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Home My WebLink About01-0372 Estate of BETTY O. RABUCK also known as BETTE O. RABUCK PETITION FOR PROBATE and GRANT OF LETTERS 2./- 01- 0:372 No. To: Register of Wills for the . Deceased. County of CUMBERLAND in the Social Security No. 1 (}6-14-7361 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut r ix in the last will of the above decedent, dated June 15. and codicil(s) dated named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h ,::or last family or principal residence at :l00f) Hnrvnrd Avenue BOro1lf}h of Camp Hi 11 (list street, number and muncipality) Decendent, then 78 years of age, died Fe bruary 28, 2001 at :1006 Hnrvard Avenue, Camp Hill. PA Except as follow;, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ 96,500.00 $ $ $100.000.00 2006 Harvard Avenue, Borouqh of Camp Hill Cumberland County. PA WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. VJ V u t:: II) ~3 II) .... C:::II) I: -00 1:''= ~.~ .-,11) ~o.. II) <- 50 ~ I: OIl Vi e. V'7/Z / '-..A../?Lda- /). /' I L-nda L. NiziOlek~ 68 Ochs Drive Milltown, NJ 08850 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I -.~ COUNTY OF CUMBERLAND J s~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ;; ~4<----tL'~ .~ ~. ~ l:::l - ;:: ~ :B: J(; - ~").3 -, No.~,031Z. Estate of BETTY o. RABUCK a/k/ a BETTE O. RABUCK , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW AP(~I L ,.X , 0 2001, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June 15. 1991 described therein be admitted to probate and filed of record as the last will of Betty O. Rabuck a/k/a Bette O. Rabuck and Letters Testamentary are hereby granted to Linda L. Ni z iolek 230.O'V Probate, Letters, Etc. ......... $ 3"1 ~erlificales(t) .......... $ i2 on y~~~tion.. . ~.:-.p(.~ . .. .. $ 15.0,9 =s- (1 f) $ ~ 5trYJ TOTAL _ $2..10, OD FEES tr<JJ.;\Jf~.~1 pL1 V r)~~[L? , J 'Register of Wills 'k~ 1/ Edmund G. Myers, Esq. (20558) Johnson, Duffie, Stewart & Weidner ATTORNEY (Sup. Ct. I.D. No.) 301 Market St., P. O. Box 109 Lemoyne, PA 17043-0109 ADDRESS (717) 761-4540 Filed PHONE ~ L~ tJ:.\TER ~ TO AT f'-f , , I' 't' c., tl1' t thpl 'nformation here given is conecd\' copied from an original certificate of death duly filed with me as 11 ~ is to ce r it y ,1 .. . . '~fT I.(k:l! Registrar.~ The original cerrificate will be forwarded to the State Vital Records Ofhce for permanent 1 mg. WARNING: It is illegal to duplicate this copy by photostat or photograph. fee for this certificate, $2.00 -/ij/ii;;;;;,~;;-';"-., li~~\\liJ[flt~:~ l#./// . "-:~~\~. &~~I "~ \,~~ /~:Ji!{ :. \?::. I~ ~;':, :-~\ )~~ ~ c.J\ "'.~1'..,/ '~I \\ * '\: .~," -' * ~ \\~,~.y~_..-> /~/ ~~,.. '. ./,,~\\\ ~-,!/lj~~---- -~ ~~ 11'\\\ ,'"EN1 \\ Jj/,,!J-~ ~ P 7177868 No. :4 Rev. 1/91 ....... ,-'j;;,,:y) c.v:J.tAr:..-" /' I" '- '~~_<,,~,-;<:,!L__ (/ Local Registrar ~H) II;-\i\ r" l) rlL.f O' o~ v!....; I Date COMMONWEALTH OF PENNSYLVANIA e DEPARTMENT OF HEALTH e VITAL RECORDS CERTIFICATE OF DEATH (Coroner) MARITAl STATUS. Marr'-d ~r Marr'-d, Widowed, Divorced (Specify) 4. Widowed Pa Old 17e.D V..,dec8dentllvedln decedent IIvelne n mhPrl rim townahJp? 17dXJ ~=a1~1=01 MOTHER'S NAME (Fwsl, Middle, Maiden Surname) 1.. Stella Mitchell INFORMANT'S MAILING ADDRESS (511881, CIty/Town. State, Zip Code) 68 O::hs Avenue Milltown,New Jersey 08850 PlACE OF DtSPOSITION - Name Of Cemetery. Crematory LOCATION. City/Town. State, Zip Code or Other Place NAME OF DECEOENT (Fllst, Midde, Last) SEX BIRTHPLACE (C~y and Stale or Foreign Country) ---- ~I. _COUNTY OF OEArH ~.. Cumberland , DECEDENT'S USUAL OCCUf'lIITlON ;: ~~Iif~:o~~;~:r _11.. Office Manager 11b. Doctor's Offi :"DECEDENT'S MAILING ADDRESS (SIr88l, CltylTown, State, Zip Code) DECEDENT'S ~-= 2006 Harvard Avenue ~~~~DAiNCE Canp Hill, Pa 17011 ~~::r~rs ~, tWHER'S NAME (First, Middle, Lasl) Olar les Baish 78 Vr. Ie. 17a. Stete 17b. Coun 11. INFORMANT'S NAME (Type/Print) Linda Niziolek METHOD OF DtSPOSITION ~ Buri~ Cremation D ::ii Donation 0 Other (Spec.fy\ ._.tta. SWE FILE NUMBER SOCIAL SECURITY NUMBER 3.196-14-7361 28 2001 ~=ify) D RACE. American Indian, Black, White. elc. (Specify) 10. White SURVIVING SPOUSE Qf wife, give maiden name) twp. citylboro. Ramovallrom State D ~ n_ 24-26 muat III completed by =- petaon who pronounces death. ~ Ua. TIME OF DEATH 8:00 IIIMEDlATE CAUSE (Final diaMse or condition ~ resulling in death)_ ~ __tiaIy fiat conditions 45.!!!! if any. leading to immediate ...._. EnlIW UNOEJll.YING - CAUSE (Oi8ease or inJUry -1haI inili8ted evenls .resulling in dealh) LAST d. __ ~ AN AUTOPSV WERE AUTOPSV FINDINGS _ PERFORMED? AVAILABLE PRIOR 10 --C COMPLETION OF CAUSE - OF DEATH? b, DUE 10 (OR AS A CONSEQUENCE OF): DUE 10 (OR AS A CONSEQUENCE OF): MANNER OF DEATH DATE OF INJURV (Monlh, Day, Year) ~ D o Homicide o D D Natural :;;; ~ Yea D No iJ Accident Pending Investigation Hill, Pa 1903~kepaSI70I1 DATE SIGNED (Monlh, Day. Vear) 23b. 23c. WAS CASE REFERRED 10 MEDICAL EXAMINER/CORONER? VesS NoD 28. I Approximate : interval belween : onset and death ! I ! PART II: Other significant condillonl contributing to death, but not resu"lng in the underlying cause given in PART I TIME OF INJURV INJURV AT WORK? DESCRIBE HOW INJURV OCCURRED. Ye. D NoD ... 21b, ClRTIl'IER (Check only one) .CERTIFYING PHYSICIAN (PhYSIC..n certifYing cause 01 death when another phYSICIan has pronounced death and completed l1em 23) To the blat 01 my knowledge, deathoceurredd...to~eeuae(.).ndmanne,.....ted.,................................................... Ve. D No D Suicide at. Could not III determlnad -- ~ .- ::;;; - .PAONOUNCINO AND CERTIFYING PHVSICIAN (Physician both prOnouncIng death and certifying to cause of deoIth) To tile... 01 my knowledte, death occurred at the time, dat., and p1aca, end due to th. Cluae(e) and manner 'IItated.. . . . . . . . , . . . . . . . . . . , . . . . . .MEDICAL EXAMINER/CORONER On the bMIa of e.amlll8tlon end/or Inv..llgatlon, In my opinion, death occurred at the time, date, and place, and due to the eau..(.) and manner.. elated.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31a. REGIST S SIGNATUR~U% _ .,..'c ~ ~/0/vl D Coroner ATE SIGNED (Month. Day, Yea.!) D 1c. 1 March 1, lOOI NAME AND ADDRESS OF PERSON WHO COMPLETeD CAUSE OF DEATH (Ilem 27) Type or Prlnl Michael L. Norris, Coroner ~ 6375 Basehore Road, Suite #1 ~ Mechanicsburg, Pa. 17050 c:100/ 34. 2.1 -OI-a72. REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS John M. Eakin ~ (em!ff) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that he was present and saw Bett~ O. Rabuck a/k/a Bette O. Rabuck the testat rix , sign the same and that he signed as a witness at the reqUest of testat r i x in her 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 12 (; Y-" day of /11 Oi-t rL- .., 2001 /YI ~_ L( CA"?V"V'<., Notary PubllC a ln (Name) quare Building, Mechanicsburg, PA 17055 (Addre~s) Notarial Seal . Marilyn E. Witliams, Notary PublIC ~ Bora, Cumbefland County My Commission Expires Nov. 6, 2001 M6t1'1ber, pcnnsylv.ama Association 01 No:aries (Name) (Address) REGISTER OF WILLS OF CU\vt~~,-~.+A) COUNTY OATH OF NON-SUBSGRIBING WITNESS L-l. 1\ ol it l. iJL b. 0 ( e f/e.- (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ~ ~ .'j familiar with the signature of ~ 0 jL().-14..IcCt ~1-~C: fu ~odieik will presented herewith and codicil believes the signature on the will is in the handwriting of testat ~I\ ~ of (one of the subscribing witnesses to) the that S'~ ~~ 0 B'l~IIC~ to the best 0 f knowledge and belief. Sworn to or affirme~ subscribed before me ~s q ~a~~f ~~-- r~e _ ", ~';'L '-' .. ~';X'~~ (Name) G rJ c) c4 J II-vu~- . ~:'lit tvV\JVl, (Address).;,f O'O~-SV (Name) (Address) LAST WILL AND TESTAMENT OF BETTY O. RABUCK I, BETTY O. RABUCK, of the Borough of Camp Hill, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I bequeath Two Hundred ($200.00) Dollars to the Humane Society of Harrisburg, Pennsylvania. 3. All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, I give devise and bequeath as follows: a). Five (5%) Per Cent to Trinity Lutheran Church of Camp Hill, but in the event my membership is transfered to another Church then to that Church. b). Five (5%) Per Cent to my sister, MARION L. LANDT, but if she should predecease me the gift shall lapse and pass instead to my granddaughter, CHRISTINA E. NIZIOLEK. c). Ten (10%) Per Cent to my granddaughter CHRISTINA E. NIZIOLEK. d). Eighty (80%) Per Cent to my daughter, LINDA L. NIZIOLEK. -1- ~ ... ...... 4. I nominate, constitute and appoint my daughter, LINDA L. NIZIOLEK, to be the Executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this l~fA day of June, A. D. 1991. ~.---tJ. -fi?~SEAL) Bett o. Rabuck Signed, sealed, published and declared by the above-named BETTY O. RABUCK, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. .~ -2- 21-0l-.?;/,Z. REGISTER OF WILLS OF _ . . . . ~~~~~~D. . . . . . COUNTY BOND AND SURETY FOR PERSONAL REPRESENTATIVE KNOW ALL BY THESE PRESENTS, That ..,.. ~~~~~ .1:-. ,~~~I_~~E.K. . . . . . . . - . . . . . . . . 0 . 0 0 . , . . 0 , . . 0 . . . . . . , . . . . . .. as prirlclpa1(s) 8.Ild ..... 0 . 0 . . . . . . . - . . . - . . PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY . ..,........................."..........,......,....._...........'.........'. I I................... as surety (sureties) are held and finnly bou.."'ld untD the Commonwealth of Pennsylva.. cia in the sum of .':rwQ .lllfflQR,~~ oT~~o :rtIP~~~J? dollars ($ 210,<XXl_OO) to be paid to the Commonwe~~tht for which payment we do bind ourselves, jointly and s~erally, oW" heirs 1 e.xecut01'87 administrators and successors. the condition of this obligation being that if .. _ . . _ . . . . .L.I~J>A. J..-. ~"J~lQL~~ 0 . . . . . . . . . . . , . . . . . . . . . . , . , . . 0 . . . . . . . . . . . . _ . . _ ~ . . . . . . . . . _ _ . . . . . . . . . . . . .. as (state fiduciary capacity) ...... 0 . . . - . . . . , . 0 . EXECUTRIX . ' .. I' .... ......... I'. .......,.... ,. ........ ..,."........ ,...."...... ............ of the estate of ,.. _ .l~E_T_T.Y. P.-. ~~1}<;~. _ _ _ . . . . . . . . . . . - . . 0 . . . . . . . . - -, deceased7 or any of them, shall well and truly administer the estate according to law, then ,this obligation shall be. void as to the personal representative or representatives who shall so ad~ter the es~ate and his or their surety or sureties; but othercyise it shall remain in fun force. Signed and sealed this _. .9~~. . . . . . _ _ . .. day of ,_.. .~~~~I: . . , , . ., ~. ?<??leach int~nding to be lega.lly bound hereby. ' . .' . .L,Ifl.n~. ~~ . ~!~~(n.~I}. . . . . 0 . . . . (Seal) ,,\, 7 ,', , . If' (Seal) . i , ., . . . . ~ . . w . .. .. . . , . . ~. . .. . -, I . ..~ . , PENNSYLVANIA NATIONAL I1gTU~~4I:TY, .1 S E ~9~r~Y. (Seal) . 'd I . .. . . .. II II . (Seal) . .~r..SP~. P: _ ~Q~<tQ'-f'J;" , , . -0 . -: . . . . . . (Seal) ATTORNEY IN FACT . Adopted April 26, 1979, effective Aug. 1, 1979. n- t-f1) .} 1m I · /WRIL 10 JJJ v - \ J PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY Harrisburg, Pennsylvania POWER OF ATTORNEY Know All Mcn By thesc P.'cscnts, That PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, a corporation of the Commonwealth of Pennsylvania, does hereby make, constitute and appoint JOSEPH G. BUYAKOWSKI, JAMES R. GOULD, ALSON O. WOLCOTT, JR., EDWARD L. JAMES AND CHRISTINA M. HAGGERTY, ALL OF CAMP HILL, PENNSYLVANIA (EACH) its true and lawful Attorney(s)-in-Fact to make, execute, seal and deliver for and on its behalf as surety as its act and deed: ANY AND ALL BONDS AND UNDERTAKINGS PROVIDED THE AMOUNT OF NO ONE BOND OR UNDERTAKING EXCEEDS THE SUM OF TWO MILLION DOLLARS ($2,000,000.00)------------------------------ ------------------------------------------------------------------------------------ ALL POWER AND AUTHORITY HEREBY CONFERRED SHALL HEREBY EXPIRE AND TERMINATE WITHOUT NOTICE AT MIDNIGHT OF THE 31ST DAY OF JULY 2002, AS RESPECTS EXECUTION SUBSEQUENT THERETO. and the execution of such bonds in pursuance of these presents shall be as binding upon said Company as fully and amply, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Company at its office in Harrisburg Pennsylvania, in their own proper persons. TIlis appointment is made by and under the authorization of a resolution adopted by the Board of Directors of the Company on October 24, 1973 at Harrisburg, Pennsylvania, which resolution is shown on the reverse side hereof and is now in full force and effect. In Witncss Whcreof: PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY has caused these presents to be signed and its corporate seal to be affixed on JULY 21, 2000 - " ,"""Y""!'.(.h.~ ;J1":,'; .:..:~;::'tt '. r~ ',." 1 \ :~.., ..~~;/ .,1; /;... ~;"'i:~'~ .'/ PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY By !;~ /:;(;/t?, U,:tfJ - . Kenneth R. Shutts-Secretary Commonwealtil of Pennsy lvania, County of Dauphin - ss: On JUL Y 21, 2000 ' before me appeared Kenneth R. Shutts to me personally known, who being by me duly sworn, did say that he resides in the Commonwealth of Pennsylvania, that he is Secretary of PENNSYL VANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, that he is the individual described in and who executed the preceding instrument, and that the seal affixed on said instrument is the corporate seal of said Company, and that said instrument was signed and sealed 011 behalf of said Company by authority and direction of said Company, and the said officer acknowledged said instrument to be the free act and deed of said Company. :..;\~<'iiJ;" ':;-'" :.:.~:.~:<.~;,:;..,~~~r.~:.:. : O~,'~_~\ (\ ~~'-~~t?~ Public NOTARIAL SEAL CHRIST'NA ENCK, Notary Public Harnsburg, Dauphin County My Commission Expires Jan. 27, 2003 I, Thomas L. Vehar, Vice President, Surety of the PENNSYLVANIA NATIONAL MUTUAL CASUALTY INSURANCE COMPANY, a corporation of the Commonwealth of Pennsylvania, do hereby certify that the above and foregoing is a true and correct copy of a Power of Attorney, executed by the said Company, which is still in full force and effect. i r \:~:~..:2~~::..:;) >. Commonwealth of Pennsylvania, County of Dauphin - ss: In~;~;s IWheren) I have h;;into set my hand and affixed the corporate seal o~ lid- Vice President, Surety IMPORTANT NOTICE: This border must be RED in color. If it is not RED, this is not a certified copy. Telephone us at Area Code 717-255-6870. ~ 78-190(Rev 1/99) s -- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: BETTY O. RABUCK a/kla BETTE O. RABUCK Date of Death: February 28,2001 Will No.: 2001-00372 Admin. No.: To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 5!t'fi)c)( Linda L. Niziolek, Executrix Address Sinclair & Eppley Roads Mechanicsburg, PA 17055 2000 Chestnut St., Camp Hill, PA 17011 2203 Page St., Camp Hill, PA 17011 1111 Stony Brook Way North Brunswick, NJ 08902 68 Ochs Ave., Milltown, NJ 08850 Name Humane Society of Harrisburg Area Trinity Lutheran Church Marion L. Landt Christine E. Niziolek Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: 51, 'O{ () I ~!f14t- Name Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Personal Representative X Counsel for personal repre$entative r-"~ ~ u_ TO Register of Wills Office FROM Cumberland County Courthouse JOHNSON, DUFFIE, STEWART & WEIDNER 1 Courthouse Square Attorneys at Law Carlisle, PA 17013-3387 P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 SUBJECT: Estate of Betty O. Rabuck DATE: May 23,2001 No. 2001-00372 000: February 28,2001 Enclosed is a check in the amount of $8,750.00 as a payment on account of Inheritance Tax for the above-captioned Estate, being made within the 90 days to allow for the 5%) discount. SIGNED: Edmund G. Myers csh ~ .. 1l.. ." ~... ~ . >4, . $ .. .~ \ .. --., ..,_....~ " \ \ \ \ \ ~ ~ z o ~ ~ ~ cS ~ '6 i:-' ~ ~ ~~O'l<- (/)~~O~ \.l.lvr/'}....,.... U ~ ~ ?< <- ~~~O~ a r/).. ~ ~. ~ ~~<oz -1 ~ ~ . z ~....p...~ ';:) 0 p...- o~ ~ z .. >'" z. 0 o ~ r/) ~ z ,.J ~ o -- O'l o .... o , ~ u.l Cf) ::> o ~ ~ u.l::> 00 ). u: 0 u.l r- Ct u.. >- ~ OJ o\-:c(~ ~ Cf) z ::> ch \'\1 .J::> d ~ .JoCf)O \ ~o~r;: ....... u.. 0 ::> <( G o~oo.. ~-3~ui \u.l~~.J ~u.l::>~ - _coo.J ~ <.930~ 'V 'fi!o~o ...., ('.) \.) (.) .~.. (.) ':'" C) r'" .:..1 b---A COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG. PA 17128-0601 ~';";";"';"''-;'''''~_O_''~___ ,. .............,;;;..;;.;. ~.,..,_.. . -'~'C~=='::::-:::::'::'=::-C'::::::':;--==-"_----=-'--:~~::::::'-=:=:" _ PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. AA 496642 REV-1162 EX (11-96) RECEIVED FROM: I , ACN ASSESSMENT CONTROL AMOUNT NUMBER for, V E ::1 c; L ~) f.!ti r-J D C; C, 1 ~;8 t'75(,. <J(~i . , . 3(:" ... ~"lAr~YL T ~:~ T F.~ F~ E~-r .. CJ PO ~ 1 (>9 J, LCr..]U";' f\, E: . F'?'l L '-.7 () '... -::1 FOLD HERE FOLD HERE ESTATE INFORMATION: I FILE NUMBER ..~ .i. "..2(,l() .'" (J _~) rl ~7! ~; fJ N j c;b 1 (.. ,...7:36 c ~ .l .... NAME OF DECEDENT (LAST) (FIRST) (MI) , " PABUCi< UEi J '1 U ~ ',... DATE OF PAYMENT .......~. t:' '2t.+ c:' C) () . .. oJ ... " i- :. POSTMARK DATE .W- e-, / r-: ::J f .' . 1 .... ,_J . .11 J . COUNTY Sf] ~5! ~ ! ~),:) . . L U"'~BE ?t.{'-t1'J:) TOTAL AMOUNT PAID . . I DATE OF DEATH e.r] -, "'::7' c', / ;2C)(J /J '/:' : .:___.i;;;/ c l.. ....' _. ,.",- " ;,! .,/>... _ I /.J' I I r~DA ;\1 T I OLEv /Co!:.;: /f,i_( ~., f2/.i..,./ REMARKS .... - .-- RECEIVED BY ~ /, /{.",I., , ( C /0 f2 [} IV; U !.,,~ [) C3 f ..:.{ t.~ f:;~ 'S C ': (:J "j :''': :::~ ',1{4n 'fl "- ~r C 11! '_. ~:~:"' '~~;".' \; j ,/ . '. ~ .. '/ ,-"", ,...... -:" ~."- ~ I " r" /1 ,"'''! ' U-,[ L". # 1 CH) -~ SEAL REGISTER OF WILLS .., L (, 1 ~,1 Lt..... .r1.I- I. :'" ,.'~/t, / ..I-f / . ..... ,-, ...... '7' <v I _.......~ ../<....:...j~f.r/. ........-t:>..... " //~' ~,-:-~._-".~..-----_.._--.-'- TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 FROM JOHNSON, DUFFIE, STEWART & WEIDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 DATE: August 23,2001 SUBJECT: Estate of Betty O. Rabuck No. 21-01-00372 Enclosed for filing in the above-captioned Estate are the following: 1. Original Inventory 2. Original and copy of Inheritance Tax Return. 3. Check in the amount of $25.00, filing charges. 4. Check in the amount of $1 ,202.42, Inheritance Tax balance. SIGNED: Edmund G. Myers csh ~.- ~~ I I I \ ~ ~ \ {!>N\ '0 -~\ ::;:;l ll/ ~r#' "'" ...... "t~-"- lr"'~" :-g ": } . " ,f, '1 r"l J ,..~"" (.}r-- "'7:'~""" ~~v _ 16 V~ d- 4 t:) a. ~h;i .~ WI' .-' I fA .I u 16 .. .- u. (t. \11 Z o \ii 3 ~ d5 ~ <r" ~3~ ~ ~~'&O\~ 3~~~3 \11 X~ \-\J)~O\J) rj) ~ 'J. tn Z ~zt!6; w t! 4. ~ _o~o:.o.. \1.. r <r" ui \.1.. \; 0 Z ::> ~ tt) ~ o ~ i '1 o \fl Z 't. o .., ..,-....,............ ~ P rJJ ? o ~::: ub' r- r-\ cG cf) \.1-1? ('1l \.1-10 ('1l ou'Cl-1\ cG('1l tf)~.c:,-I ~b'?O ~zar- r-\oiJJ,-I ~8N4'. \.1-1 iJJP-I op? Z 0 ~ ~4'.:r:~ ~~b'~ b'cGcGcfl tf)~?1-I r-\COO~ t?~U~ ~? 4'. ~u~c.J .. -~."..... -:-- II') \, .... i,t \\\\ ,- (t j \t. ,t t~ ,.. 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 MYERS EDMUND G 301 MARKET STREET POBOX 109 LEMOYNE, PA 17043 -------- fold EST A TE INFORMATION: SSN: 196-14-7361 FILE NUMBER: 21-2001- 0372 DECEDENT NAME: RABUCK BETTY 0 DATE OF PAYMENT: 08/24/2001 POSTMARK DATE: 08/23/2001 COUNTY: CUMBERLAND DATE OF DEATH: 02/28/2001 NO. CD 000196 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,202.42 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: LINDA L NIZIOLEK EDMUND G MYERS ESQUIRE CHECK#1026 SEAL INITIALS: PB RECEIVED BY: $1,202.42 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS 'STATE OF NEW JERSEY COUNTY' OF } ss: LINDA L. NIZIOLEK being duly sworn is Executrix according to law, deposes and says thaT sne of the Estate of Betty O. Rabuck a/k/a Bette 0,. Rabl,lck late of Camp Hill Borough . I Cumberland County, Pa., deceased and that the 'th" . t d b Linda L. Niziolek the 'sa.d Executrix W I In I san 1 nv en ory m a e y '. - ,I of the e~tire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. (2"J^,id f. (q, 0 ; ~:1 ~;K~~ai! ~ otary PubllC ~.'Yl'Y\;~ 'Iun er- (I res 40,:1' 2'5,2. 0 02 2001 ~!.:[;.~)~ Llnda L. lZlole, xecutrlx 68 Ochs Avenue Sworn to and subscribed before me, j('-1 Milltown, NJ 08850 Address Date of Death 28th February Month 2001 Day rur INSTRUCTIONS r. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of dis<;overy of additional assets. 3. Additional sheets may be. attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. M o:;t' 0 r--.. ....-l ..:x: CO ..c: P-l ......... tn N ~ ::s -d t' >- ......... 0 ~ <l> M I- W CO 14 WI . c: 0:: I- 0 ra 01 :>; 0 ~ w ;:; ~ ~. CO CI) en 0 0 a.. lJ 0 UU ~. CD w >06 I 0 W V) ,::J ~ r-f 0 C"I ,....j ~ W IQ CD (l) 0 }- :r: a.. u.COCO r-f 0. cl-.::! I- ...J .r-! en .. I Z O..:x:..:x: ra 0 r-f U. ...J <( 0::0:: ~ c... 14' ~O'\ UJ <( UJ N 0 c::: >. <l> <!o > Z . . P-t - :>; .Z 0 00 E c ~ ....-l 0 ::r ci V') Z CO 0 ~ <( ~w u U ~ . >< Z l.U E-lE-t (.9. 0 Co. '"0 E-tE-t c CO ~~ ra ro COCO ...... I: c: .. 0 ~ ::s 0 ...0 CI) E '"0 ..loC 6 0+- CD 0 ro ~ ::r 0 ...J U u: c:Q W P-l lnventory of the real and personal estate of BETTY O. RABUCK a/k/a BETTE O. RABUCK 1. Real Estate - No. 2006 Harvard Avenue, Borough of Camp Hill, Cumberland County, PA Sale Price 2. $25.00 Series E Bond dated 9/1974 3. $100.00 Series E Bond dated 12/1975 4. $25.00 Series E Bond dated 12/1971 5. $25.00 Series E Bond dated 8/1972 6. $25.00 Series E Bond dated 8/1972 7. $25.00 Series E Bond dated 8/1971 8. 1984 Bu~ck Regal - appraised value 9. 1,172.920 Shares - Lutheran Brotherhood High Yield Fund-A @ $6.39 per share 10. Blue Cross/Blue Shield - premium refund 11. Continental Casualty Company - premium refunq 12. Waypoint Bank - balances, plus interest: Certificate No. 400002020 Certificate No. 400002040 Certificate No. 400002127 Certificate No. 461300135 Certificate No. 461300170 Certificate No. 461313748 Certificate No. 461313754 Certificate No. 461316829 Certificate No. 463273773 Certificate No. 465313705 13. 460 Shares - Waypoint Financial Corp. @ $9.906250 per share TOTAL deceased ~~- 115,700 00 110 97 442 16 119 05 119 87 119 87 1-21 91 1,800 00 8,133 96 158 45 328 68 10,043 05 17,998 88 5,638 69 10,026 66 2,464 10 10,043 05 7,033 14 5,021 16 13,550 33 10,414 14 4,556 88 223,945 00 I 1 'v /C -0:2c:23. 7 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-22-2001 RABUCK 02-28-2001 21 01-0372 CUMBERLAND 101 EDMUND G MVERS ESQ JOHNSON ETAL PO BOX 109 LEMOVNE PA 17043 * REY-1547 EX AFP el2-00> BETTE o Allount Rellitted CHANGED (1) (2) (3) (4) (5) ( &) (7) 115,700.00 15,327.07 .00 .00 94,520.33 9,943.43 10,391.64 (8) 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 ~ R'fV'=is47-EX-AFP--fi'2-:0(ir-NCificE--OF-YNHEifiTANci-i'-Aic-A-PPRA-isEi'-ENT~--Aii-oWAiici-[fR------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RABUCK BETTE 0 FILE NO. 21 01-0372 ACN 101 DATE 10-22-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage 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 NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: IS. Amount of Line 14 at Spousal rate (lS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: (9) nO) 20,259.57 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 245,,882.47 21 n4n 47 224,,842.00 10,,335.23 214,506.77 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 9,,196.72 1,216.23 .00 10,,412.95 PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 05-23-2001 AA496642 460.53 8,,750.00 08-23-2001 CDOOO196 .00 1,,202.42 TOTAL TAX CREDIT 10,,412.95 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 780.90 nl) (12) (13) (14) .00 X 00 = 204,371.54 X 045 = 10,,135.23 X 12 = .00 X 15 = (19)= . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION Of ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1" NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)" YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~i/ PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: BETTY O. RABUCK a/kla BETTE O. RABUCK Date of Death: February 28. 2001 Will No.: 2001-00372 (21-01-00372) Admin No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete:. 3. If the answer to NO.1 is yes, state the following: A. Did the personal representative file a final account with the Court? Yes No ~ B. The separate Orphans' Court No. (if any) for the personal representative's account is:. Did the personal representative state an account informally to the parties in interest? Yes ~ No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~{jJ~ Signature Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemovne. PA 17043-0109 Address 'j...';' C. D. Date: g//(p/02-- (717) 761-4540 Telephone No. Capacity: Personal Representative ~ Counsel for Personal Representative REV.l~EX(t;..QOi'" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 , fo^<V.3~ 7 REV-1500 OFF!CIAL llSE ONLY w .., ):::$cn " ,n" w"" ",00 ,,"'" ..co .. " FILE NUMBER 2 1 _ 0 1 0 0 3 7 2 INHERITANCE TAX RETURN RESIDENT DECEDENT YEAR NUMBER COUNTY CODE I- Z W C W U W C DECEDENTS NAME (LAST. FIRST, AND MIDDLE INITIAL) RABUCK, BETTY O. a/k/a SOCIAL SECURITY NUMBER 196 14 7361 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DD-YEAR) February 28, 2001 September 6, 1922 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) [!l1. Original Return o 4. Limited Estate [Xl 6. Decedent Died Testate (Altach copy 01 Will) o 9. Litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (dale 01 death aller 12-12-82) D 7. Decedent Maintained a Living Trust(AltachcopyofTrust) o 10. Spousal Poverty Credit (daleofdealhbelween 12-31-91 end 1.1-9S) o 3. Remainder Return (dale ofdealh prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (AtlachSch0) >- z w c z o .. '" w " " o " ,;t;!-II$;~E;(;TIQ:l'Jt;I.1.I~j,~g~Q"'ei:!1;rl!P;:~J,;t!(;OR~ES~9,NPEj;/qI!:5.NEI'..(;9NFjI!E~:ti~J,;~t,.' .;Il'!fQ.6",~t(litN'$Hpot;p;llE;PI~E;c;:tl;Iil;to; NAME COMPLETE MAILING ADDRESS Edmund G. Myers, Esq. 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 FIRM NAME IIf""""'"1 Johnson D TELEPHONE NUMBER ffi (717) 761-4540 (1) (2) (3) (4) (5) 115,700.00 15,327.07 OFFICIAL USE ONLY z o ~ => l- ii: c:( u W 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule 8) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Une 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Scl1edule J) (11) 21,040.47 (12) 224,842.00 (13) 10,335.23 (14) 214,506.77 x.O_ (15) -O- x .04..5.... (16) 9,196.72 x .12 (17) 1,216.23 x .15 (18) -0- (19) 10,412.95 94,520.33 (6) 9,943.43 (7) 10,391.64 245,882.47 (9) (10) 14. Net Value Subject to Tax (Line 12 minus Una 13) z o ~ I-' => a.. == o u X ~ SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 204,371.54 10,135.23 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.0 1 . .,'. .., ,.., ,,1,..''''',1:,::*: ,::>~BE,SU,RE.:rQ ll-NsWER ALL aUEstlo,NS ONREVElj.$ESjI!lE AND,RECflECK MATH <<c:', ,.;' ,.'" . ~". " Decedent's Complete Address: , STREET ADDRESS 2006 Harvard Avenue CITY CamD Hill I STATE I ZIP PA 17011 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A, Spousal Poverty Credit 8, Prior Payments C, Discount (1) 8,750.00 460.53 Total Credits (A + 8 + C ) (2) 9,210.53 3, InteresUPenalty If applicable 0, Interest E, Penalty -0- TotallnteresUPenalty ( 0 + E ) (3) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAVMENT. 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) 10.412.95 A, Enter the interest on the tax due, (SA) 1.202.42 -0- 8, Enter the total of Line 5 + 5A. This is the 6ALANCE DUE. (56) 1 . 202 . 42 Make Check Payable to: REGISTER OF WILLS, AGENT ijj'~lllt~~~~~~\\f~~r;_~,iij~lf.~"~~~~_~_ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Did decedent make a transfer and: Ves a, retain the use or income of the property transferred;""""""..."""""".""""""""""""""""""""""""",..."""" D b, retain the right to designate who shall use the property transferred or its income; """"""""".".""""""""""" D c, retain a reversionary interest; or""""""""""""""""""""""""".".""""""""""""""""""""""""""",,,,,,...,,,,, D d. receive the promise for life of either payments, benefits or care? ..............................................................."..... 0 2, If death occurred after December 12, 1982, did decedent transfer property within one year of death withou1 receiving adequate consideration? """"""...""""."""""""""",:"""""""""""""""""""""""""""""".", D 3, Did decedent own an 'in trustfo~ or payable upon death bank account or security at his or her death? """"""" D 4, Did decedent own an Individuai Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? """""",,,,,,,,,,,,,,,,,,,...,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,...,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,",,""'"'' [Xj No ~ IXI ~ [ZJ Under penaJUes of perjUlY, ! dadars that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and benef, it is true, correct and complete. Declaration of preparer other than the personal representative is based on an information of which pre parer has any knowledge. SIGNATLRE OF PE~S9N R~SPONSIBL FO LING ETURN DATE I d.LL . CUI ' ADDRESS L nda L. Niziole Executrlx 68 Ochs Avenue, Milltown, New Jersey 08850 SiGNATURE OF PREPA HER THAN REPRESENTATIVE ADDRESS Edmund G. Myers, Es q, 301 Market St.. p, O. Box 109. Lemovne. PA 17043-0109 ~1~~~1,~J1Jt~.r.];'{E~~~~~~~~~~~m~~~~~~~~~~~~_~M~~:~i: For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P,S, ~9116 (a) (1,1) (i)], 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)), The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the survMng 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 slepparent of the child is 0% [72 P,S, ~9116(a)(1 ,2)J, 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, 29116(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, R~lSll28f~11.9n' *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RABUCK', BETTY O. a/k/a FilE NUMBER RABUCK, BETTE O. 21-01-00372 All real property owned solely or as a tenant in common must be reported at fair mar1<et value. Fair market value is defined 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 facts. Real property which is jointly-owned with right of survivorshio must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Real Estate No. 2006 Harvard Avenue, Borough of Camp Hill, Cumberland County, Pennsylvania. (Deed Book A, Volume 22, Page 118) Sale Price $115,700.00 (Copy of Settlement Statement attached). TOTAL (AlsDenterDn line 1, Recapitulation) $ 115.700.00 (If more space is needed, insert additional sheets of the same size) A. Settlement Statement U.S. Oepartmllnt or Houslll!l i1ndUrbanDeve\opmenl~ ,r 'I' OMS NI;l. 2502-0265 B. Type of Loan ,. 0 FHA ~. 0 FmHA 4. 0 VA 5. 0 Cony. Ins. C. NOTE:This form Is furnished to give you a statement of actual settlement costs. Amounts paid to and by the setdemenl agent are shown. Items marked "P.o.c" were paid outside of closing; they are shown here for informaUonal purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: PAUL F. ZANGER JOANNE D. ZANGER ,PA ,PA UNDA L NIZiOLEK. EXECUTRIX ,PA opnON ONe MORtGAGE ,PA 3. t8l Cony. Unins Fil&Nllmber 23879 Mortgage Insurance Case Number Loan Number 151010885 E. NAME AND ADDRESS OF SEllER: F. NAME AND ADDRESS OF lENDER: G. PROPERTY LOCATION: 2006 HARVARD AVENUE CAMP HILL. PA 17011 H. SETTLEMENT AGENT: PLACE OF SETTLEMENT: TIN; CEDAR CUFF ABSTRACT AGENCY, INC. 414 Bridge Street, New Cumberland, PA 17070 23-213316$ , , , , I. SETTlEMENT DATE: 0612912001 RESCISSION DATE: J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SEL ER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101.Conlm:tSalesPrb Stt!L7oo.00 401. ContractSaIllsPrit:e $115 700.00 102. Personal Property <402. Personal property 103.SeItlementachargras1oborrower: 403. (Jromllne1<4Q0) $4,915.27 104. '04. "5. <<>5 ADJUSTMENTS FOR ITE.MS PAtD BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: 10B.C~lkwtntaxel 10 .fOLl.CilyItownTiU:es \0 107.County'TllltelJ 06/29/2001 10 12/31/2001 $2.<8.78 407. County Taxes 06/29/2001 \0 ~2/31/2001 $228.78 1GB, Asaeum8nt. 06/29/200J. 10 06/30/2001 $6.70 40B. As$essmenb 06/29/2001 10 06/30/2001 $6.70 109. 409. 110. 410. 111- 411. 1" 412. 120. GROSS AMOUNT DUE FROM BORROWER: $120,850.15 420. GROSS AMOUNT DUE TO SELLER: $115,935.48 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTiONS IN AMOUNT DUe TO SELLER: 201. Deposit or eamelt money $1,000.00 S01. Excess deposit (see Instructions) 202. Princlpe! amountor new 1000n(s) $109,915.00 502. Setllemenltharges to aeller (Mne 1400) $1,161.00 203. Exlstlngloan{s} laken subjecl.lo 503. Exf$Ung Ioan(lj IlIf;en sulI/edlo 204. 504. PilIyoll"ollll'lll mortgaoe loan 205. S05. Payoll" of setond mortgage loan 206. 506. 207. S07. 20B. S08. 209. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210.Cllyftownlillxell 10 510.Cily/loWnlaKeS 10 211. County taxel 10 511. Countj"laxes 10 212.Asseumenls 10 512.Assessments 10 213. 513. 214. 514. 215. 515. 218. 518. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID 8YfFOR $110,915.00 520. TOTAL REDUCTIONS $1,161.()(J BORRO'YVER: IN AMOUNT DUE TO SELLER: 300. CASH AT SETTLEMENT FRQMITO BORROWER 600. CASH AT SEmEMENT TO/FROM SELLER I 301. Gross amount due from borrower (line 120) $120,850.15 601. Gross amount due to seller (line 420) $I15,~:iI.lL4B 302. Less .matln! paid byltor borrower (Ilne 220) $JI0,915.00 802. Less reductions in amf. due sel1er (lIne 520) $1,161.00 303. CASH ( ~FROM ) ( DTO) BORROWER: $9,935.7S 603. CASH ( DFROM) ( ~TO) SELLER: $114,774.1.(8 1 I o 8 8, n wi HUD-1 (3-86)- RESPA, HB 4305,2 w ~ PAGE 1 t(Q)~Y I, HUO_l(R9V.3I!I6) L 7~. TOTAL SALES/BROKER'S COMMtsSlON BASEOO~PRfCE OMB1'lo, 2~02-o265 SETTLEMENT CHARGES $11.5,700.00 0 PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S FUNDS AT SETTLEMENT DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: ,. " " 101. 702. 103.COlnm;u;o.,paldel..llklm",,1 "" BOLl IIt:M:S /-'AYAHU:. IN c.;UNNt:c.;IIUN VVIIH LUAN. 8Il1,l......"";glruwon'.. , .. Ol''l'ION Om: MOR'l'GAGE B02.lo.ndIJCO<.rll , .. Oi''l'ION om; HOIU'(;AGI: H03.ApIltlIisalfHIo; .Pnw ASSOCIA7'ES $275.00 804,CrtldIlr.portlo: OP'l'.tON ma: MOR~ t!05.landef...opecllCH1fH OP'l':tON OHB HOR~ 806.~........_apll\\cat"""f_\oOFnON 0HE.MaRTGAGE' H07.AI......pl'-lee A. c. A. Ht::UU"GAGI: SERVICES, mc. $1,000.00 808. 2:'AX SERV:tCB CONmAC'1' OPTION 0Nz: $70.00 1109. nJNVING FEE :ro OP'J!ION om: $SO.OO 810, f./NIl.IlRIOUT1"NG lEE OPTlON ON& $515.00 Bll. FLOOD SEA1lCH nB: ro Ol''l''ION om:: $12.00 1lO1.lf1lef.,lfrof\1 O~ 00' .. 07 0' 2 0' .. 26,26'II.y 52.52 lI02. Mortgeg"lf!I:ur.-a premium for moa.1o lI03.HII>.ar<l.~pr.vn'unIQt "'.. 904,FlOodinlur.tntefW8mIUm'''' 'if1.1<> ..,. 1001.Hazard..,turan:>I "'''''IhIQ parmontll 1002.MorlIl~~ mc>r1IhlO ...-. l003,Cily~ropertylalc" ...... parmon\h 100t.Cwnl)rpn>pertylu... -." ...m'" 10C6.I\rnJlIl.I_lmanll _... parmonlh 100l!i.Floodln&uran<ol m...... pernl""lI\ 1001. -.... ...m... '''". monllll@ parmonlh "'''. Aggregate Accounting Escrow Adjustment 1101,SIIII_nlorcblnaf...IoCedar CJ.J.t:f Ab.ll"trllot Agt'D IDCI. 1102.AbItre<:torllllel..-d11o 1103.nla"...Il""Iic:N1lo 1104.T....In""""""bhloIrl" 1105. D<>a.manf IlflIpnt;onlo 1106,Nolar\lf_'o CASH $15.00 $4.00 1107. AIIomayl'ee. to STONE urA~ " SHmCLETSKI $225.00 [onducf..lbovaham.Numbart. ) 1108.TIIl........arulD """'" aur ABSnaCT AGENcr, rRC. $g08.15 (indlJd". OIbove hame Num~ :rI'1'LIIl INSURANCS ONLY ) 1109.lender'.oo__ae ( $109, !l1S. 00 ) 1110.Ownar'e<::lWWll ( $1.15,700.00 I 1111.J:ND, 300, 100, &.1 $150.001 1112. INSfJRED c.LCSING 1oE'l"'rER $35.00 1113 I 10!OU uVVI:.KNMJ:;NI Kt:t;UKU'Nl.::iAND IKI\N~,...t:KL:HAKl.::it:::; 1201_Rec<>rdirogl...' "'"" 2 .50 ;MorIQIta. 45. 0 ;R.IlllI.... 15,00 1202.Cty/<lGuNyWJ~: 0.., $2,314.00 Mortgea. $1,1'7.00 $1,157,00 1203. SlltetllXlttempl: """ ;Mllrf08a. "'" ,,,,. 1301. s....ay k> 1302.PNlnopadiclnlo 1303. SUI rED EX FSE $20.00 ''''. GLOBEL aw,," $218.00 ",. COLI.EC7ZCH IRe. $137.00 "'" 1307. 1400. l'OTAl SETTLEMENT CHARGES $4,915.27 $1,1.61.00 I have ~lty ~ \he HUD-1 Settlemenl SlBtemenl Bnd 10 thB best of rtrf knowledge and tlellBr, II Is, InJB and accurate llalemenlof all ~p\$ ar.d dilbUrsemenll made onmy.ccounlOf me In Ihll lransacllon. 'furtharOlHtif'lUl&tII\aV1l~acopyorIhIHUD.1 SettfemenlSlalerrulnl. _c. D..~=t"~ &.KlJ LINDA L. NIZIOLEK, EXECUTRIX /<,r S",,~ Dille: fc!/...l!it1lL Agent Date: bhr~tl Date: "The HUD-1 SeIIlefTIIlrn Slat8ment Whlcll I have prepated Is a IruB and .ceurele ICCOUfII of ltIil lransac:lion. wlltllhls llalameol Date: Set\leme<'ltAgent . ~G"ti . WARNING: 1111. c:rime 10 kllO>H~ ITl;Ike fals8 slatements to lhe United Slates on ll1il U( any other sImilar form. ......,..;; es upon I118nl For delalls see: TIlle lEI U.S. Code Slcllon 1001 andsecticn 1tUO. D.~ hqrV' I ' vJctloncan lnciudtletIDealldlmpr\sPn- II ~.'~M~. COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RABUCK, RABUCK, SCHEDULE B STOCKS & BONDS BETTY O. a/k/a BETTE O. FILE NUMBER 21-01-00372 All property jolntly-owned with rlght of survivorship must be disclosed on Schedulo F. ITEM NUMBER 1. 2. 3. 4. 5. 6. DESCRIPTION $25.00 Series E Bond dated 9/1974 $100.00 Series E Bond dated 12/1975 $25.00 Series E Bond dated 12/1971 $25.00 Series E Bond dated 8/1972 $25.00 Series E Bond dated 8/1972 $25.00 Series E Bond dated 8/1971 7 . 1,272.920 Shares - Lutheran Brotherhood High Yield Fund A @ $6.39 per share 8. 460 Shares - Waypoint Financial Corp. @ $9.90625 per share 9 . $25.00 Series E Bond dated 9/1973 - Decedent or Christina E. Niziolek, granddaughter .S100.00 Series E Bond dated 9/1974 - Decedent or Linda L. Niziolek, daughter $100.00 Series E Bond dated 1/1974 - Decedent or Linda L. Niziolek, daughter S500.00 Series EE Bond dated 3/1991 - Decedent or Christina E. Niziolek, granddaughter S100.00 Series EE Bond dated 1/1984 - Decedent or Linda L. Niziolek, daughter 10. 11. 12. 13. VALUE AT DATE OF DEATH 110.97 442.16 119.05 119.87 119.87 121. 91 8,133.96 4,556.88 118.56 443.88 456.36 438.40 145.20 . 15.327.07 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of Ihe same size) .....,.."'."..". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RABUCK, BETTY O. RABUCK, BETTE O. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY a/k/a FILE NUMBER 21-01-00372 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1984 Buick Regal - appraised value L 800.00 2. Waypoint Bank - balances, plus interest: Certificate No. 400002020 Certificate No. 400002040 Certificate No. 400002127 Certificate No. 461300135 Certificate No. 461300170 Certificate No. 461313748 Certificate No. 461313754 Certificate No. 461316829 Certificate No. 463273773 Certificate No. 465313705 10.043.05 17.998.88 5.638.69 10,026.66 2,464.10 10,043.05 7,033.14 5.021.16 13,550.33 10,414.14 3. Blue Cross/Blue Shield - premium refund 158.45 4 . Continental Casualty Company - premium refund 328.68 TOTAL (Also enlefOl1 lineS, Recapitulation) $ 94.520.33 (If more space is needed, insert additional sheels of the same size) REV.150SEX.(1.S7) ,. SCHEDULE F JOINTL Y.OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RABUCK, BETTY O. a/k/a RABUCK, BETTE O. FILE NUMBER 21-01-00372 If an asset was made joint within one year of the decedent', date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(Sj NAME ADDRESS RELATIONSHIP TO DECEDENT A Linda L. Niziolek 68 Ochs Avenue Milltown, NJ 08850 Daughter B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOtNT MADE Include name of financiallnstitution and bank account number or similar identifying number. Attach DATE OF DEAH-l DECO'S VALUE OF NUMBER TENANT JOINT deedfot}oinUy-held real estate. VALUE OF ASSET JNTEREST DECEDENT'S INTEREST 1. A. MJre Allfirst Bank - Checking Account fun 2 No. 00701-0816-1 ',<RB date of death balance 1,849.46 50% 924.73 2 A " Allfirst Bank - Money Fund Alternative Account No. 00982-1663- date of death balance, plus interes 18,037.40 50% 9,018.70 TOTAL (Also enter on line 6, Recapitulation) $ 9,943.43 (If more space is needed, insert additional sheets of the same size) R""'~EX.,'~n. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF RABUCK, BETTY O. a/k/a RABUCK, BETTE O. FilE NUMBER 21-01-00372 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM lNCLLJDETHE NAME OF THETRANSFEREE,THEIRRELATIONSHIPTODECEDENTA NO THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE flnACH A COPV OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IFAPPLICABL-E'" NUMBER 1. Waypoint Bank Individual - Retirement Account Account No. 123003324 10,391.64 10,391.6 Beneficiary: Linda L. Niziolek, Daughter TOTAL (Also enter on line 7, Recapitulation) $ 10,391.64 4 (If more space is needed, insert additional sheets of the same size) "".."""'."..,,.. COMMONWEALTH OF PENNSYLVANIA INHERlTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF RABUCK, BETTY O. a/k/a RABUCK, BETTE O. Debts of decedent must be reported on Schedule J. FILE NUMBER 21-01-00372 ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. Myers-Harner Funeral Home 7,212.00 2. Rolling Green Cemetery - grave opening/closing 760.00 3. Linda Niziolek - reimbursement for funeral lunch 250.00 B. ADMINISTRATIVE COSTS: 1- Personal Representative's Commissions Name of Pelllonal Rep....ntatlve (s) Linda L. Niziolek Social Setunty Numbe~s) I EIN Number of Pelllonal Repreaentative(s) 1,000.00 Street Address 68 Ochs Avenue City Mi11town, NJ 0885~te Zip Yea~s) Commission Paid: 2001 2. Atlomey Fees - Johnson, Duffie, Stewart & Weidner 6,500.00 3. Family Exemption: (If decadenls address Is not the same as dalmanls, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of wills - Cumberland County 270.00 - 5. Accountanfs Fees 6. Tax Retum Prepare;s Fees 7. Insurance & Surety, Inc. - Fiduciary Bond Premium 885.00 8. Cumberland Law JOurnal - advertise letters 75.00 9. The Patriot-News - advertise letters 93.81 10. Register of wills - file Inv. & Inheritance Tax Ret. 25.00 II. Barbara Coble Abstracting - Search - 2006 Harvard Ave 40.00 12. Recorder of Deeds - 1% transfer tax 1,157.00 13. Notary Fees - real estate settlement 4.00 14. Anne M. Ramsey, Tax Collector - 2001 County/ Borough real estate taxes 444.29 Total. from Continuation Sheet 1,543.47 TOTAL (AlsD enter on line 9, Recapitulation) $ 20,259.57 (If more space is needed, insert additional sheets of the same size) SCHEDULE H - CONTINUED Estate of: RABUCK, BETTY O. a1k1a RABUCK, BETTE O. 21-01-00372 15. Verizon - telephone charges 16. Comeast Cable - final charges 17. Walter Pond -lawn maintenance 18. PA American Water Co. - water service 19. PP&L - electric service 20. York Disposal - trash service 21. AT&T - telephone charges 22. UGI - gas service 23. Borough of Camp Hill - sewer charges 24. Allstate - homeowner's insurance 25. Linda Niziolek - reimbursement for charges to remove root from sewer line 26. Allfirst Bank - charge for Estate checks 27. Walter Pond - service/parts - repair tail pipe- decedent's automobile 28. Reserve for close-out costs Total 60.36 14.50 180.00 60.52 80.42 51.84 44.20 468.22 60.00 23.62 125.00 8.50 191.29 175.00 $ 1,543.47 " REv.IS12EX~I'-91) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT OECEDENT ESTATE OF RABUCK, 'RABUCK, SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS BETTY O. a/k/a BETTE O. FILE NUMBER 21-01-00372 Include unreimbursed medical expanses. ITEM . NUMBER 1. DESCRIPTION . AMOUNT Internal Revenue Service - tax due on decedent's Form 1040A for 2000 125.00 2. FA Department of Revenue - tax due on decedent's FA 40 - 2000 61. 00 3. Anne M. Ramsey, Tax Collector - decedent's personal taxes 4.90 4. Jean Shettel - final nursing charges 590.00 . 780.90 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, Insert additional sheels of the same size) REV"51JEX.(1..g7)~_ ..~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER 1. SCHEDULE J BENEFICIARIES RABUCK, BETTY O. a/k/a RABUCK, BEITE O. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) - FILE NUMBER 21-01-00372 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1. Marion L. Landt 2203 Page Street Camp Hill, PA 17011 Sister 5% Residue 2 . Christina E. Niziolek 1111 Stony Brook Way North Brunswick, NJ 08902 Linda L. Niziolek 68 Ochs Avenue Milltown, NJ 08850 10% Residue Granddaughter 3. Daughter 80% Residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON liNES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE 1. B. CHARiTABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Humane Society of Harrisburg Area Sinclair & Eppley Roads, Mechanicsburg, PA 17055 200.00 2. Trinity Lutheran Church 2000 Chestnut st., Camp Hill, PA 17011 5% Residue TOTAL OF PART n. 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)