlsle Pike Mechan~sbufg, PA 17055 G. PROPERTY LOCATION: 1821 FtsherRoad Mechanlcsburg, PA 17055 H. SETILEMENT AGENT: 23-2048775 I. SETILEMENT DATE: James D. Bogar Law Offlcea PA2150 August 28, 2001 PLACE OF SETILEMENT One West Main St. Shlremanstown, PA 170t 1 J. SUMMARY OF BORROWER'S TRANSACTION 100, GROSS AMOUNT DUE FROM BORROWER: 101. Centricl Siles Price 102. Personal Pr 103. Settlement Coo es to Borrower Une 1400 104. 105. K SUMMARY OF SELLER'S TRANSACTION 400. GROSS AMOUNT DUE TO SELLER: 63 OeXl.(XJ 401. Contract Sal" Price 402. Pel1lOOlllP 2556.14 403. """. <05. 63 000.00 A ustments For Iteffl$ Paid B Seier In advance 106. Count IT Ts)(" 08I2BI01 to 01101102 t07. School TalreS 08128101 to 07101102 t08. Assessmenl. to 109. Sewer 110. 111. 112. f~. GROSS AMOUNT DUE FROM BORROWER 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 201. De sit or earnest mone 202. Prlnel al Amount of New Loan. 203. Exlsl loan s taken s 10 204. 205. 205. 207. 20.. 209. Ad stments For Items Pstd B Selhtr In edvance 406. Count IT TelleS 08128101 10 011OtlO2 834.04 407. School Tax" 08128/01 10 07101102 408. Assessments to 409. Sewer 410. 41" 412. 66,458.94 420. GROSS AMOUNT DUE TO SELLER 1500. REDUCTIONS IN AMOUNT DUE TO SELLER: SOO.OO 501. EJ(CH;s II See Instructions 50 400.00 502. Settlement Cha esto Sallef Line 1400 503. Eldsl Joan s taken au eet to 504. P ff of first MortQ8Q8 osee ort II 506. De sll retained seher 507. 508. 508. . 834.04 63,902,80 634.00 500.00 Ad'usfments For Hems Un 210. CounllT Talles 21,. School Ta)(es 2t2. Assessments 213. 214. 215. 216. 217. 2t8. 2t9. 220. TOTAL PAID BVn=OR BORROWER 300. CASH AT SETTLEMENT FROMITO BORROWER: 301. Gross Amounl Due From Borrower Line 120 302. Less Amount Paid B IFor Borrower line 220 B Seier 10 10 10 SO,900.00 A ustments For Hems Un 510. Coun fT Taxes 511. School Taxes 512. Assessments 513. 514. 515. 516. 517. 518. 519. 520. TOTAL REDUCTION AMOUNT DUE SELLER 800. CASH AT SETTLEMENT TO/FROM SELLER: 801. Gr08sAmount Due To Seller Une420 602. Less Reducllons Due Sellef Line 520 IdB SeIer 10 10 10 1,134.00 303. CASH ( X FROM) ( TO) BORROWER 66 456.94 50,900.(0) 15,556.94 603. CASH ( X TO) ( FROM) SEllER 63902.80 t,134. 62,768.80 The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of Ihie statement & any attachmenls referred to herein. I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BEliEF, IT IS A TRUE AND ACCURATE STATEMENT~F. LL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE RECEIVED PY OF T HU[}.1 SETTLEMENT STATEMENT. Borrower - ',A(~..,;- --:"':f~ Seller I.orlnlolhyW. Noaa Sa K. Noss Estate .t('./A g. Archie A. NOH, Jr., )(ecul E HUD-' SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF NO HAVE BEEN OR WILL BE DISBURSED BY THE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS Jam s ,Booar Law setllement AOent WARNING: IT IS A CRIME TO KNOWINGC KE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT, FOR OETAllS SEE: TiTlE 18 U.S. CODE SECTION 1001 & SECTION 1010. HUD-I(3-I!I5)RESPA.Hfl.lJO!U 700. TOTAL COMMISSION Based on Price Divislon ot CommiSSIon e 700 as FoIows: 701. 10 10 703. Commission Paid al Settlement L. SETTLEMENT CHARGES s .. % 100. ITEMS PAYABLE IN CONNECTION WITH LOAN 801 loan 0 Inallon Fee "'" to nt Home loans 802. loan Discount "'" to ~ als ee 0 ou a ome ns 80<1. Credit Report to Count Home loans ocume re rat 0 aun e orne OHM 806. Mort_S!Q!..tns. A . Fee 10801.1 e Home loans s~ ee 0 a ome oans 808. Flood Check Fee to e Homa loans ax ervce ee 0 e orne ns 810. Count de Home loans 8 1. ou a ome oans 100.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 08l28I01 to 09101101 C!! $ 9.320000/dav { 902. Mort a a Insurance Prem m or mant to 903. Hazard Insurance Premium for 1.0 ra 10 904. 905. 1000, RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 1002. Mort a elnsurance 1003. Coun rr Taxes 100<1. School Taxes 1005. Assassmanls 4dsva %, 8.000 4.000 months monlhs monlhs monlh. month. moo C!l s s 13.58 er s 15.60 52.53 "" , 1008. A .Escrow Ad. 1100. TITLE CHARGES 1101. SeUlemeotorClos1 Fee 1102. Abstract or TlIla Search 1103. Title Examlnallon 1104. Tille Insuranca Binder 11OS. Document Pre ration 1106. Nola Fees 1107. Altor sFees includes above Item numbars: 1108. Tlllelnsurance des above Itam numbers: 11 OJ' 1109.lender'sCovera e 1110.0wne sCovera I 1111. Allorn Fees 11 ax Certification 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. RecordlnaFees: Deed $ 25.5O;M $ 51.50; 1202. CII/Count Tall/Starn s: Deed 630.00' Mort 1203. Stale Tall/Slam s: Revenue Sla 630.00' Mort 1204. Ass nmentofMort e e 1205. SII ulatlon..... Liens 1300. ADDITIONAL SETTLEMENT CHARGES 1301. SUMW 1302. Pest In 1303. Courier 1304. 1305. 1.00. TOTAL SETTLEMENT CHARGES (Enter on linea 10). Sldlon J and &02, Secllon KJ mo""" s 10 10 10 10 10 10 a.WIlllams 10 James D. B ar law Offices to ames D. B ar law Olllces 1104-End.1oo 300 6.1 CSl S to James D. B ar law Omces to Marlin A. ohn Sr. Prothonota lk>n 10 10 to United Parcel Service Certirled 10 be a true copy Loan Docs - PAlO FROM BORROWER'S FUNDS AT SEmEMENT 2,556.14 "'\1'" PAlDFRQM SELLER'S FUND$AT SETll.EMENT 25.00 25.00 37.28 15.59 634.00 (:Ma7_1 1:Ma7_1 1 12) REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Sara K. Noss SS# 209-28-9272 03/18/2001 21-01-0345 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION Blue Cross/Blue Shield - Refund VALUE AT DATE OF DEATH 166.80 2 PNC Brokerage Corp., CUSIP #53054M493 - Account No. 63343444 consisting of 491.719 shares of Liberty Colonial Federal Secs Fund Class A, date of death value per share $10.59 5,207.30 3 PP&L - Refund 2.94 4 Contents of home and personal property 1,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 6,377.04 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-15GB EX (Rev. 1-97) 05-14-2201 e2'24PM p.e1 Thomas Dilello Senior Viee Prt!idt'r'It ~niOr InvtStmtnt Con$ulta~\' o PNCBROKERAGECORP James D Bogar One West Main St ShiremanstoWD, Pa 17011 May 14,2001 Dear Mr. Sogar, Date of death balances for Sara K Noss are calculated for March 16lll which is the last business day before the date of death of March 18, 2001. On March 16'h Mrs. Noss owned 491.719 shares of Liberty Colonial Federal Sees Fund Class A at $10.59 per share. The account is and has always been titled in Sara K Noss individual and was opened 11/23/94. To redeem the account we will need a Death Certificate and a Short Certificate. AsJ.y questions please call 717-691-4050. Sincerely, cj~~ Heather Grubic A PNC bnle. Comp,ny < Eist M9in Street Mech.-,njcsburg Pennsylv:.nia 17055 www.pnebrokcr3gc.com ~~ ltIformatioft.~uritic'oro\tCnlSlCandot'nC'rprOOuct':lnds.cl'Yil.:~l1rt tl'Qvidcdby PNCBrolc('rag<" Corv, 31 rcgimtel:ll:mlkn~IM':1nd mfm~r !)Ipc' PNC lkO..,c,..gc corp i~;I oub5icli9ry of PNC San"- Nl)titm~ A"oci"tiQrI, W"il"'h i. I'tft~ '" "l'Qktr<<a~r ~l""\w'~ I I *No~Gumntee TOTAL P.101 REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sara K. Noss SCHEDULE F JOINTLY-OWNED PROPERTY SSfl 209-28-9272 03/18/2001 FILE NUMBER 21-01-0345 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT(S) NAME Archie A. Noss, Jr. ADDRESS 1790 Orrs Bridge Road Eno1a, PA 17025 RELATIONSHIP TO DECEDENT Son B. Larry E. Noss 602 W. Keller St. Mechanicsburg, PA 17055 Son c. Wayne E. Noss 2845 Morningside Dr. Camp Hill, PA 17011 Son JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOIN MADE Include name of financial institution and bani DATE OF DEATH DECD'S VALUE OF account number or similar identifying numbs . NUMBER TENANT JOINT Attach dee<fforjointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 D 07/09/98 AmeriChoice Federal Credit 12,546.70 50.00% 6,273.35 Union - CD Account No. 24998-21 2 A 03/04/98 AmeriChoice Federal Credit 6,123.88 50.00% 3,061. 94 Union - CD Account No. 24998-22 3 E 07/09/98 AmeriChoice Federal Credit 12,546.70 50.00% 6,273.35 Union - CD Account No. 24998-23 4 B 07/09/98 ~eriChoice Federal Credit 12,546.70 50.00% 6,273.35 Union - CD Account No. 24998-24 5 A 07/09/98 AmeriChoice Federal Credit 12,546.70 50.00% 6,273.35 Union - CD Account No. 24998-25 6 C 02/21/98 AmeriChoice Federal Credit 6,274.32 50.00% 3,137.16 Union - CD Account No. 24998-26 7 E 02/21/98 AmeriChoice Federal Credit 6,274.32 50.00% 3,137.16 Union - CD Account No. 24998-27 8 D 02/21/98 AmeriChoice Federal Credit 6,274.32 50.00% 3,137.16 Union - CD Account No. Tou1 of Continu ation Schedu1e(s) 27,040.35 TOTAL (Also enter on line 6, Recapitulation) $ 64,607.17 T (If more space is needed insert additional sheets of the same size) Form REV-1509 EX (Rev. 1-97) CopyriQht (e) 1996 form software only CPSystems, Inc. REV.l509 EX + (1--97) '*' SCHEDULE F JOINTL Y.OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sara K. Nass SS#209-28-9272 03/18/2001 FILE NUMBER 21-01-0345 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATJONSHIP TO DECE:l~iiT D. Mary K. Lantzy 116 Winston Dr. Mechanicsburg, FA 17055 Daughter E. Sara M. Sanders 1938 Chatham Dr. Camp Hill, FA 17011 Daughter JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEAT;.. ITEM FOR JOINT MADE Include rlame of flnarlcial irlslitulion and barlk accourll number or similar iderllifyirlg rlumber. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INER::2~ TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Estate of: Sara K. Noss Soc Sec #: 209-28-9272 Date of Death: 03/18/2001 Continuation of Schedule F (Jointly Owned Property) Item Ltr for 1/ Jt Ten Date Joint Description of property 24998-28 9 02/21/98 AmeriChoice Federal Credit Union - CD Account No. 24998-29 A 10 02/21/98 AmeriChoice Federal Credit Union - CD Account No. 24998-30 B 11 03/04/98 AmeriChoice Federal Credit Union - CD Account No. 24998-31 B 12 03/04/98 AmeriChoice Federal Credit Union - CD Account No. 24998-32 D 13 E 03/04/98 AmeriChoice Federal Credit Union - CD Account No. 24998-33 14 07/09/96 AmeriChoice Federal Credit Union - Checking Account No. 24998-13 C 15 C 01/05/96 AmeriChoice Federal Credit Union - Money Market Account No. 24998-4 16 12/23/92 AmeriChoice Federal Credit Union - Savings Account No. 24998-0 C Total Val of Asset 6,274.32 6,274.32 6,123.88 6,123.88 6,123.88 983.05 20,205.02 1,972.34 Decds % Int 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% 50.00% Dollar Val of Deeds Interest 3,137.16 3,137.16 3,061. 94 3 ,061. 94 3 ,061. 94 491.53 10,102.51 986.17 27,040.35 ~ AmeriChoice - .......FEDERAL CREDIT UNION Cumberland County's Community Credit Union April 23, 2001 James D. Bogar Attorney at Law One West Main Street Shiremanstown, Pa. 17011 , RE: The Estate of Sara K. Noss S.S. # 209-28-9272 Dear Mr. Bogar, In accordance with your request for information on the accounts of Sara K. Noss, Attached is a list of each account. I have provided account numbers, opening dates. CD terms, current maturity dates, opening deposits, date of death balances, current balances, interest rate, and joint owners. Sara K. Noss is primary owner of all accounts listed. Please let me know if I can be of further assistance. Sincerely, I' J, v . { l/Uli.,.c, Yrl.cv, h.~ Eloise Markel Branch Manager Main Office: 20 Sporting Green Drive, Mechilnicsburg. PA , 7055 . Phone: (7171 697-3474 . Fax: 17171 697-3:"13 Pennsboro Commons Office: 326 East Penn Dri\/(~, Enola, PA 17"023 . Phone: (717) 909-04iiO . Fax: (717) 909-0..1()j Mechanicsburg Office: 5267 East Simpson Ferry Road, t'\{\echanicsbl..lr~, p-\ 170S5 . 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Noss COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX-RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS SSfI 209-28-9272 03/18/2001 FILE NUMBER 21-01-0345 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Eberlys Mill Church of God - Use of hall for funeral meal 100.00 2 Gingrich Memorials - Engraving expense 75.00 3 Parthemore Funeral Home - Funeral expense 8,142.00 4 Sir D's Catering Inc. - Funeral meal 240.00 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Sodal Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: Z. Attorney's Fees James D. Bogar Esquire 4,375.00 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. Probate Fees Register of Wills 132.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 B. Will i ams - Notary fee re sale of real estate 2.00 2 Cumberland County - Fil ing fee for house assessment challenge 10.00 3 Hutter Agency - Homeowner's insurance 286.15 4 Mark Hilbert - Appraisal of real estate 275.00 5 Marlin A. Yohn, Sr- - Tax certification re sale of real estate 2.00 6 PP&L - Electric 367.00 Total of Continuation Schedule(s) 2,755.75 TOTAL (Also enter on line 9, Recapitulation) $ 16,761. 90 (If more space is needed, insert additional sheets of the same size) Copyrlght(c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev.1~97) Estate of: Sara K. Noss Soc Sec #: 209-28-9272 Date of Death: 03/18/2001 Item If Continuation of Schedule H-B7 (Other Administrative Costs) Description Amount 7 Recorder of Deeds - Realty transfer tax re sale of real estate 630.00 8 RESERVES: Costs to conclude administration of Estate including filing fee for PA Inheritance Tax Return and Inventory, First and Final Account and preparation of Fiduciary Income Tax Returns 750.00 9 Tax Collector County/township real estate tax 209.19 10 Tax Collector School real estate tax 991. 63 11 u.S. Postal Service - Certified mail fee 3.74 12 Verizon - Telephone 111.67 13 Waste Management - Trash removal 59.52 2,755.75 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sara K. Noss SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSlf 209-28-9272 03/18/2001 FILE NUMBER 21-01-0345 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Alert Pharmacy Service - Final bill AMOUNT 219.72 2 AT&T - Long distance telephone 1.07 3 Messiah Village - Final bill 1 ,881. 00 TOTAL (Also enter on line 10, RecaDitulation) (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. $ 2,101. 79 Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Sara K. Noss SSfl 209-28-9272 03/18/2001 FILE NUMBER 21-01-0345 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. AXABLE D[STRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Mary K. Lantzy 116 Winston Dr. Mechanicsburg, PA 17055 Daughter One-fifth (1/5th) of rest, residue and remainder of Estate 2 Archie A. 1790 Orrs Eno1a, PA Nass, Jr. Bridge Road 17025 Son One-fifth (l/5th) of rest, residue and remainder of Estate 3 Larry E. Noss 602 W. Keller St. Mechanicsburg, PA 17055 Son One-fifth (1/5th) of rest, residue and remainder of Estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18 AS APPROPRIATE ON REV 1500 COVER SHEET II. ,"ON-TAXABLE DISTRIBUTIONS: 1'" SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE . CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) Estate of: Sara K. Noss Sac See #: 209-28-9272 Date of Death: 03/18/2001 Continuation of Schedule J, Part I (Taxable Bequests) Item If Name and Address of Beneficiary Relationship Amount or Share of Estate 4 Wayne E. Noss 2845 Morningside Dr. Camp Hill, PA 17011 Son One- fifth (1/5th) of rest, residue and remainder of Estate 5 Sara M. Sanders 1938 Chatham Dr. Camp Hill, PA 17011 Daughter One-fifth (1/5th) of rest, residue and remainder of Estate NOTE: Archie A. Noss, husband of Sara K. Noss, predeceased her, having died February 20, 1986. " ifctst JIIiU ctub QTestctmeut OF SARA K. NOSS I, SARA K. NOSS, of Upper Allen Township, Cumberland County, Pennsyl- vania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I direct the payment of all my just debts and the expenses of my last illness and funeral from my estate, as soon after my death as conveniently may be done. SECOND: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate lmto my husband, ARGUE A. NOSS, provided he survives me by sixty (60) days. THIRD: Should my husband, Archie A. Nass, predecease me or die ffil or before the sixtieth (60th) day following my death, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate unto my children, ARaUE A. NOSS, JR., LARRY E. NOSS, WAYNE E. NOSS, MARY K. LANrZY and SARA M. SANDERS, or the survivor or survivors thereof, in equal shares. Should any of my children predecease me, I devise and bequeath that child's share under this, my Last Will and Testament, to such of that chilJ's children who survive me, in equal shares. FOURTII: My Executor and personal representative shall have the following powers in addition to those vested in them by law and by other provisions of this Will, applicable to all property, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as are deemed proper. (B) To compromise any clann or controversy. FIFTH: I direct that any and all inheritance, estate and transfer taxes imposed upon my estate passing lHlder my Will or otherwise shall be paid out of the principal of my residuary estate. SIXTIl: I nominate and appoint my husband, AROUE A. NOSS, Executor of this, my Last Will and Testament. In the event of the death, resignation or inabil ity to serve for any reason whatsoever of the said Archie A. Noss, I nominate and " appoint, ARCHIE A. NOSS, JR., Executor of this, my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties as such in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this .:;(.2.. day of !/,-tvW""-7 ' 1980. _.v/;;:";~c<- Sara K. /7.L , A-, /tIOd/ Nass (SEAL) Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Test(llTlent in our presence, who. at her request, in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address ~"d/;J(~",{"i0 , () At&AA~/r;'(i+ Address