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Home My WebLink About01-0495 Estate of R\'(\~().rr\ fY'\ I (If)t;) \lL also known as PETITION FOR PROBATE and GRANT OF LETTERS ~/-o ( -L.{ q I) No. To: Register of Wills for the County of ('.ur"r\~e..r \~0\ in the Commonwealth of Pennsylvania . Deceased. Social Security No. ~Oy - 0--3 - 6q5 ~ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated ,T~nlM.Lt'd Ii? and codicil(s) dated r-e.bV'L\.C&.'::1 lto, aDO \ named , l)J' JlI:1!l (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in (Y\c;C\cr).L \' uJp. ,~r~b~(\d:ounty, Pennsylvania, with hi":) last family or Prin~-?a~residence at I y 5.1 t _cx:X.1.:L\.f:' ~..c..dJsw \>r\\ \"L. \ r~:n\\j~ ~pn~'"Q.. \7007 l '(y}\[)'Y) '( , . () (list street, number and muncipality) Decendent, then '11o at \ ~53 \. 13<.>\\\ . :'). Except as follows, decedent did not marry, as not i:livorced 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 sit*ted j..s follows: Ie;S3 Gu:Jdey.r ~w ~J-"v~ I ~~,. PA. /7~()7 $ $ $ $ .,j?:> / t/1/t:7. 00 &/brll ~ri"lc ~h...lurk~~ d2 0, f)()() . DO WHEREFORE, petitioner(s} respectfully request{s) the probate of the last will and codicil(s) presented herewith and the grant of letters f€.'"';)fc rr-.u,,~..rJ (testamentary; a minIstratIon c.La.; admlOlstratIOn d.b.n.c.t.a.) theron. Vl or ~'C> ~~ d. ~ ~ ~ 'P It Tit. I Co t II- Co t3 t.,;' -g.g So 7 "'. {.t!'WIt; ~IGY IZoIH) ~ ';:; Il'tGC#lA-NICSAu.fl 0-, P"i /70S-S- 601 ~ 3~ v,- :; 0 ~ c eo iJi OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF CUIY\r'?>~LA-^,D J The petitioner{s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner{s) and that as personal represen- tative{s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~~~ ~ ~. :::s l::l ..... ~ ~ ~ Mary C. ewis It, -v2j'/~ C3 ~o. 21-2001-495 Estate of Richard M. Coble , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW May 21st, x~ 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 Codicil May 16th,2001, Will, January 18th, 1974 described therein be admitted to probate and filed of record as the last will of Richard M. Coble Testamentary Patricia J. Coble and Letters are hereby granted to 115.00 Probate, Letters, Etc. ......... $ Short Certificates( 5) . . . . . . . . .. $ 15. 00 Ren:u.nciatio,n ................ $ CoCIlCli .,.., lU. ~u x-Pages (6) $ 18 00 JCP TOTAL _ $ 5.00 Filed .. .May;21st.,.2001. . . . . . $ .163..50 . . Register of Wills Mary c. Lewis ~ &'~4~ n A TIORNEY (Sup. Ct. LO. No.) 38'S- / S I.: 1-11+ P- {., ~ oS e:: SIi 1~l>.5 21r 6 CL()li's;l:7( ;e.})." /I1l!:l3HA-/VICSB/t/C6- ADDRESS ~/f 17os$"' 7/7- 7~~ -o2?-CJ1 PHONE FEES MAILED LETTERS 'TO ATIORNEY 21-2001-495 REGISTER OF WILLS OF C LlIY\ 6ec LII-AJ]) COUNTY OATH OF SUBSCRIBING WITNESS :r tGo13EI2T S77/LlFF!:::7? fh.II codicil of /" fi!.h. Ul? I ~) a subscribing witness to the will presented herewith, (~being duly qualified according to law, depose(s) and say(s) that he WtlS present and saw /? /CIfA-/<j) /PI. &~L-E the testatif , sign the same and that he signed as a witness at the request of testat~ in hi...L- presence and (in the presence of each other) (in the presence of the :::::::S::i::;i:~~:n:~~ C:~~scribed before ' ~/0:, me this .I 71h day of>J. /206El2T -fl:ft:;;. ,r/-200/ }. /I1llrke/ ~ -~[i)//~ Notarial S_! Charles E. Shields III. f\lh,,\r.. ~\.j13lie Monroe Twp., CUmbtrla: Ie cQI:::lf1tv My Commission &PI,., Aim;, ?n ~{}04 Member, pennsylVanllAuocfIiOO"€fff fle~ R~istei '()~y (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of codicil testat_ of (one of the subscribing witnesses to) the will presented herewith and codicil that believes the signature on the will is in the handwriting of to the best of knowledge and belief. Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) 21-2001-495 REGISTER OF WILLS OF CulitlJelCUfN.D COUNTY OATH OF NON-SUBSCRIBING WITNESS ~/lr~/CK /I.. &ASL~ ~ a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he iJ familiar with the signature of Rlc}//J.eP m. ~t3LE CtAAd codicil of 110 Feb. 2001 testat~ of (ARP nf th"" 'i" l,1l~ril?iRg Ulitnpl;:l;:pc t.il the will presented herewith and codicil that he believes the signature on the will is in the handwriting of (ZI cHIII2J) m. CoaLE to the best of h .'~ knowledge and belief. ~~/O~. ~ PIf-r~I~K A . (!o/j~Name) ,Sl:? 7 A/, L.ewI.skr,y /(~ lJ!eelutn/~sju7J (Address) j?/I- / 7DS~- -61)/9' (Name) (Address) 1 11 i<. is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as lo,:.d Registrar. The original certificate will be forwarded to the State Vita] Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. & 11"/111/"'/// .t,,'lf~\.\" OF fl--"-, ,l'\~~~/~~'4';--:'___ ~,~ ~--- ~~_f'~~ ~~ ~ .~ \'?~ ~ ~(r .. 'Z~ ,c:::::>> -.... ~<-' tr~ ,b.~ ~ 'j.:f. ~ \\*~ - ~'?';*f ---~\. /.....~,\' ...~ /~\\ "'-"'---~~-~{~\,~,/ ----'_/" ENl \\\ 111,,1.1 ""J/NNJlJIIJIJ \ ~~fk Local eglsrrar l~tfJ Fee for this cerriflcate, $2.00 P 7386440 111 Ii I ,~oo i Date 21-2001-495 H 10S ;43 Aew 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH ,VPE/PRINT IN PERMANENT BLACK INK AGE (L." EIo<1M.vl UNDER I VEAR Monoho D.,. UNllE R I DJIt SEX 1. STAtE FilE NUMBE.R SOCIAl. SECURITY NUMBER Richard M. Coble Male 3. 204 03 - 0952 DAlE Of DEATH .MCtlVl. Da,. ......, a. May 11, 2001 NAME Of DECEDENT If"". ModOIe.Laa, 76 Yr. - l Minu... BIRTHPUcE Ie.'; .r.d Stale 01 fCl8qn COtJflUV) PlACE OF DfATH 4Ct>ecil ~V ONt -- ietI '1l511U(;I.ort:J on Ulhel ~i HOSPITAl: Inp....nt [J EfllQulpallont 0 .... Ion gIve 501. eet anO numbell g'::"YIO 5. COON TV Of llEAlH RACE. Amancan InelI.". Black. Wl\ll.. aU: I~) Cumberland 10. White 110. 1" FIlJHER'S NAME IF.sr. Mo<l<Ia. L.SI) 17b. Coun Clod -- w...... Cumberland -",? l7d.O :""-='=01 MOTHER'S NAME ,foOl. ModOle. Maldon Suon""",) MARITAL STIlJUS . M...1OCl Nev., ....arried. WIdDwed. ~cecl(Speclly) 10. Married l7e.1X) y...__Mclin Monroe Twp SURVIVING SPOUSE tit w.t.. ~fTlaIOIInOMn4ll. WAS DECEDENT EVER IN us ARMED FORCES? v.. OCJ No 0 Mae J. Warfel DECEDENT'S USUAL OCCUPRION I~".:..~ :c~.:~ ':::'J.:di' . .... Delivery 1110. Dairy DECEDENT'S MAl\.ING AOORESS (S..... Cay"""" _. Z", Code) DECEDENT'S 1453 Cockleys Meadow Drive ~~:::NCE Boiling Springs, Pennsylvania 17007 :-.,;::..'";"'" 17.. Slate ..... e",,_ May 12, 2001 Iva M. Rhoads ~ ~ o o ~ .. z ... INfORMANT'S NAME (l ypalPnnl) 2001. MeTHOD Of DISPOSITION U. IlunaI 0 c......._ 00 Conal.... 0Ihaf (Spec"" . 21.. SIGN James D Coble Mae J. Coble 21e. Conolite Crematory Schaefterstown, Pa. 17088 FD-012662-L NAME AND ADDRESS Of fACILITY 21e. M ers Funeral Home Inc 37 East Main Street Mechanicsbur Pa 17055 LICENSE NUMBER DATE SIGNED lMonlh.Oay. Yearl 2310. 13e. WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER? Yo. 0 NoQ- LICENSE NUMBER DATE PRONOUNCED DEAD tM..mth, Day, Year) 20. Oi$. ::.0 f1M 25. "'/~'1 'I. ~'-'..J I 21. PART I; Ent.' the diM.ses, inlUf..S Of comphcahoflS which caused the death 00 not enl.,. lhe mode of dv1ng. such as cardiac Of resplralory arras!. shock or hear1laduta LISt only ~ c.ua. on each hoe . III V -, t.:.. M 'I {) (' A ~ j) I A-L [ ^' fA tl.t.. T' iJ "! DUE mcOR AS A CONSEOUENCE Of)' :N. I Approxmala : inC8IVaI between ,"'-' .nddaalll I l H",u,tS PART II: 0Ihaf sogndlcO/ll COndlIIonS contnIJuling 10 <loath. buI nol ..1UIIing in thO ~ng..... _ in Pt.RT I Co:-,e ~ N kit..,.. A y'2 fLit,. I~l ~ c.1\.$ E t"' N 6.6S '1' V t::.. ,,- 1~"'lILU.-!C '" --.) b I DUE m COR AS A CONSEOUENCE Of) < --ouE mlOR AS A CONSEOUENCE Of)-~------_.~~--- ----~ d - -.- WERE AUTOPSY fiNDINGS MANNER Of DEATH AlAIlA8lE PRIOR m COMPLETION OF CAUSE Of DEATH? I : ---;---- : '..1 DATE Of INJURV (Monttl. ~'1, 'rear. TIME Of INJURV INJURV J(f WORK? DESCRIBE HOW INJURV OCCURRED S-:kle GY o o PeOOll"!9lnveshqilllOn o o o ~CE Of INJURY - A' horn.. ,...:.':;..,. foct.,..,. olfic. busldiRQ,"~ ,SptlLllv' _. o NoD .MEDICAL EXAMINER/CORONER ~~~~~~:i:t::=.~~~~~t.'~~ ...n.~:. ~~~~~l~~~t.i~~: ~~ m,Y, o~i.n.'~~: ~~~~~ ~~~~~r.e.~ ~~ ~~~ ~I~~,.~~.~: ~~~.~I~~~: ~~~.~~~ ~~ ~~~ ~~~~~~~).~~~ 0 3'. REGIST kdJ.~WlJ I ') ~ :t '" ~~ v.. 0 NoB"'" M. JOe. eouid not be dele. mined 1.... 2110. CERTIFIER let-eo. 00)' one) . CERTifYING PHYSICIAN (p"'i's.c~Cef''')'.og cause UtI (k>dth Iolohe" .)nOlh~ lJh..SA:lan hdS pronounced dt:dltl dll(J ull'nlJl~l~ l1etn2Jl To Ihe be.C o' "'y knowMdg.. ..U\ occuned due to Ihe cau..(s) and manner a. .Cated. . n. . PRONOUNCING AND CERTIfYING PHYSICIAN (PhVs.(;idO l:x)th >)fOllOUlIC1rl<] lJe..Uh 4fld cel'11lyll19lo CduSti 01 dedltl) To the bNC of my kl'Owledg.. death occurred.t Ibe tIm., dac.. ~nd place..nd due 10 Che cau..(.) and mann.r.. sl._ad ... LAST WILL AND TEST AMENT OF RICHARD M. COBLE I, RICHARD M. COBLE, of the Township of Monroe, 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. All the rest, residue and remainder of my estate, real, per- sonal and mixed, I give, devise and bequeath unto my dear wife, Patricia J. Coble, absolutely and in fee simple. 3 · In the event that my said wife should predecease me or should she die at about the same time as I do, such as in an accident common to both of us, then in such event, I give, devise and bequeath my entire estate, of whatsoever nature and wheresoever situate, to my three sons, to wit, Richard E. Coble, Patrick A. Coble and David L. Coble, share and share alike. LASTLY, I nominate, constitute and appoint my wife, Patricia J. Coble, Executrix of this my Last Will and Testament, and in the event that my said wife should predecease me or should she for any reason be unwilling or unable to serve in such capacity, then in such event, I nominate, constitute and appoint my three sons, to wit, Richard E. Coble, Patrick A. Coble and David L. Coble, Co-Executors of this my Last Will and Testament in her -1- . .. place and stead and direct that they be permitted to serve in such capacity without posting bond or other security. IN WITNESS WHEREOF, I have hereunto set my hand and seal this I 5" day of January, A. D. 1974. , ;~'Ci;-:;~;" :-::. ,.'" / /1 .-' ." ! (;'- L'--., ( SEAL) Richard M. Coble Signed, sealed, published and declared by the above named Richard M. Coble, as and for his Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence of each other. f ,j /1 oil.. J /_(.11.,-1..-/ / I '\ ........--- ,.' ,," I // /~ ( ; ~ ,JJ/~__,J,< !? , [..-(/.'--vl--t._1 -2- . , r CODICIL I, RICHARD M. COBLE, of the Township of Monroe, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this the First Codicil to my Last Will and Testament. 1. Inasmuch as my wife, PATRICIA J. COBLE, has predeceased me, I hereby revoke the appoint of an Executor and/or Executors as stipulated in my Last Will and Testament, and I do hereby nominate, constitute and appoint my son, PATRICK A. COBLE, Executor of this my Last Will and Testament, and in the event that my said son should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, RICHARD E. COBLE, Executor of this my Last Will and Testament, in his place and stead, and in the event that he should also predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, DAVID L. COBLE, Executor of this my Last Will and Testament, and in all instances, I direct that my - 1 - said personal representatives be excused from posting bond or other security for the faithful performance of their duties in this jurisdiction or any other jurisdiction. 2. I hereby ratify and confirm my Last Will and Testament dated January 18, 1974, in all other respects and to all intents and purposes not inconsistent herewith. IN WITNESS WHEREOF, I have hereunto set my hand and seal this II~ .Y) day of February, A. D. 2001. :s:;t;L) eft! ~ Richard M. Coble Signed, sealed, published and declared by the above-named, RICHARD M. COBLE, as and for a Codicil to his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. d<~ e--' d. 714 r - 2 - ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Richard M. Coble Date of Death: May 11,2001 Will No. ,2CJ61- CXJ~S- 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 May 29, 2001: Name Address David Lee Coble 507 N. Lewisberry Rd., Mechanicsburg, PA 17055 2508 Bedford Way, Tallahassee, FL 32308 1002 15th Avenue East,Polson, MT 59860 Patrick A. Coble Richard E. Coble Mae 1. Warfel Coble 1453 Cockley's Meadow Dri ve,Boiling Springs, P A 17007 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: May 31, 2001 ~Efs~/ 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative ~ ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Richard M. Coble Date of Death: July 25, 2001 Will No. Admin. No. 21-01-0'786- 4<=\ b 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 August 3,2001: Name Address Hubert A. Corbe 110 Salem Church Rd., Mechanicsburg, PA 17050 450 Lapidary Lane, Young Harris, GA 30582 Robert Corbe Grace Stoner 6 Dewalt Drive, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: August 5,2001 (~ CHARLES E. SHIELDS, III 6 Clouser Road Mechanicsburg, P A 17055 Telephone: (717) 766-0209 Counsel for Personal Representative FIRST AND FINAL ACCOUNT INCLUDING PROPOSED DISTRIBUTION OF PATRICK A. COBLE EXECUTOR OF THE ESTATE OF RICHARD M. COBLE LATE OF MONROE TOWNSHIP, CUMBERLAND COUNTY. PENNSYL VANIA. DECEASED ;;V -t)/- 'If ~ Date of Death: Letters Granted: Dates of Publishing Notices in the Harrisburg Patriot Metro West Dates of Publishing Notices in the Cumberland Law Journal Covering the Period: 5/11/01 5/21/01 6/5/01; 6/12/01; 6/19/01 6/8/01; 6/15/01; 6/22/01 Purpose of the Account: Patrick A. Coble, Executor, offers this account to acquaint interested parties with the transactions that have occurred during his administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with Patrick A. Coble, c/o Charles E. Shields, III, 6 Clouser Road, Mechanicsburg, P A 17055. TABLE OF CONTENTS Real Estate $ 90,000.00 . . . . . . Page 3 Cash and Miscellaneous 58,150.83 . . . . . . Page 3 Total Receipts of Principal 148,150.83 ... . .. Page 3 Funeral Expenses 734.81 . . . . . . Page 4 Fees and Commissions 14,333.57 . . . . .. Page 4 Miscellaneous Probate and Administrative Expenses 8,037.99 . . . . .. Page 4 Inheritance Taxes 6,122.75 . . . . . . Page 5 Debts of Decedent 2,564.26 . . . . .. Page 5 Receipts of Income 102.00 . . . . .. Page 5 Proposed Schedule of Distribution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Page 6 RECEIPTS OF PRINCIPAL Real Estate: Homestead Property at 1453 Cock1eys Meadow Drive, Boiling Springs, Cumberland County, Pennsylvania Stocks and Bonds: None Cash and Miscellaneous: 1. 1991 Ford Truck, VIN IFTCR14UIMPA45273 sold to Ralph J. Mozingo 2. PNC Bank, Certificate of Deposit # 31300087916 3. Interest Accrued to D.O.D. on Item 2 4. PNC Bank, Certificate of Deposit # 313000086994 5. Interest Accrued to D.O.D. on Item 4 6. Members First Federal Credit Union: a. Regular Savings Account # 60053-00 b. Interest Accrued to D.O.D. on "a.)" c. Life Savings Account # 60053-04 d. Interest Accrued to D.O.D. on "c.)" e. Certificate of Deposit #60053-43 - 18 months f. Interest Accrued to D.O.D. on "e.)" g. Certificate of Deposit #60053-44 - 18 months h. Interest Accrued to D.O.D. on "g.)" i. Certificate of Deposit #60053-45 - 18 months j. Interest Accrued to D.O.D. on "i.)" 7. F&M Trust (aka Farmers and Merchants Trust Company): a. Certificate of Deposit #016-2965226 b. Interest Accrued to D.O.D. on "a.)" c. Checking Account #33-18516 d. Interest Accrued to D.O.D. on "c.)" e. Checking Account #70-30053 f. Interest Accrued to D.O.D. on "e.)" 8. Payment of pro-rated real estate taxes, sewer, etc. on sale of real estate 9. CGU-Partial Refund on Home Owner's Insurance 10. Partial Refund of Advance Payment ot Church of God Home 11. Partial Refund on National Flood Insurance Program 12. Refund from Payment to Urological Institute 13. Payment due on DeMutualization of Prudential Insurance Company 14. Abatement on income tax for year 2000 15. Abatement on income tax for year 1999 16. Personalty in and about the residence (see listing attached) *Informational Note: Intervivos Transfers and IRA Accounts per Schedule G of Inheritance Tax Return have already been accounted for separately to the beneficiaries. TOTAL RECEIPTS OF PRINCIPAL 3 $ 90,000.00 $ 3,450.00 5,309.27 27.63 5,309.27 27.63 830.47 .65 2,000.00 1.57 10,336.88 18.97 10,931.49 18.21 2,696.33 3.97 3,096.03 61.40 2,832.29 2.24 6,475.11 19.92 687.05 74.00 500.00 286.00 6.42 881.64 66.21 14.08 2,186.10 $58rI50.83 $ 148.150.83 DISBURSEMENT OF PRINCIPAL Funeral Expense: 1. Myers Funeral Home of Mechanicsburg 2. Reimbursement to Patrick A. Coble for Family Funeral MeallWake 3. Reimbursement to Trindle Springs Lutheran Church for Refreshments, etc. 4. Gingrich Memorials for Engraving Fees and Commissions: 1. Executor's fees to Patrick A. Coble 2. Attorneys fees to Charles E. Shields III (reserved) Family Exemption: 1. Mae J. Warfel Coble, widow *per prenuptial agreement Miscellaneous Probate and Administrative Expenses: a. Probate Fees and original issue of Short Certificates 1. Greenawalt & Co, P .C. re non-filing/incomplete filing for multiple years prior to death 2. Additional probate fees 3. Reimbursements to Charles Shields: Advertising in Cumberland Law Journal 4. Reimbursements to Charles Shields: Advertising in Patriot News Metro West 5. Reimbursements to Charles Shields: Additional short certificates 6. Liberty Check Co. - Checks for Estate Checking Account 7. Reimbursements to David Lee Coble: Flight for funeral 8. Mark E. Hilbert & Associates - Real Estate Appraisal 9. Reimbursements to Christine Coble: Flight for funeral 10. Reimbursements to Chris Coble: Flight for funeral 11. Reimbursements to Patrick Coble: Changing locks to secure property 12. National Flood Insurance Program 13. Mary E. Murray, Tax Collector 14. Reimbursements to Richard E. Coble: Travel for funeral 15. GPU Energy 16. Sprint 17. Tim McCurdy, "Meadow Mowers," cost of mowing property 18. GPU Energy 19. Monroe Township sewer charges 20. S. H. Black & Son, Inc. - cleaning and refurbishing in prep for sale 21. Sprint 22. Iron Forge Storage 23. Federal Express charges for sending deed for signatures (x 2) 4 $ 181.00 390.00 88.81 75.00 L 734.81 7,407.54 6,926.03 L 14,333.57 waived $ 163.50 1,905.00 120.00 75.00 77.52 9.00 7.64 850.95 275.00 566.00 657.00 69.55 425.00 899.63 1,223.00 34.98 50.40 30.00 48.04 132.00 202.28 58.50 130.00 28.00 $8,037.99 Inheritance Taxes: 1. Estimated payment to Pa. Dept. Of Revenue (early payment: credit amount $ 5,175.00) 2. Payment of Balance Due Debts of Decedent 1. Comcast Cable 2. Comcast Cable 3. Comcast Cable 4. GPU Energy 5. Shipley Energy 6. GPU Energy 7. Monroe Township - Sewer 8. Rogert W. Fickette, Dig, install sewer line, hook-up, etc. 9. Sprint - Phone Service 10. West Shore Emergency Medical Services 11. U. S. Treasury for Taxes due for 2000 12. U. S. Treasury for Taxes due for 2001 13. U. S. Treasury 14. Orthopedic Institute of Pennsylvania 15. Department of Veterans Affairs - Prescriptions 16. Sprint - Phone Service 17. Waste Management of Central Pennsylvania 18 . Walnut Bottom Radiology 19. YeHow Breeches Family Practice 20. Moffitt Heart & Vascular Group 2 1. HB C S Medicals 22. HBCS Medicals TOTAL DISBURSEMENTS OF PRINCIPAL $ 4,916.25 - 11206.50 1- 6)22.75 - $ 15.84 19.59 32.93 78.37 80.32 40.33 124.08 840.00 154.03 108.75 212.00 223.00 43.00 29.99 .54 52.91 31.71 7.12 11.80 169.59 116.00 172.86 1- 2r564.26 $ 31,793.38 RECEIPTS OF INCOME: $ 102.00 Interest earned on accounts before transfer to Estate checking account and on Estate checking account. * *Itemization of each income entry has been waived by the beneficiaries, they being totally familiar with the same from previously supplied documents. DISBURSEMENTS OF INCOME: INCOME BALANCE ON HAND: RECAPITULATION: TOT AL PRINCIPAL RECEIPTS TOTAL PRINCIPAL DISBURSEMENTS TOTAL INCOME RECEIPTS TOTAL INCOME DISBURSEMENTS BALANCE ON HAND FOR DISTRIBUTION $ none 102.00 $148,150.83 31,793.38 102.00 0.00 116,459.45 5 PROPOSED SCHEDULE OF DISTRIBUTION 1. Patrick A. Coble $ 38,819.82 507 N. Lewisberry Road Mechanicsburg, Pennsylvania 17055 2. Richard E. Coble 38,819.82 1453 Cockley's Meadow Drive Boiling Springs, Pennsylvania 17007 3. David Lee Coble 38,819.81 1002 15th Avenue E Polson, Montana 59860 PATRICK A. COBLE, Executor of the Estate of RICHARD M. COBLE, deceased, hereby declares under oath that he has fully and faithfully discharged the duties of his office, that foregoing First and Final Account is true and correct and fully discloses all the significant transactions occurring during the accounting period; that all claims now outstanding against the Estate; and that all taxes presently due from the Estate have been paid. ~(::) d PATRICKA. COBLE ~ Sworn and subscribed to before me this ~ day of ;/,~ ~002 ~ rr ~b~____ 9:- _ ~ Notary Public NOTARfAl--SEAL -....--..-1 Charles E. Shields, 111, Notary Public Monroe Twp. Cumberland County My Commission Expires June 20, 2004 NOTARiAl SEAl I Charles E. Shields, III, Notary Pub!!': 1 Monroe Twp. Cumberland <)': ';1"; i My COmmission Expires Jur,f:1 ~o;:i, 0'; /).! i _..,_---J 6 ::J J ... 0/- Lf9,s- ESTATE OF RICHARD M COBLE 507 N LEWISBERRY RD MECHANICSBURG PA 17055 Date ~t~" d~ <~9- 60-8224/2313 $ /~.ao ~~)lY trtJVotLars m1i::i~:E~'g:i'~lD MernberslSl' FEDERAL CREDIT UNION P.O. Box 40 Mechenlceburg. PA 17055 Memo,f])j)/TlONAt PilI/BAt€" ~tlt-L M' I: 2 ~ . ~ 8 2 2... .1: 0 . L,? ... 2 . 8 2 0 5 b g 2 5 II- ... ... '" LIBERTY J ..<~"If ,"'~' " I ,:)./- 01- ~9S ESTATE OF RICHARD M COBLE 507 N LEWIS BERRY RD MECHANICSBURG PA 17055 ~_: ~ - t" .' . -;' .. ~ ,,~ .~. ., .. , ".' "';;' :: ~ _/ 146 Date .." ~ ~O.;L..- "60-822412313 $ IO:4t:J ,(0 (j1J Dollars m ifr!Ar~':.\'~D Memo FIL/Nfr FElF _ _~~__~. __/J J" r1 ".. M' ~~~,-- I: 2 3 . :i a 2 2 L. .1: 0 .... b'.' 2 . 8 2 0 5 b g 2 5 II- ... ... ill LI BERTY d>.I-tJ/-'11S'" ESTATE OF RICHARD M COBLE 507 N LEWIS BERRY AD MECHANICSBURG PA 17055 $ /~t>'~,o-. 0 ~ '-- .s;r4"t:) Dollars m ir.~f~':1'.l"D M1rLqlg~r P.O. Box 40 Mechentceburg. PA 17055 ._~_~~A_4 f;;L ~.~.._. ~ Memo tJA-/.;fJlCt ~t: I NII6if'. TA.x I: 2 ~ . 3 a 2 2... . I: 0 . L, 5 II' 2 . 8 2 0 5 b q 2 5ul L. ... E'~4 ;" :t. iO LIBERTY LAST WILL AND TESTAMENT OF RICHARD M. COBLE I, RICHARD M. COBLE, of the Township of Monroe, 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. All the rest, residue and remainder of my estate, real, per- sonal and mixed, I give, devise and bequeath unto my dear wife, Patricia J. Coble, absolutely and in fee simple. 3 · place and stead and direct that they be permitted to serve in such capacity without posting bond or other security. / IN WITNESS WHEREOF, I have hereunto set my hand and seal this I ~ day of January, A. D. 1974. I .. " " / / / '7/1 /v(..;;{)I,Lc .:_..;;"~.-?.;~ ,.) .." ~ I L Richard M. Coble (SEAL) Signed, sealed, published and declared by the above named Richard M. Coble, as and for his Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses. at the request of said testator, in his presence CQDICIL I, RICHARD M. COBLE, of the Township of Monroe, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this the First Codicil to my Last Will and Testament. 1. Inasmuch as my wife, PATRICIA J. COBLE, has predeceased me, I hereby revoke the appoint of an Executor and/or Executors as stipulated in my Last Will and Testament, and I do hereby nominate, constitute and appoint my son, PATRICK A. COBLE, Executor of this my Last Will and Testament, and in the event that my said son should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, RICHARD E. COBLE, Executor of this my Last Will and Testament, in his place and stead, and in the event that he should also predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, DAVID L. COBLE, Executor of this my Last Will and Testament, and in all instances, I direct that my - 1 - ~,,'j,,'f said personal representatives be excused from posting bond or other security for the faithful performance of their duties in this jurisdiction or any other jurisdiction. 2. I hereby ratifY and confmn my Last Will and Testament dated January 18, 1974, in all other respects and to all intents and purposes not inconsistent herewith. IN WITNESS WHEREOF, I have hereunto set my hand and seal this II~ -II) day of February, A. D. 2001. -d;~) eft! ~ Richard M. Coble Signed, sealed, published and declared by the above-named, RICHARD M. COBLE, as and for a Codicil to his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~M~~/ tl 717 - 2- 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 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 ____nn fold ESTATE INFORMATION: SSN: 204-03-0952 FILE NUMBER: 2101-0495 DECEDENT NAME: COBLE RICHARD M DA TE OF PAYMENT: 03/01/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DA TE OF DEATH: 05/11/2001 NO. CD 000903 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,206.50 I I I I I I I I TOTAL AMOUNT PAID: $1,206.50 REMARKS: PATRICK A COBLE C/O CHARLES E SHIELDS III ESQ. CHECK# 145 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS 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 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 _nn___ fold ESTATE INFORMATION: SSN: 204-03-0952 FILE NUMBER: 2101-0495 DECEDENT NAME: COBLE RICHARD M DATE OF PAYMENT: 04/22/2002 POSTMARK DATE: 04/19/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/11/2001 NO. CD 001093 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $153.83 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHARLES E SHIELDS III ESQUIRE CHECK# 453 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $153.83 MARY C. LEWIS REGISTER OF WILLS 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 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 _n___n fold ESTATE INFORMATION: SSN: 204-03-0952 FILE NUMBER: 21-2001- 0495 DECEDENT NAME: COBLE RICHARD M DA TE OF PAYMENT: 07/27/2001 POSTMARK DATE: 07/26/2001 COUNTY: CUMBERLAND DATE OF DEATH: 05/11/2001 NO. CD 000089 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,916.25 I I I I I I I I TOTAL AMOUNT PAID: $4,916.25 REMARKS: PATRICK A COBLE C/O CHARLES E SHIELDS III ESQ CHECK#125 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS /6 -c20 /- /~/ \ -- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REV-I6D7 EX AFP (01-02) 'OZ CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG PA ~~Y~5 31 :)! :t..:2 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-28-2002 COBLE 05-11-2001 21 01-0495 CUMBERLAND 101 RICHARD M Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i6o-j-ix-AFP--fc.-f:02Y------...--iNif€RITANc"E-TAx-STA-fEHfliT-OF-ACCouiif--.-..--------------------- ESTATE OF COBLE RICHARD M FILE NO. 21 01-0495 ACN 101 DATE 05-28-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-15-2002 P R I NC I PAL TAX DU E : ........................................................................................................................................................................................................................... 6,529.87 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-26-2001 CDOOO089 258.75 4,916.25 03-01-2002 CDOO0903 .00 1,206.50 04-19-2002 CD001093 5.19- 153.83 TOTAL TAX CREDIT 6,530.14 BALANCE OF TAX DUE .27CR INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .27CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l /6.c23/-/3 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION · DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE \, NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER CO~T~ ACN - 'OZ /ih7 1 0 I .r" CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG fA 17055 t._ .~ (... ~ ., { J (~ 04-15-2002 COBLE 05-11-2001 21 01-0495 CUMBERLAND 101 * REV-1547 EX .FP (01-02) RICHARD M Amount Remitted (1) (2) (3) (4) (5) (6) (7) (9) (10) 90,000.00 .00 .00 .00 58,150.83 .00 19,331.08 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. 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: 19..809.42 2.564.26 (11) (12) (13) (14) .00 X 00 = 145,108.23 X 045 = .00 X 12 = .00 X 15 = 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-Ex-AFP--('o1-:o2i--NC)T'icE--oF-xNHEifiTANCE-TAX-APPRAisEHENT-,--ALi-oWANCE-cfli----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF COBLE RICHARD M FILE NO. 21 01-0495 ACN 101 DATE 04-15-2002 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: . IF PAID AFTER DATE INDICATED.. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account.. submit the upper portion of this form with your tax payment. 167..481.91 2?373 68 145..108.23 .00 145..108.23 (19)= .00 6..529.87 .00 .00 6..529.87 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. Mortgages/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 . "'. ....., . l'u:"'C.Lr I T+J AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-26-2001 CDOOO089 258.75 4..916.25 03-01-2002 CDOO0903 .00 1..206.50 INTEREST IS CHARGED THROUGH 04-30-2002 TOTAL TAX CREDIT 6..381.50 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 148.37 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 5.46 TOTAL DUE 153.83 ( 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.) REV-1470 EX (6-88) '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME Coble, Richard M. FILE NUMBER Daniel Heck ACN 2101-0495 101 REVIEWED BY ITEM SCHEDULE NO. H B- 12,14, 15,19 EXPLANATION OF CHANGES The deduction for travel expenses has been disallowed. The executor or administrator of the estate is the only person entitled to claim these expenses in conjunction with the administration of the estate. ROW Page 1 noil v,// STATUS REPORT ~NDER RULE 6.12 Name of Decedent: K i (..hard M, Co'o\e, Date of Death: 5-1/-01 <z /-01- 49.)- Will No. 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: Stat~hether adrninist=3tio~ of the estate is complete: Yes~ No 2. If the answer is No, 3~ate when the personal representative reasonably believes that the administration will be complete: 1 . 3. If the answer to No.1 is Yes, state the following: a. Did the personal r~5esentative file a final account with the Court? Yes NO~. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the persDnal ::-epresentati'/e sWe an account informally to the parties in i~terest? Yes~ No d. Copies of r~ceipts, releases, joinders and approvals of formal or informal acccunts may be filed with the :::::Of ;::::;:ans. Court and may ~;t.;jl!)l; Sig~ature ~ CAarles 6- ohlelt/S .217 Name (Please type or print) ~ UH{,ISaz-,eD~ /J!eoIvJl1/csbtl/i:iJ d Adores s -(J r7o"'::J-r ({/7, 7& (, /tf ehJ C) Tel. No. Capacity: Per~onal.Representative )( Counsel for personal ~representative (MAH: rmf/ AM3) RE'I.1500EX'G.1)0\ REV-1500 .' COMMONWEALTH OF PENNSYLVANIA , ., DEPARTMENT OF REVENUE DEPl 280601 HARRISBURG, PA 17128-0601 W I- ::.::::!cn 0"'>: w"O ,,00 0"'--' ..<II .. '" INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) e 0 8 LI~ J ;:( / elf /I- ~ ]) /11. DATE OF DEATH (MM-DD-YEAR) 05-1/-01 c rn::t:;;I("lAl IH;:;C: "-'I\d v ......'..-- -'#- ~.._. __-1..k-=--r23-1:=..i0______ FILE NUMBER 21 - 0 I COUNTY CODE YEAR D () Lj 'LS NUMBER DATE OF BIRTH (MM-DD.YEAR) of- ,;(.)'- /9;ZJf (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) {!.013LE, /J'J/fE ..:r. N/fR,cEL ~ 1. Original Return D 4, Limited Estate k8J 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dale ofdealh after 12-12.82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl) D 10. Spousal Poverty Credit (date of death ootween 12.31-91 and 1-1.95) SOCIAL SECURITY NUMBER ;lo'! - 03 - 09.5'2.. THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ;J,D' D 3. Remainder Return (dale of dealh prior to 12-13-82) D 5. Federal Estate Tax Return Required I 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach 5ch 0) z o 3 ::l l- ii: <C U w a:: z o < I- ::l a.. :!; o u >< ~ I- Z W C Z o .. '" w '" '" o o NAME C If/!-~LFS E. COMPLETE MAILING ADDRESS FIRM NAME (lfApplicable) C, CLOUSGR. tel:>. !J7e:Cf/AIII/CSBuft!G ;::7/9 l7oSS- J (11) , ~S, b7f). H (12) 1/-'1/ r 1/,:;.'6 , (13) (J I Ii I, 'ill. 28 (14) X .0 (15) 0 - xo'f,5:... (16) '0, 3f'/.,S?J X .12 (17) 0 0 X .15 (18) ~ 6, 73 a I, ,,-V (19) TELEPHONE NUMBER 717-7C,{g -ozoq 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 'If), DDO.OO o o o ~ St. IS-P. 13 o "1'1 331.03 , 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (1) (2) (3) (4) (5) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sche<lule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Sche<lule G orL) 8. Total Gross Assets (total Lines 1-7) (6) (7) (B) 7' .;l3, /pr.,. 37 ., ~. Sc.tf ..Go 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 Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (9) (10) 14. Net Value Subject to Tax (Line 12 minus line 13) 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) o ~ Nt, ?II. t(J o 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14taxabie at collateral rate 15' 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,....,.......'. ~W'..F r_": QFFICIAL 'mE ONLY fa :;~p~ , \.,' r-, ::3: = 7..J -0 ["''oj '1J 16 /r., 7. Lf 81. '1/ , > > BE SUIIE:rlil:ANS1!IERlJ!iLlt'QUES Decedent's Complete Address: STREET NlDRESS / /453 ~ekLEYs /}1EAJ)t/t<J D,Jelyj; CITY /11 E Cftll,A/IC5/3tdG- I STATE ;:JA I ZIP /70 SS- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) <; {., 331.~ o ~ 4,914. z:r AS/f. 75 Total Credits (At 8 t C) (2) # 5; /7S"~ 00 3. InteresUPenally if applicable D. Interest E. Penalty '" (7 TotallnteresUPenally ( D t E ) (3) 4. If Line 2 is greater than Line 1 t Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) '" l> 5. If Line 1 t Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 'I, ~I/", SV A. Enter the interest on the tax due. (SA) '" B. Enter the total of Line 5 t SA. This is the 8ALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT ~~,~':\?~~~*"~: II, 3/J~.SD '~,/f. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 [XI 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? ............................. .......................... ............. D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................ ... ................ ...... .... ........... .... .................. D I:8l 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............. D ,..I:8J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .. .................................................................... ................................................ ~ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct and complete. Declaration of prepa r other than the personal representative is based on all infonnation of whict1 preparer has any knowledge. DATE ;;,~~ C:>,L.. 1'/1 /70$S" F P PARER OTHER THA E ADDRESS ~ CLf/USE'1l /</>') m€(!#~JY/(!S"gl(~c.-, ""/f /700:> DATE ;:r.;;'~t:>z :.,'::'-;7:~"'Ji1i',iirW~lJili~!o'!l'~'ll\t~,""~.~.,.liJl.MlIJL..."_,.I!!li!Illj!l1!"':~ 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. S9116 ia) (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 survivin9 spouse is 0% [72 P.S. S9116 ia) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from lax, 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 chiid is 0% [72 P.S. s9116(a)(1.2)]. The tax rate imposed on the net value of Iransfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116i1.2) [72 PS. s9116ia)(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. ",V'~'''.I''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /I /J' /1 /J]) GOIJL~ /'(Iell,r'c SCHEDULE A REAL ESTATE /11. FILE NUMBER :J.I-OI-'ffjS All real property owned solely or as a tenant in common must be reported at fair market 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 survivorshin must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION A-LL (/'IpSE "Ttf/tl C!Ek'm/N T",'fC7S cF ~Ul//O S rruATE /N mRN~()E -nk/ffSH/f/, Ctth18/F/lL/I-ND ~~/II7y, ,..oBl'.4'~ l/J1hZot/ffl) 1v/7f!,4 PItIFu/NG- ,L//PUSL: IPH/eN -fRG /)10-e€ /l/l/lT/cuL-/I/lt-Y ~EgC,f'ISED /A) /iy'/l-/ C!Ek'77f/# VALUE AT DATE OF DEATH f 90,000.00 DE/?/) DIIIEt> .4tlGtlST /tJ:" 1911 ,4-/lJ/) /2g:~Itf)e1> /IY j)~n:!J ;.geo/<( '(F," YOLw/J1€ .;2'0 !l,4(jE 6'71, sy ~ ~ ~ jr;I(ICf( J/J.5E;/1-! ~ f!,f-tl;J~tE7(; ET U><- G-n/iNT€j) /HIJO ..; ~ ~lzItlp VEl) 7/1E ~/lE/11/5ES 7C ~/(!h'/l-Rt> /If. /!tJI3lE,.1tz/tJ ?//77C/c//f J: &/JtG; #/.5' U;/FE: :4YE -5,4/j) /-l//71l/{!//I J: t>>/JIE ,o/'?EOErT<;cD WE S#/D d/t!# /Ill iJ /Jf. &t8tE /f//lE~Et(~1V FULL /lTL.G" f/ESiELJ IN I///IJ PHRSt(/f;1/T -n /JIE L.4Je1S Or -rEF/VIfAlrHcs lSy i0"E EJ1//l/'?P7/ES. HE HAS SllVeE IN/ta? /11/fletlt€D to/T/f /lME,J. /f/,4If.FEl &StE. Sh"e 1//1-5 /YtJ C!LA//I! 7P 0;( /IV 7/Y'E ~"eE/H/5"ES ,8y UR1llE cF' A-1J7F-1Iwf171/1-L A6ItEe'"IIfElf/T lJ.4TEb ..rUNE 1(/ 19'17. 7H1,S PR/iPE/lTY WAS StlLf) 7b RICII/I/lf) E &$t.E, SoN OF 7)IHJtf1)SVT, ON f)(!Tt?~ffR -5; .;{U'I R>~ 7J-/€ SCtm e>F iyc;ctJtJ,t7t1. ""7if/s Sum JSE/N6- /YEGPT//fTeiJ 1fN/) FUII!TJI!f71 SEINe; ~3,C>t??>.00 h"1C;/I~ ;WAN T~E AP/'J('/lISGl) PIe/Cli:, , SeE eJp,lly 6?F fi/,tJ.KK IIIL8L:i2TS /lPI"'R.I'1/S','fL. '" 7r.l'1CH€Z) Mf) ~Py PI=' SE"TTZ€d18V:f 5/f~r / u/l'E /1Jr! SHOkl//v6 ~ ~ /l~V'O~F /0 eS'T/1TiF p"c 60OOo,C)p, $€ ,97""-e7? 30,.",,,,,,,,<10 {(/~S 77S'-Ke7V /IS If C!Rl!CoIT A6AINST ?VNL'#"A'SENS Y3 5E(.4RE IF 7W"€ Res/LJue. {l'-l- oj a ..j; f! .. <e ~ !: () <:t ~ 1 " .,,~ '" ~d.. J -i ~ ~ ",-""l! ~ ~ l: "--.. '" 0) L'= .. rl :I )( - Q " ro :4:.i' VI " Q to ~(i ~ ~ ~~' ~ ". ~ ill " "l <lI ~f~ TOTAL (Also enter on line 1, Recapitulation) (If more space IS needed, Insert additional sheets of the same size) $ 70,000'''''''' File No: 01-127 APPRAISAL REPORT of 1453 Cockleys Meadow Drive Boiling Springs, PA 17007 Summary Appraisal Report PREPARED FOR: Mr Charles Shields Esq. 6 Clouser Road Mechanicsburg, PA 17055 AS OF: June 16, 2001 PREPARED BY: MARK E. HILBERT & ASSOCIATES 14 North Walnut Street Mechanicsburg, FA 17055 MCS, ~ Div"lsion of ACI Development !SOO) 697-7783 Valuation Section MARK E. HILBERT & ASSOCIATES UNIFORM RESIDENTIAL APPRAISAL REPORT File No. 01-127 ESTIMATED SITE VALUE. . . . . .. .". ... ... . , , . . .. - $ 20 000 Comments on Cost Approach {such as source of cost ESTIMA TED REPRODUCTION COST.NEW OF IMPROVEMENTS, estimate, site value, square foot calculation and for HUD, Dwelling 1,920 Sq. Ft. @ $ 38.15 ~ $ 73,248 V A, and FmHA, the estimated remaining economic life of Basement N/A Sq. Ft. @ $ = the property}; In reproduction cost of Fireplace, Fla.Room. = 3,500 improvement, Marshall & Swift Handbook Garage/Xarport 672 Sq. Ft. @ $ 15.25 = 10,248 and local contractors are referenced. Total Estimated Cost New ... ... ... .". = $ 86,996 Physical Functional I External External depreciation due to FLOOD ZON! Less 15 % 10 % Depreciation 13 049 8 699 = $ 21,748 Depreciated Value of Improvements. , , , . . . . ...... .. = $ 65 248 "As-is" Value of Site Improvements .... .. ..... .. ... = $ 2 500 INDICATED VALUE BY COST APPROACH .. ..... ..... - $ 87 748 Remaininn Economic life 30-35 Years 11)1 ITEM 1 SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3 1453 Cockleys Meadow 305 West Pine Street 76 Cold Springs Road 337 York Road Addc,,, . Boiling srin%~t~IBOilini SIPr~;s, PA rarliS1e;1 P~I IcarliS1e'G PA ProxlmitvtoSubiect 4 5 Sales Price $ Estate $ 87 $ 85 $ 87 ,000 Prlce/GrossLlv,Area $ II $67.10 I $56.22 I $56.49 II Data and/or C.P.M.L. C.P.M.L. C.P.M.L. Verification Sources Insoection Aaent Aqent 1 "aent VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION +(-)$ Ad'ustment DESCRIPTION +(_\$ Adjustment DESCRIPTION +(-)$ Ad'ustmel Sales or Financing DOM 19 DOM 108 DOM 7 Concessions Conventional Conventional Conventional Date of SalelTime 1-26-01 10-30-00 1-2-01 Location Averaae Averacre Averaae Averaqe Leasehold/FeeSimole Fee Simn1e Fee Simn1e Fee Simn1e Fee Simn1e Site 0.53 Acre/Ava 0.24 Acre/Ava 0.85 Acre/Ava 0.34 Acre/Ava View Averaae Averaae Averane Averaoe Gesinn and Anneal Cane Cod/Avn Ranch/Avn Ranch/Ava Cane Cod/Ava Qualitv of Construction Aluminum Brick/Alum T-1ll Stucco Aoe 30 +1- 25 28 40 Condition Averaae Above Ava. -3 000 Averar:7e Averaqe Above Grade Total I Bdrms I Baths Total I Bdrms I Baths Total I Bdrms I Baths Total I Bdrms I Baths Room Count 5 12 11 5 13 11 6 13 11 5 13 11-1 -1,000 Gross Livin Area 1 920 So. Ft. 1 304 Sa, Ft. +6 100 1 512 Sn, Ft. +4 100 1 540 So. Ft. +3 BOO Basement & Finished None Full -1,500 None Full -1,500 Rooms Below Grade Unfinished Unfinished Unfinished Unfinished Functional Utilitv Averaae Averaae Averaae Averaae Heatin /Coolin Hot Air/None EBB/None EBB/None Steam/None EnernvEfficientltems None None None None Garaoe/Caroort 2 Car Garaae OffStreetPark +3 500 1 Car Garaae +2 000 1 Car Garaae +2 000 Porch, Patio, Deck, Fla, Room Fla. Room Porch/Deck Scr. Por. /Pati FirenlacelsLetc. Firenlace Firenlace Firenlace Fireplace Fence, Pool. etc. None None Wood Stove -1 500 None ..... -3 000 No -3 000 No -3 000 Net Ad.. (total) X + l-I, 2 1OO1i11i 1 600II1II' 300 Adjusted Sales Price of Comparable , 89 600 , 86 600 , 87 300 Comments on Sales Comparison lincluding the subject property's compatibility to the neighborhood, etc.): * Comparables chosen were the best closed sales available within a reasonable distance of the subject. Subject is on well/septic which is typical of the neighborhood and does not adversely impact marketability. The lack of storm sewers, curbs, gutters, sidewalks, and/or street lights is typical of the neighborhood and does not adversely impact marketability. The property's heating, plumbing, and electrical systems appear to be functioning properly to the best of the appraiser's knowledge and expertise. Itis noted that comparable No(s) 1-2-3 is/are more than three miles for surburban location It is noted that comparable No(s) . 2 occurred over six months prior to the appraisal date and is/are considered to be the best available. The vacant land in the area is changing to single family and does not have a negative effect on the value. I am unable to verify the insulation 'R' factor. The presence of UREA-FORMALDEHYDE FOAM INSULATION could not be determined. If UFFI is present, the appraisal market value may be adversely affected or voided. Any information about insulation stated on the appraisal was provided by inspection, owner, or agent, and is assumed to be accurate. The appraiser is not aware of the existence of Radon Gas and/or Radon Daughters, and does not have the necessary equipment to test for the presence of SaIne. If a future test shows unacceptable levels of Radon present, the appraised market value may be adversely effected or voided. Freddie Mac Form 70 6-93 MCS, a DIVISion of ACI Development 1800) 697-7783 Page 2.' Fannie Mae Form 1004 6-9. Valuation Section MARK E. HILBERT & ASSOCIATES UNIFORM RESIDENTIAL APPRAISAL REPORT Please be advised that in the market data analysis grid, bathrooms are first line and gross living area/roam count are adjusted together as a the second line. ';iI1:.: ~\ {ilf{ ,,;1:', '.!\fi... ,~. lilt :::&~:: * I I ;1 to the best of the appraiser's Realtor. knowledge. All comparable sales are settled settlement is with County and/or ITEM SUBJECT None N/A Owner's Deed COMPARABLE NO. None N/A C.P.M.L. Court House COMPARABLE NO.2 None N/A C.P.M.L. Court House Date, Pdceam:l Di>ta Source for prior sales wilhin year of appraisal File No. 01-127 adjusted for on the single adjustment on Verification of COMPARABLE NO.3 None N/A C.P.M.L. Court House N/A Analysis of any current agreement of sale, option, or lisling oft he subject property and analysis of any prior sales of subject an d comparables within one year of the date of appraisal: The appraisal is made X "as is" subject to the repairs, alterations. inspections or conditions iisted below subject to completion per plans and specifications. Conditions of Appraisal :The appraiser assumes a marketable title and that all of the equipment associated with the improvement is in working order. Final Reconciliation :The market approach reinforced by the cost Market Value. The fact that the seller is or is not has no effect on this appraisal or resale. INDICATED VALUE BY SALES COMPARISON APPROACH. INDICATED VALUE BY INCOME APPROACH (If A licflblel Estimated Market Rent $ {Mo. x Gross Rent Multi lier approach is a good paying any portion $ 87 , 000 $N A indicator of Fair of the closing costs The purpose of this appraisal is to estimate the market value of th ereal property that is the subject of this report, based on the abov e conditions and the certification. contingent and limiting conditions, and market value definition that are stated in the attached Freddie Mac Form 439/Fannie Mae Form 10048 (Revised 6/93 I. IIWE) ESTIMATE THE MARKET VALUE. AS DEFINED. OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT, AS OF D.O.D Ma 11 2001 WHIC STHE ATE OF INSPECTION AND THE EFFECTIVE DATE OF THIS REPORT) TO BE $ 87,000 / APPRAISER: '" SUPffi~SORY APPRAISER (ONLY IF AEOUlRfD) Signature Name Date Report Signed State Certification II Signature NameMar Date Report Signed Julv 3, 2001 State Cerlilicallon I1RL 000388-L Or State license II RB-029755-A StalePA StatePA Or State license II MCS, a Division of ACI De\lelopment \BOOI 697-7783 Freddie Mac Form 706-93 o Did 0 Did Not Inspect Property State State Page 2.2 Fannie Mae Form' 004 6-9 MARK E. HilBERT & ASSOCIATES Property Description COBLI File No. 01-127 UNIFORM RESIDENTIAL APPRAISAL REPORT Pro 8rt Address 1453 Cockle s Meadow Drive La 81Descri tion Attached elt Boilin S rin s State PA Zi Code 17007 Count Cumberland S aelal Assessments $ None Knc Dccu '.lnt Owner X Tenant Vaeill Assessor's Parcel No. Borrower Coble Richard M Estate CUffentOwner Same Tax Year RE. Taxes $ Pro ert ri htsa raised X Feesim Ie leasehold Nei hborhood or Pro'eet NameMonroe Townshi Pro-ect T e PUD Condominium HUD/VA onl ) HOA $ {Mo. Me Reference Census Tract Descri tionand $ amount of toan char es/concessions to be aidb seller N A 117 Sales Price $ Es ta te lender/Client Charles Date of Sale N A Es . A raiser Address 6 Clouser Road Mechanicsbur PA 17055 Address 14 North Walnut Street Mechanicsbur PA 17055 Rural Predominant Single family housing Present land use % Land use change o Under 25% occuPanGY PRICE $ (000) AGE (yrs) One family 61 o Not likely o Likel\ o Slow IK] Owner 65 Low New 2-4 family 12 ~Inprocess DoeCiining o Tenant 225 Hi h 110 MultHamily 03 To; ResidentiaJ o Oversupply [K] Vacant (0-5%) Predominant Commercial 04 Vacant (over 5%) 140 40 VacLnd 20 Location Urban o Over 75% o Rapid [K] Increasing o Shortage 6uiitup Growth rate Property values Demand/supply Marketin time Note: Race and the racial composition of the neighborhood are not appt"aisal factors. Neighborhood boundaries and characteristics: Property is located along Cockleys Meadow Road in Monroe Township, Cumberland County, Pennsylvania. Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, etc.): Property has good access to employment and services. Market conditions in the subject neighborhood (including suppa rt for the above conclusions related to the trend of property values, demand/supply,andmarketingtime.. . such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.): With the improving markets sellerf are not required to offer sales or financing consessions. Financing is readily available fram a variety of sources. Vacant land should have no effect on resale or marketabilit . Project Infocmatioo for PUGs (If applicable)uls the deveioper/builder in control of the Home Owners' Association IHOA)? No Approximate total number of units in the subject project N/A Approximate total number of units for sale In the subject project N/A Describe common elements and recreational facilities: Tract #2- 60 x 25 x 60 x 25 =1 500 S .Ft. DimensionsTraxt #1-122.81 x 165.83 x 152.32 x 150 -21 723.58 S .F Topography Level Site Area 23,223.57 Sauare Feet Corner Lot 0 Yes [K] No Size 0.53 Acres Specific zoning classification and description Residential Shape Irreqular Zoning compliance ~ Legal 0 Legal nonconforming (Grandfathered use) 0 Illegal 0 No zoning Drainage Aooears adeaua te Highest & best use as improved [K] Present use 0 Other use (explain) View Residential/Water Landscaping Adeauate Private Driveway Surface Macadam Apparent Easements TvDical Utility Front Utilities Off-site Improvements Street Macadam Curb/Gutter None Sidewalk None Street lights None Aile None FEMA Special Flood Hazard Area [K] Yes D N FEMAZoneA-5 Map Date 6-2-92 FEMA Ma No. 420364 Public Other Type Public IKI o Water 0 Sanitary Sewer [i] Storm Sewer 200 AMP Electricity Gas None Private None COmmenls(apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning, use, etc.): None apparent. however to reservations, easements, conditions and right of way of record. Subject Jll' il! ..~... ..~... Ii .l!i.. ..;j.. ..141. l!!. ...~... I Hi o GENERAL DESCRIPTION No. of Units One No. of Stories One T ypei Oet./ A tt.IDetached Design (Style} Ranch Existing/Proposed Exis tin Age iYrs.l 30 + - Effective A e (Yrs.) 10-12 Manufactured HousaNO EXTERIOR DESCRIPTION Foundation Block Exterior Walls Aluminum Roof Surface C osit Gullers & Dwnspts Aluminum Window Type Dbl.Hun Storm/Screens Yes Yes FOUNDATION BASEMENT INSULATION Slab No Area Sq. Ft. NA Roof 0 Crawl Space Yes % Finished Ceiling IKI Basement None Ceiling Walls IKI Sump Pump None Walls Floor 0 Dampness NoneNoted Floor None 0 Settlement NoneNoted Outside Entry Unknown 0 Infestation NoneNoted Den Famil Am. Aec. Rm. Bedrooms # Baths Laundr Other Area S .F NA 1 1 1 1 Utilt 1 344 1 576 2 Bedroom s . 1 Bathls' 1 920 5 vare Feet of Gross Livin Area KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE Refrigerator IKI 0 Fireplace(s} # 1 IKI None 0 Range/Oven IKI IKI Patio Brick IKI Garage /I of Cars Disposal 0 0 Deck 0 Attached L- Dishwasher IKI 0 Porch Fla. Room IKI Detached Fan/Hood IKI IKI Fence 0 Built-In Microwave IKI IKI Pool 0 Carport Washer/Dr er X X Drivewa 4 ROOMS Basement Level 1 Level 2 Fa er Livin Dinin Kitchen 1 Area 1 Finished area above rade contains: 5 Rooms' INTERIOR Floors Walls Trim/Finish Bath Floor Materials/Condition HEA TING Type Forced Air Fuel Oil Condition Avera e CODLING Central None Other None Ca et Av D all Av Wood Av Ca et Av CeramicTile Hollow Core Bath Wainscot Doors Condition Additional features (special energy efficient items, etc.):None Noted Condition of the improvements, depreciation (physical, functional, and external). repairs needed, quality of construction, remodeling/additions, etc.: No major repairs noted. No evidence of functional or external obsolescence. THIS IS A CREEK FRONT PROPERTY. Adverse environmental conditions Isuch as, but not limited to, hazardous wastes, toxic substances, etc.l present in the improvements, on the site, or in the immediate vicinity of the Subject property: There are no visible or apparent adverse environmental conditions that would negatively im act the value of the sub'ect. Summa A raisal Re ort Freddie Mac Form 70 6-93 MCS, a Division of ACI Development (800) 697-7783 Pagel.' Fannie Mae Form 1004 6-9: . - - 'ir 'A. ~. I WE Or LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.0FHA 2.0FmHA 3.~CONV. UNINS. 4.0VA 5-DCONV.INS. 16. : I ( : SETTLEMENT STATEMENT COB187.01 6543881 8. MORTGAGE INS CASE NUMBER: G. NoTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC)" were paid outside the closing; they are shown here for informational purposes and are not included jn the totals. 1.0 3/98 (COB187-01.PfD/COB187-0tn) LJ. NAME AND ALJDRE~$ OF BORROWER: E. NAME AND ADDRESS OF SE LER: I F. NAME AND ADDRESS OF LENDER: RICHARD E. COBLE FIRST UNION MORTGAGE 1453 COCKLEYS MEADOW DRIVE CORPORATION BOILlNGS SPRINGS, PA 17007 214 NORTH HOGAN STREET, 8TH FLOOR JACKSONVILLE, FL 32202 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1619811 I. SETTLEMENT DATE: 1453 COCKLEYS MEADOW DRIVE CHARLES E. SHIELDS, III ESQ. BOILlNGS SPRINGS, PA 17007 October 5, 2001 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT Disburse:10/11/01 J. ~T ur Ik",,~,,-';IION K. vr II' ; liON 100. GROSS AMOUNT uUE rROM BORROWER: 400. AMOUNT DUE TO SELLER: 101. {;ontract :sales pnce I 401. Con raCI ~ale5 nce 1 UL. personal !-'ropertY I 402. Personal t-'ropeny lU:.:s. ~ettlemem Gl"larges 0 t:Soorrower (Une 1400) 2,692.82 1403. 1U4. "MUrr 'U ~"''''~ to ~"'''''' Ot' RICHARD M. {; 60,UOO.UO I40C I w,. . UN ".~. IP .to 'OrKI{; o"r.oo -.as: I MOjUSlments For Items fJald I::Jy ~el1er In advance Adjusrmenrs rer lCems r-ala oy ;;:,euer In advance 106. Cityll own I axes 0 4m. CltvlTown axes \0 1Uf. {;ounty I axes 0 407. County Taxes to 10". . TAX 0 40E. ' ''''' to 109. 409. 110. <mr. 1'11. 411. 11<. -412. 120. GROSS AMOUNT DUE FROM BORROWER 63,379.87 420. GROSS AMOUNT DUE TO SELLER I 200. AMuUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 1 :':::U1. ueposlI or earnest money 5U1. t::xcess Ueposlt (::iee InstructIons) i ILW.. I"'nnClpall-\mOunt at New lOan(s) "4,000.OU --SUZ.--Se:Urement t.;narges to :seller (Line 14UU) I 1203. EXisting loan(5) taken su Ject '0 -S03.-Exlsting loan S) :aKen SUDJeC[ IO , ,204. 504. Fayoff or TlrSI Mongage , , '200. ~ ayOff 0 secona Mongage ,200. 506. 120f. 507. 12U8. 508. 1209. 009. MjUstments For Items Unpaid tjy ::ieller AOjUWnems ror Items unpalO "Y Miler IL-lU. l.;lIYf I own I axes to ""511I.l:ilylT own Taxes 10 I L11. Lounry I axes to ~tv laxes to I ILl<. ''''' to 012". . lAX to I '213. oIT I 1214. 014- I 210. 015. I 1:/10. 516. I L1f. 517. I IL10. 5'". I ILl". 519. I 220. TOTAL PAID BY/FOR BORROWER 84,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER Ijuu. "''':II "<OMII U : 600. CASH A I ''':I II : !JU1. brass Amount uue tram l:Sorrower (Line 120) 63;jf"."' 601. Gross AmOunt uue 10 ".IIe'lLlTle 4LUI I ,jUL. Less Amount r ala "y'ror "orrower (LITle :/:10) <l4, '002. Tess KeOUClIons LJue ".IIer (Line 020) II 303. CASH ( FROM)( X TO) BORROWER 20,620.13 603. CASH ( TO)( FROM) SELLER 0.00 OMB NO 2502 0265 "" The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments 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 STATE OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTKER CERTIFY THAT I EIVED A F TK D-1 SETTLEMENT STATEMENT. _'.~. / f ".. Borrower Seller "r<~1,( t::. '-,- C-r. (! ^ t~ L ~-- . ~t,"L~ RI DE. TO THE BEST OF MY KNOWLEDGE, THE HUD.1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WHICH R RECEIVED AND KAV EE OR WILL BE DISBURSED BY THE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS TRANSACTION. ) - eUlement Agent WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010. L. SETTLEMENT CHARGES 700. TOTAL lOuMMISSluN Based on Price $ @ % PAID FROM PAID FROM vlVls/on l , [;ommlSSJon (llnB IUU) as rOIlOWS: BORROWER'S SELLER'S IV'. , '0 fUNDS AT FUNDS AT IV<.' to SETTLEMENT SETTLEMENT IV~. vommlSSlon .....alO at ::settlement I/U4. '"UN""" -to 800. In,M~ "A Y ABLE IN CONNECTION WITH LOAN OU-I, Loan ungln3 Ion Fee % to ~IK~ I UNIUN MUK I GAG" ...U" MU~' L~N 1802. Loan D,scount % to I OUO. Appralsa, r ee 'to :;1 rv" ,uv.vv lou4. "reoOl Kepan -'a 10uo. Lenaer s Inspec"an ..ee - to ! OUb. Mongage Ins. App, ~ee -10 OU/. ASSUmp1lan ~ee - to ouo. ow, o.v. 0". 0'<. "'N" ..toto - to FlK:; r UNIUN MOl< I GAG~ OUU.UU 0'0. , to I AI" IAJ<. 10.VV 0". ,cvvu "toK "ro,,~ "v.H~~ to ~IK:;I 14.VV 0'0. " ,toto to ~IK:; I UNIUN MUKI GA"" .v" "U.VU 0'0. ~IK:; I UNIUN MUK I GA"" IIUN ...U" 10.VV 00/. .'ee to "K:; I UNIUN MUK I GAG~ ' "v", 1'.00 0'10. 01". O<U. 900.11 EMS KEQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10/11/01 to 11/01/01 @ $ 16.970000/day ( 21 days %) 356.37 :;IV":. IVIOr Lgage nsurance remrumror montns 0 I HUJ. Hazara, nsurance remrum or 1.U years to "V4. I"vo. 1000. t<E:;Et<VES DEPu:;1I ED WI' H LENDER 1UU1. Hazard Insurance 3.000 months $ 28.67 per month 86.01 11 V02. Mangage Insurance montns $- per month' 11UU.J. vltyfTown Taxes montns ~ per mamn 11UU4. L.oun y r axes 4.000 months ~ 16.06 per month r.l..J, I'VVO. IIV\ 4.000 months $ 76.50 per month 306.0C Ilvvo. mantns ~ per menm , 1007. ;j.UUU monms $ 02.50- per month 101.Ot lUVt. , ":;"KUVV months ~ per month -94.6, 1100. TITLE cHARGES 1101. Settlement or Closing Fee to 100<. IV", LE'III=K to oC O'.OV 1103. Title Examination to 1"04. Iltle Insurance Hinder 0 11105. uocument preparatIon to 1106. Notary ~ees o "A:;H O.VU 1107. Attorney s Fees to '-'. i ~. ;lIfESQ. 440.'0 f me uues BOove /lem numuers: 'IUO. me Insurance o THI-GUUN I ,. ABS I HAG I ,AG~NI t-'UL NC. J20.0U (mCluaes above Item numDers: ) 11 V". Lenaer s \Coverage ~ 04,UUU.uu O<U.UU O'UL: "L<' 0 I11V. uwners "overage ~ "u.uuu.uu "',. , I " lUV, OUU ANU O. o I KI-lOUUN" A":;' KALd IOU.UU 11,.. 1110. 1200. GOVERNMENT DING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 25.50; Mangage $ 55.50; Releases $ 81.00 l<U<. \CllY/"aumy ax/t1lamps:ueea ; Mongage 1 ZUJ. ~Ia[e I aX/::)Iamps: Kevenue ~tamps ; Moifgage 1<U.. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to -I,;)U,. rest lnspec Jon to 10UO. ,"^ ~ TION ~I=E to (A. , TAX COL. LVt 'IOU.. IU\CIV""K- to 'L! 'n" 110.Vt 1305. r MAIL FEES to TRI-COUNTY 14.,t 1400. I uTAL "ETTLEMENT CHARGES (Enter on Lmes 103, Section J and 502, Section K) 2,692.82 B si l1il1 eloflhlsslalement.thesi natortesaekl1ow1ed ereeei tofaeom letedeo o a e?o this two a estatement. y 9 gpag Page 2 9 p py pg P~I!~:h ENI P Certified to be a true copy. Settlement Agent (C08187-01/COB1B7-01 /7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CtJ ;( lel//f,r<J) 13LS REV-15Cl!:X + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY /J1. :V-ol- '-I'tJ FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F. (lAIC 1.3/1/VK / CE,(!7/F. pF DE! .# 313~O~oli(, 'i9Lf /N'T. /! {!eR. 7Ci D. ,t? b. ,t?!V /T€ /J1 ~ (~et: Idler Q~CHec/) 4... m EM !JE/{s FIRsr FEDE/t/l-t. (!,(!FDIT u.N/oN : ITEM NUMBER 1. .<. 3. 'I. s: DESCRIPTION VALUE AT DATE OF DEATH /91/ FNe)> -r;euc/(, Y"/N IFTC/(ILfll//11I'/I'IS"2.73 SOL.D 7P /Ut/l/-l -T /J10ZINOO (S~fIt~ruawl''''flfJr.c<~hLd) ~ 3, i/So.P() PNC .{J.4NI< / {!EtltlF. of D€/'. ,(f 313tJoO 8 79/' ~ .5;3tJ9.27 ~ ::l7. ~3 ? .s;, 30;T.2T ~ ;<. 7. ~3 /NT. -1co? 72? D.t:?L>. ,t?;1/ ItEm 2. a.) b.J I?r/ar r5aJ/'lS /kd: #' fpOOS3-,t?O )jeer. //It w do p.d M <to "lr 30.47 . '-5"' Ll~ SaV'/n;s .-f~d. #' futJo 5'3-i?4 ;leer. /1'It. Iz; do. 01. e:>n c. 1 .:l, 000. 60 Jr/. S7 e.) ct.) e.) e~rf;f. 4 D~. #' 6~05J-'I3 f) /I(!~r. ;/Ji w "'/'.t?d ",n e. I') h.) i,J /J /leer. 1'r1/ Iv d.o.d, on I. (see /elltfr A/lAched) /,f'mi? i' I~, 33'-. fig .#/3.97 (!erfJ pi /)ejJ. #- fu0053 -'1'1 AC'~r. /Ili ,z, dt:? eI. M ;. r!erf/f ,1 j)ep. # (Pt>{)S3-~5' /,f dip. 11 It), 93/. Lf? " II'. 2/ It!' mo. J' .2, ~ 't~. 33 .8 :3.77 7. F f. //I -r/Ul.5 T (q~ nr/ner.r _tI /J!erd1fJ/,1s Trust t1,~"'?): ti.j (!e,.f,:{ t7!' Dep. # p/~- d9~5 -<:'.2' 6.j /leer. /"f. ~ e/.P.eI. "'*' a. , 3,096.03 l' 61. 'fo TOTAL (Also enteron line 5, Recapitulation) $ 5Y, ISo. ?3 (If more space is needed, insert additional sheets of the same size) SCHED. ~ &/It'el. ,eST. t?F &/3I..E/ ~/CII/f-<lJ /VI.. 7. e. ClteeK:"!,hd # 33- I.fSIt;, d. -fur. ,"iff Iz, d.o.eT. dN e. ;;l.J - 01- l.J1$" .r .::lJ 83Z. z'l 1< z. Z<f ~~, '17S.I/ '11. 'lz fJ. '1. /0. 1/. /~. /3. 1'1-. IS. Ie, . e. CJ.uk:et Acid. '" 719- 300$3 f. .#eer. //It iT> oI.o.qI. on e. (S<u /en?r alfachul) P"1MMt of flro- ra-hd rea.! esf-. i...:xt:S, ~""'J ,,-1;;. Dn ~",I" ",f t?.../ Esf. C- G- U - Ib.rf-i 0./ 1( "~Lln eI Orl Home Ou.n~/s J.. n S ....... Parf,;,/ tfet4.ml e/ A:/v(I.oHa ~IHMt ~ C/wrc/' ",t 6.d Heme ~rf'A/ ~elu171 011 /!Id/iMP/ PI""n:/ .z;,Sur. f1,.ogr".., IM.me! r;..".., fJayntent n, UY'ot>I"Iica/ .n,sf-;-lu.1i !o/l1Ienf d~ on IJe!lIafllo.1iZA.h'o" "f ~M-h''''' -MSld: a.. ~6,./Mle"t on income k>< f",.. fUr .:looo /!I;alQlfMt en /11~ itx hr )'=r /199 ftrSOdtllf)' in t2hdab"'u1' ~ res;'t:H/lce Gee bhif al!ndreJ) , (. S T. oS- '74. .0 ~ Sl;O.DO !> ~e'.DO '"6. '(z .1<331.1. '{ J'~,. 2/ Jl' /'/.",1/ J' .;;, /"6./0 7.7At:. 'f _ 57; I~O. ~3 COBLE INVENTORY (HOUSE) DONE ON JULY 24, 2001 BY CHARLES E SHIELDS, III AND PATRICK COBLE MASTER BEDROOM $100.00 $100.00 $ 2.00 $ .50 $ 7.50 $ 26.50 $ .25 $100.00 $ 49.75 $ 4.00 $ .75 $ 35.00 $ 2.00 SPARE ROOM small wooden gun case 8 drawer dresser-wood table lamp clothes hamper small wooden table set of small end tables plastic waste can chest of drawers brass bed frame (headboard brass) two table lamps small lamp old window air conditioner anniversary mantle clock (broken and inoperative) $ 62.50 old china closet wi glass doors LIVING ROOM $ 75.00 $ 35.00 $ 10.00 $ 1.25 barrel chair-floral upolstery small backed chair w. Partial upholstery old VCR small magazine rack KITCHEN AREA $100.00 $ 95.00 $ 7.50 NV $ 3.50 small wooden table & four chairs--wicker backslupolstery refrigerator small hand-held kitchen appliances small oak chair (broken - no value) small lamp SUN ROOM $15.00 $35.00 $ 5.75 COBLE INVENTORY(continued) table wrought iron 4 chairs & 1 couch w/o any cushions 3 small lamps AUXILIARY ROOM $50.00 $60.00 UPSTAIRS $75.00 $10.00 $ 8.00 $ 2.00 $ .75 $27.50 $ .50 $12.25 NY $ 1.00 $ .50 $ .75 $ .60 $ 1.50 $ 2.75 $ 3.50 $ 4.50 $21.50 washer dryer vanity w/chair old kitchen table 4 metal chairs small wood chair old floor lamp old sewing machine sewing machine chair (beat up) old daybed 2 old single beds (sway backed and lumpy and unstable - no value) small end table small lamp small wooden stand small lamp small formica table small floor fan miscellaneous books, x-mas ornaments old dresser old desk and chair set CRAWL SPACE $6.00 old small cedar chest $2.00 2 old lamps $ .50 x-mas ornaments $3.25 old floor fan $ .75 old luggage GARAGEW A Y COBLE INVENTORY(continued) $10.00 $15.50 old barbecue grill old snowblower GARAGE LOFT $1.25 2 old folding lawn chairs $ .75 umbrella stand NY old fishing nets and inner tubes (no value) NY old bicycle (no value) GARAGE $ 60.00 $ 5.00 $ 8.00 $ 12.00 $ 50.00 $300.00 $ 10.00 $ 10.00 $ 8.50 $ 15.50 $ 15.00 NY $ 16.25 $ 3.75 $ .25 $ 75.00 $ 45.00 GUNS $ 225.00 $ 80.00 $ 50.00 -;;; T /!t. , ..:{, /.?6./ t? old upright freezer old upright refrigerator misc fishing rods and nets small workbench & miscellaneous handtools old table saw small lawn tractor old push rotary lawn mower table grinder 2 old kerosene heaters string trimmer small drill press old car top carrier (no value) old ladders old window fan old cooler chest old canoe old small boat Remington 1100 12 gauge Semi Automatic Two (2) Iver Johnson 12 gauge singles 16 gauge Foreign Db!. . ~~~/-c:9/ cf;?/ b:nd ~ or 2/~G'CZS &/~ &.70 ~c.c-.s / /67 A/, E~c/l ~a( c:6ddL~ ~ /7d-2...s; Ye..e'//-;y 7;?/;t?- :T A/ll/e' /E~AJ-4t::~ /4....5~C'/e.2'> /'P /97'/ ~..e.vM4h:;Ee ,..bC:'~o"u6/4J.G *' ~C;e ~ ~~ 4~ ~.:::/:E/E ~r- ~ ;/e/r/~,g /$ /AJ ~2> a~~d,u.. 7Ae CU/.::.y z::;e~eT...s fi/tJf7<:!E..D G..Q;yE7/~~ /,9..<"E /f' S..w.4'cC: 2)EAJ/ /;0 ~ ~/.c~/2":" /1 ~A1L.L- z;;e.,vr /~_ ?:!-e ~ .&~r~ A7M2J .-'f? ~-<.A.I &&!5E; .;;)E/lL ~T /:k' <::U/)e"C..J cZt:9C)~,ae ;k./{'/etc /.5 G!l&"oc;; $c?cZ; ~-e $3~.&J, aJ#/C!# h'i,e 7/le ~AJ.D/.n-';..v /s /? M/--c ~,e~.e/ ~?4'e, OEALERS CHoa AUTO SALES 187 N. ENOVt RD ENOLA. FlA ,,. 717 111 fiIJfID , " l' =R;~;~~~~~~-~~~~.~;~ m I ".~ -.. -ME iNCWDED ON MV-1A - TYPE OR PRINT MAKE CHE;CK PAYABLE TO COMMONWEALTH OF PENNSYLVANIA 4168-0805-8228@1998. Moore Document Solutions. All Rights AeseNed...o305 No. 6236826 o -~ -- -- -._-- ~ A. 0 .. "" "~ ." ~. , . B. . ~ . ~ c. ~ z . ~ . ~ ~ " . , . ~ . . PA TI~~9i J jH725;AC;?O TTTL~) MAK~;:;E VEHICj;;:J;:i";};; / H P' /II ~ ~?::: ~::::N 0 F~R lASTNAM~ORFULLBUSINE5::;NAME) ~~E /""'~,e T)'7'.e/(!A:::. CO-SEllER IM~99/ o POOR ADU::.INmAl LAST NAME (OR FUll BUSINESS NAMEl; ~/tJ 2/,rJtM CO-PURCHASER ..fRST NAME . ~t.-"''u MIDDLE INITIAl I~C~~~IAEOI ..;r; PU6_~/~"/ STREET /71' .;Jd-'!/,./U. ,e:d. crrAJ,c~d.dA~ h. COUNTY CODE 1 r -21/ ZIP CODe /7':?~() REFER TO COUNTY CODES J. Uen ~~ ~~ERSE SlOE Fee D. LAST NAME (OR FUll BUSINESS NAME) MIDDLE INITIAL I DATE ACQUIREDI I PURCHASED FIRST NAME " z . . ~ . ~ ~ ~ ~ 0 , ~ . 0 ~ E. ~o g~ :< ~~ F. CO-PURCHASER STREET COUNTY CODE 11 1 CITY SlATE ZIP CODE REFER TO COUNTY CODES 6, Transfer Fee USTING. ON REVERSE SIDE OF PINK COPY 11.GRAND TOtAL (Add 9 & 10) I REASON FOR REPLACEMENT I OLOST 0 DEFACED . I DNEVERRECEIVED (LOST IN MAILl NOlE.: If "Nl:VER RECEtVED" btock is checked a IVlN ....;. - S1GNATU~. OF P~~~N FROM. SIGN HERE 1 RELATIONSHIP TO APPLICANT ~~D~lfuEI~T~~~~i tJ I VEHICLE PURCHASED ~GVWR I UNLADEN WEIGHT REO. REG. GROSS WT. iii ~~ REO. REG. GROSS COMB. WEIGHT INFO. INCLUDING LOAD ' /\ WT. (IF APPLICABLE\ IF APPlICABLE) CJ INSURANC-5.COM!:"NY NAME, --"- i~OL1CY NO. lOR / /J > AA :"'J ~~. ...~.l!-CY EF~CT';:E POLlf':.EXPlRATION .'7'.P7',J; ~.<Aw imACHBINDER) ihY/e./V'Ii-_-,.-..<'/--v'i"'" M-~/~()/ DA,....-'~". . ISSUING I CERT1FYTHAT ON MONTH DAY.~YEAR-O.L=SSUINGAGENT(PRINT~~ _ _ d_i"'-? AGE~T d. AGENT I HAVE CHECKED TO DETERMIN~~T THE VEHICLE IS INSURED AND r ~/'" -~ INFOR- ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPliCANT IN E IG ~ TELEPHONE NO . ~ MATION COMPlIANCE WITH ALL APPLICABLE PROVISIONS OF THE VEHICLE COOE<:"I" -'C ~~.. 71!""':""A AND DEPARTMENT REGULATIONS ~ ~ IIWE CERTIFY THAT I/WE HAVE EXAMINED AND SIGNED THIS FORM AFTER ITS COMP\...ETION AND THAT THE INFORMATION GIVEN IS AND CORRECT IF AN EXEMPTION IS CLAIMED. THE PURCHASER FURTHER CERTIFIES THAT HE/SHE IS AUTHORIZEO TO CLAIM THIS EXEMPTION. I/WE ACKNOWLEDGE THAT l/WE MAY LOSE MY/OUR OPERATING PRIVIlEGE(SI OR VEHICLE AEGISTRATIONlS) FOR FAlLUAE TO MAINTAIN fiNANCIAL RESPONSIBIUTY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGISTRATION. IlWE ACKNQlNLEOGE THAT lIWE MAY BE SUBJECT TO;' FIME NOT EXCEEDING $5.000 AND IMPRISONMENT OF NOT MORE THAN TWO YEARS FOR ANY FALSE STATEMENT THAT I/WE MAKE ON THIS FOAM. 1ST ~~Ur;OfF7// rAUIh&'ile~r TELEPHONE NUMBER ~~~tur:;;-dJ~,r 7'1 4 ~~.... ~~~- signatulll'OfCCJIlNrch~fAutWb:edSigner 7/7 rt4.3;67/6 Signature of Co-Sellet I VEHICLE IDENTlFICATION NUMBER ! BODY TYPE (CP, TK, ETC.) I CONDITION I IDGOOO ORIGINAL PLATE II Ched< One o PLATE TO BE ISSUED BY BUREAU (PROOF OF IN- SURANCE MUST BE AT- TACHED.) o EXCHANGE PLATE TO BE == ~SUED BY BUREAU PLATE NO. , L..J' ~EMPORARY PlATE ISSUED BY FUll AGENT -- MAKE OF VEHICLE MOOEL YEAR o F~R o POOR o TRANSFER OF PREVIOUSLY ISSUED PlATE o TRANSFER & RENEWAL OF PLATE o TRANSFER & REPlACEMENT OF PlATE o TRANSFER OF PLATE & REPlACEMENT OF STICKER . Oz "0 zo Ilg ~iR ~. EXPIRES Month Year TRANSFERRED FROM IDLE NO. YBV63 03 8616065 G. z ~ ~ . . u Signature of Second Purchaser or Authorized Signer TELEPHONE NUMBER I I 2ND ASSIGN- MENT Sipnature of Co-Purchas8r/Title of Authorized Signer H. -' ~ . 0 ~~. g~~ ~ , PURCHASE PRICE (See note on reverse) LESS TRADE-IN TAXABLE AMOUNT 1. Sales Tax Due , .'1.061 m x7"!. .07 See noIe on nMJflle). ~=(~ be anumber,ftom'1' to 23 Of.'0) .' 1BFlrstAssiQrm'!eilt 2. Title Fee J4. Registration or Processing Fee Fee Exempt Number as assigned by the ....., 5. Duplicate Reg. Feo No,a/Cards 7.Ir\Cl'9aseFee 8. Replacement Feo TOTAL PAID (Add 1lhru8l Signature ot Saller Signature ot Co-Seller $ </Sj. dl) . I. . . gI/SJ.t14 . .4t?J.~ . I . .. 1QS9ccindAsa\gl:i~>,,:, ,;J,,:z.:>1J . . . .5? .~ . .. . . . . . . . . 9. &J/) 10. --':;Pf. . SeOO 0"" Check in This Amount . ~.~ o STOLEN licantmustc lete form MV.44. NOTE: If a co-purchaser other than your spouse is listed and you want the title to be listed as "Joint Tenants With Right of Survivorship" (On death of one owner. title goes to surviving owner.) CHECK HERE D. Otherwise, the title will be issued as "Tenants in Common" (On death of one owner, interest of deceased owner goes to his/her heirs or 8state). NOTE: IF THE VEHICLE IS BEING LEASED. CHECK THIS BLOCK _ Cd . 'F:. BLOCK IS CHECKED, COMPLETE AND ATTACH FORM MV-IL ,.(;^ rei, $(;;~ .,,"''0 0"'''' "'0..... :$ ..... n ",,,"0 c:;3>'" n...... ",-01" '" 'i~':, I; 1\1, '~\'.\- '. ....- o ',~\ r ,. .:~, ..n 4.sJ ',',\\]1 ~~ ~.~ .. 'V\ i."\ ... r,,:, .;;1u.-1" ~r ~"" ,~~ ,lfl JO ,~ - 1"'; :i - ','~ f"\.J ''''' l.... ~ ... ,', tr' -;....... \0 ',,1 '1.r" .,:\~ ,~ .. \ .:;, 1 ~ . . ~ ~ ~, (('CJ) '.. rT\ T\ -i -:c ':J"o () \~ >:J ...." ~;;;:-~. 01 ~....... >-,,~O...H' -:::I~ '& 0 \Urn ~ ~oo"OO\. ,?...."..... - :-...- ~'.?.:2. -"f1'\ ~'::-:i\JCf) :P J>~>'''C_~ ' --J...--$ %' , ~_' .\(1)_'-- P. L"- ,-- 0' ~ iJ'.:::n::: 1.0 ~.- Z GO o '" ~ ~ T '~ . ..... i 'ft ~...,~ ("l .....en '" :s:: o ... c:; -0 If> -;~ 00' .",.po ~'" ",15;;) '" 2,.- c ...- -z.'" 015;;) ~1SI 00 .r1* ",IS> ... '" ..... -< . - " o '" T ,~ ~ u At '" N ... -z. '" o :l> t z 0 ., $ $ - .1> .. '" (j) ~ .. <.J) . 0 ()i '; '" r0 r- r '" '" <;.i. 11> &.~ '"3 ... . g",~ C11 . tS(J . o , .4 - ~% IV '00 G '" ~,~ "'" ~ 9 .. '" ".. y;.. <> ... ~g . ~ ~ '~~ ",n 'S> . "':c c> . ':i~1 ",.,c <> .. ~ '" '...~ <i> ... "," U' ~ $ "," 0 GoD G ~ ",oD .. U'ao . ",IV . .JUL-12-~:E1C11 D'3:D9 F'HCBANI< C J F DEF'RF'TMErIT 412 705 0057 F'. 01./02 - ~ PNCBAN< Decedent Reporting Firstside Center P7-PFSC-4-F 500 First Avenue Pittsburgh, PA 15219-3128 /SCP July 11,2001 Charles E. Shields, III 6 Clouser Road Mechanicsburg, P A 17055 RE: Estate of Richard M. Coble, Deceased SSN: 204-03-0952 000: 5/1112001 Dear Mr. Shields: Please find the date of death balances you have requested listed below. CERTIFICATES OF DEPOSIT #31300087916 Established 05/14/1997 RICHARD M COBLE t'/ DaD Balance: 55,309.27 + $27.63 accrued interest #31000086994 Established 05/14/1997 RICHARD M COBLE DOD Balance: $5,309.27 + $27.63 accrued interest .['/ For Brokerage infonnation, please caIJ 1.800-762.611 J. Page I of2 A mel11ber of The PNC Financial ~rvices Group Cine- PNC. Plnn 249 FiHh AV~T1~lt P\Hsburgh Pl"nn5ylvnn.la lS2n 2707 .JLJL -1"2-213[1'1 [1'3: E'l9 F'HCBRHI<' CIF DEPRPTr-1EIIT 412 705 [1057 F' . [12."""02 0. PNCBAN< IRA ACCOUNT #6.5001016391 Established 051l7/1995 RICHARD M COBLE DaD Balance: $6,123.95 + $163.54 accrued interest For BeneficIary or IRA information please caU 1-888-PNC-IRAS Our office only provides date of death balances for IRA's, CD's, Checking and Savings accounts. We do NO Financial Transactions or Statement Orders. For Further iDformation please call1-800-4-BANKER or your local PNC Branch and ask to speak with a Financial Services Representative. Sincerely, ~_ ~-dft Rachelle Sciullo 1-800-162-1775 Page 2 of2 A member of The PNC Flnanc:i31 S~rvjres Group One PNC Plazd 14'3 Fi\l.h A\lenuc Pitt~bl.Jrgh Pc:nr1~ylvaniu 15222 2W7 TIJTAL F'. 02 MetnbersJ FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 LOUISE DRIVE P. O. BOX 40 MECHANICSBURG, PA 17055 1 -800-283-2328 or (717) 697-1161 June 7, 2001 Charles E, Shields, III 6 Clouser Road Mechanicsburg, PA 17055 RE: Estate of Richard M. Coble SSIN 204-03-0952 Dear Me. Shields, Enclosed is the information requested in your letter of June 1,2001 regarding the accounts held with Members 1" by Richard Coble, Mr, Coble did not maintain a safe deposit box with Members I", Effective February 1,2001, Members 1" revised our life savings insurance program which required a transfer of funds to a Life Savings Account, to be maintained solely for continued participation in the insurance program, Me. Coble elected to remain in the program and named Mae Coble as the life insurance benefits beneficiary. The actual Life Savings Account funds are held in a single ownership account and are payable to the Estate, Please allow 6-8 weeks for claims processing, Please do not hesitate to contact me at 795-5131 should you have any questions or require additional information. Dr .truly yours, " I _ l' r'-l-f' enise A, nde s Insurance Products Supervisor Enclosure MelllbersJ FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 60053 -00 07/30/1984 $830.47 $.65 $831.12 None LIFE SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 60053 -04 02/02/200 I ' $2,000.00 $1.57 $2,001.57 None CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Purchased Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 60053 -43 18 MO 05104/1999 ,;: ..-' $10,336.88 $18.97 $10,355.85 None CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Purchased Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 60053 -45 18 MO 12/03/1999 $2,696.33 $3.97 $2,700.30 None INSURANCE DEPARTMENT 5000 LOUISE DRIVE P. O. BOX 40 MECHANICSBURG. PA 17055 1 -800-283-2328 or (717) 697-1161 t~ tv 60053 -44 18 MO 1lI12/1999 ,;:..-' $10,931.49 $18.21 $10,949.70 None - 'AccounI opened by transfer offunds from 60053-00 fMBERS 1ST /~e~. Anders Insurance Products Supervisor Iune 7, 2001 Estate of: RICHARD M. COBLE Date of Death: May 11,2001 Social Security Number: 204-03-0952 TRUST July 20, 2001 Charles E. Shields III Attorney at Law 6 Clouser Road M~chanicsburg, PA 17055 RE: RICHARD M. COBLE Gentlemen: In reference to the above customer, our records show the attached information to be correct. Our total researching fee for the information we have provided is $20.00. Please send your remittance to the following address: Farmers and Merchants Trust Company ATTN Stacey Stenger 20 South Main Street Chambersburg, PA 17201-0819 Lf I may be of any further assistance, pl~ase contact me. Sincerely, f!:;;4 sC::ng~~ Operations Clerk PO. Box "T", CHAMBERSBURG, PA 17201-0819 Phone 7I 7-264-6116 . Toll-Free 888-264-6116 . Fax 7I 7-264-3415 RE: RICHARD M COBLE DATE OF DEATH 5-11-2001 ACCOUNT INFORMATION _CHECKING SAFE DEPOSIT SAVINGS ~CERTIFICATE OF DEPOSIT MORTGAGE DATE OPENED 7-20-2000 DATE CLOSED STILL ACTIVE ACCOUNT NUMBER 016 -2965226 ACCOUNT BALANCE AT DATE OF DEATH ACCRUED INTEREST $61.40 TOTAL ACCOUNT BALANCE S3.157.43 S3. 096.03 NAME(S) ON ACCOUNT RICHARD M. COBLE ------------------------------------------------------------------ ACCOlmT INFORMATION CHECKING X SAFE DEPOSIT SAVINGS CERTIFICATE OF DEPOSIT INSTALLMENT LOAN DATE OPENED 2-6-1997 DATE CLOSED 6-13-2001 ACCOUNT NUMBER 16-575 ACCOUNT BALANCE AT DATE OF DEATH -0- ACCRUED INTEREST NON-INTEREST BEARING TOTAL ACCOUNT BALANCE -0- NAME(S) ON ACCOUNT RICHARD M. COBLE , . RE: RICHARD M. COBLE DATE OF DEATH 5-11-2001 ACCOUNT INFORMATION ~CHECKING SAFE DEPOSIT SAVINGS CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 2-6-1997 DATE CLOSED STILL ACTIVE ACCOUNT NUMBER 33-18516 ACCOUNT BALANCE AT DATE OF DEATH ACCRUED INTEREST 52.24 TOTAL ACCOUNT BALANCE 52.834.53 NAME(S) ON ACCOUNT RICHARD M. COBLE 52.832.29 --------------------------------------------------------------- ACCOUNT INFORMATION x CHECKING SAFE DEPOSIT SAVINGS ____CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED ACCOUNT NUMBER 5-8-1997 DATE CLOSED 6-7-2001 70-30053 ACCOUNT BALANCE AT DATE OF DEATH ACCRUED INTEREST 519.92 TOTAL ACCOUNT BALANCE $6.495.03 56.475.11 NAME(S) ON ACCOUNT RICHARD M COBLE ------------------------------------------------------------------ ':"''''''':''''". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CtJl3LF /!I(!I!/I-/U> , SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY /J1. FILE NUMBER ;2. 1 - 01 - 'I'1S Th~ schedule must be completed and filed. the answer to any of questions 1 through 4 on the reve",e s~e of the REV.1500 COVER SHEET ~ yes. DESCRIPTION OF PROPERTY %OF ITEM INCtUDE THE NAME OFTHE TllANSFEREE. THEIR RB.ATl0H8If1P TO oeceDENT ~D THE DATE OFTRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH ACOPYOF THe DEED FORREAL ESTATE. FAPPUCA8L..E\ NUMBER VALUE OF ASSET INTEREST 1. ? f' PNC 13-1-#1<', ZR.4 AcC;. #h5"&70101("391 (", Id. 3.?S 10010 - 0- ([,,173.95" .:? /NrE/?E'Sr /fee-e 70 /). .!?~. oN /TE/J1 / ~ 1{,3.S'/ loot. -0 - ~ /,,~.S,/ (/iU I~ ff~r aH4cJ,~" ~ s;:h.d. E) 3. ~.GIe"Jr..ok L,'i An"u"1 # (;./1207 /f3 . ~ 7,,/"li.<;o /POk, -0 - 7, //,.,f. PI) b. G/&l6rook L;~ /lI/IIU'1y If ~.2{f'f2S , /~O~ . S; S'7't.6f -,p- s: 17'1.' y (S"e ~1krJ ,( 'J.24{.01 _,,/ /p./.../ 4,f4ek.e1) TOTAL (Also enter on line 7, Recapitulation) $ /'1, 33/.08 Ilf more cm::>>l"a. lei nOO/Vw'i lnc:Dri ::w1nltinn:::lI <::h~Cl nf thA ,::::.mA ~17R\ Glltnbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE A Member of Allstate Financial Group October 1, 2001 Patrick A. Coble 507 N. Lewisberry Road Mechanicsburg, PA 17055-6019 Re: Contract Number: Claim Number: Richard M. Coble GA284245 GA13894 Dear Patrick A. Coble, We, at Glenbrook Life and Annuity Company, are sorry to hear of your ioss and extend our sympathy. Enclosed please find a check in the amount of $1 ,963.75 for the proceeds payable under the referenced annuity. This payment is computed as follows: Annuity Value as of 10/1/2001 Portion Payable to You: Federal Withholding: State Withholding: Total Net Proceeds: $5,990.30 $1,996.76 $33.01 $0.00 $1,963.75 This annuity is subject to federal income taxes (on non-qualified annuities, only the interest earned is taxable). A 1099 tax statement reflecting $330.10 as your taxable income will be sent next January to assist you in preparing your tax return for 2001. The annuity value on the date of death, 05/11/01 was $5,874.69, this may be necessary for estate purposes. - If you have any questions or need further assistance, please contact me at 1-877-499-6418. Sincerely, Javier Salazar Life and Annuity Claims Enclosures '1 2Y' "i . . Glenbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE A Member of Allstate Financial Group J1.I!.I.l:,'K::.~;:;,I::l,I:::::J:: Patrick A Coble 507 N Lewisberry Rd Mechanicsburg , PA 17055 Re: Contract Number: Claim Number: Richard M Coble GA207183 GA13706 Dear Patrick A Coble, We, at Glenbrook Life and Annuity Company, are sorry to hear of your loss and extend our sympathy. Enclosed please find a check in the amount of $2,193.65 for the proceeds payable under the referenced annuity. This payment is computed as follows: Annuity Value as of 9/20/2001 Portion Payable to You: Federal Withholding: State Withholding: Total Net Proceeds: $7,312.15 $2,437.38 $243.73 $0.00 $2,193.65 This annuity is subject to federal income taxes (on non-qualified annuities, only the interest earned is taxable). A 1099 tax statement reflecting $2,437.38 as your taxable income will be sent next January to assist you in preparing your tax return for 2001. The annuity value on the date of death, 05111101 was $7,168.90, this may be necessary for estate purposes. ~"'._-" ----'-'.'...'- -,-.-._,,-- If you have any questions or need further assistance, pi ease contact me at 1-877-499-6418. atherine Haibrendt Life and Annuity Claims Enclosures REV-151tEX~(1-~l ~ ..~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Co l3 L E; If I C/-/ /Ill}) FILE NUMBER ;(,1-0/- "I'fS /II, Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 8. 0. 't. 10, II, j:(, DESCRIPTION 1. 2. :3. FUNERAL EXPENSES: rnyers F"lIera/ HOJ1/e Df /J7ec~jNJicsb,<r'y Rei",J,urse1Ylel1t Ii Palr/ek JI.. (j,j,le ~r fim/Iy /U"erA! ~1ti)uAI<'.. lfeimbuNe/1lent /0 r,.lndle opr/nus LUTheN'" Church lor r..~sJ,- ment$, eT.. G;n/rich h/emDr."ls !.r E"(j"a.v;"j 'f. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Parr."k JI.. e,61e Social Security Numberis) I EIN Number of Personal Representative(s) Street Address SP7 AI. LeJr/;s6errv /(d'. City /J1u.hAnicscur'l ' V .;?D02., State ;C' A Zip 17~55' Yea~s) Commission Paid: 2. 3. AttomeyFees Clluhs e. Sh:e/ols :or Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant AI tJAlIF Street Address 4. City Relationship of Claimant to Decedent Probate Fees Avla ori8i"a.1 issti.L. ot short cert:;;ca..f-QS State Zip 5. Accountants Fees J Gr",.n~WD...\+. ~ Co. f.,Y "",lensiv, wofl<: . rll......,..,J TaxRetumPreparer'sFees tUtd halSc~ w,ft.t ::rRSJe.tr. 'Uta WCr!<,'''j \.ul~ tu;cloc,uJ etc.) \le.c<u<s., of M~' RI;~J ....J.loY ""'<D"'l"I.t. h!.''''!' {"r 1fJ/af,'!/tJ/1,,/ ;JrPbll& he ",..I-lOpl. ytArS bak.... <le,,14. IfAvufiSi'}f ," {!tt,..cer!"na' ~.cHl JPttrn,,1 1I./..erHs/1f in ;JQTr;,f - /Yav.f' IIdd; h'pno.l ':;//01'1 eerl;;;'cafes 6. 7. L:/,.,t'f Cheek eo. - Cl,uXs ,(or IFs fam ch.cki"", .L- " ae.<.z. ])"'I//d Lu (],lle _ rei",/'"rse",."t ~, hi,:"! ;;,,. ;;:'nu....1 tS~e. ,g;II/,,~;;:;A/f #In''lItJ'z,,~ 770<<".,/ a#iIt.:hld): AMOUNT , /1'/. de ~ ..3 '0. co , U. fI '- 7S'. DO ~ 7, 907. S'f ~ ',92,-,03 tv~/VEP p~ fJj(E'Jl/UPT/At. A6~Ali;Nr. "1"3.5ZJ ,. 1,905'.f)O ;I7,{).tJO If 7.5",00 " 77. SZ .,.. 9.00 ~7,''I ? 850.95' TOTAL(Alsoenferonline9,Recapitulalion) $ .;{:3/ lol? 31 (If more space is neeced, insert additional sheets of the same size) :s eN EFi) _ II / t!M1t'd. EST 0": Cof3L-E") f(ICI-/.4/Cl> /If /3. /J1prK R. IMbed i ,#SS~(!s. - ,.feal Rdate Appraisal 1'1 ,(J~;",IJl{roement ~ C'ltri6h'ne {1,ble k- litjhl -h> lunuoal (;see ])dm e..,h-,Y "iN 6';//''7 -.#4ckd) It>. le;/ltI1t/r~dlenf ;4 elmJ (l,b}!;,r Mj4f 10 i::<m:n:J./ (see ~I.llhtvesl /1-,',- Miry _ 6;/1/"1 QfI;ulw~) I'. h;",/'.rwno,f It !l,-Ir,-c.K (},b/. h,r c=ts of- Cho..ng-i'l1 I()c.k.~ -Iz, s.c......re -fee premises. (sUo reee;pr.(;."lIJ H~ /Jtpot atfatkJ. ) 17. tV. h'Mal /:14170' :znsuraJJt:~ fi.7ram ~, /}7ary E. /lturror / ~ (j~ohr /1. i(ic-hanl Ii. dohle ,cunerlJ,! "?ravel ,fe/mburst!meat I dO. cjfJu If/l~rg!l ~/. S,r-irli :It? 7-"m IHcCurrf! I "'J?!~ /J!pwer5," test cf' /HPW;;j J~_ Gl'tI E~ Y :<1/. fJ1onro~ 1iwnd,/p ~er eita.rylS ~ - 'D.H. IMa..k ~ sP" . "{.,.e_, dl!(jJl;~ aMd Myj,;J h;"5 1M p.-ep -!by Sale. ~. 5prirll -i?7. Xr-o'l l7>'1e ~~rttF ~. c'st.s -I Fder4/ EX""~5S/1i lJ&d -Gr srafu.Y't!'s (;.2) To 7,4-L ';;"1-01- 4 'if> '.:ns.<<; , o~,~ V' ",S'7.~ ~,,"!.ss ~ 'f:? S, /X) ~Ji'l'l.{'3 JZ /,:(.? 3.DO JfC3'f. 98 /~-'1/) rr 3b.tXJ ~ <tJ'.0'f '1-/3:<.00 ;~0~.28 ;. b-7. j7J -11.30.00 ~g.OD T <<3. /b~. 37 NAVI' 225 Main Street Polson, Montana 59860 Phone: (406) 883-5222 Toll Free (800) 735-6472 Fax (406) 883-5238 INVOICE SALES PERSON: LB ITINERARY/INVOICE NO. 0022523 VXHYFM DATE: 11 MAY 0 P,;GE: 0,.~ THANK YOU FOR FAVORING US WITH YOUR TRAVEL BUSINESS. WE MUST PAY'THE AIRLINES EACH WEEK FOR ALL TICKETS ISSUED. WE WilL APPRECIATE RECEIVING PAYMENT FORYQUR TICKETS PROMPTLY. PLEASE REMITFROM THIS INVOICE TO: NAVIGATOR TRAVEL i::E~5 Mr.. IN STI'::EET POLGON MT :5'J86" FOR: COBLE/DAVID LEE ,;:m TIC!(ET':3 NW? :1.8 :I.l)91161.,"/,S~:; COBLE DAl):to LEE BILLED TO CA54'J0'J'J2'J07002'J47 O~j0. 'J~5' .......-'1.....1 041 SUB TOT,;L NET CC E< ILL. ItW B~S0n9~5 B~)0 n 9~:.i. TOTAL AMOUNT DUE 0.01.' REMEMBER YOUR ID AND PASSPORT IF NECESGARY. RECONFIRM ALL RESERVATIONS PRIOR TO DEPARTURE. TICKETS ARE NONREFUNDABLE AND NONTRANSFERABLE. CHECK VIRTUALLYTHERE.SABRE.COM FOR YOUR ITINERARY AND DEGTINATION INFORMATION. ITS COOL. THANKS PLEASE PAY FROM lHlS INVOICE THE HOME DEPOT 4120 6000 CARLISLE PIKE, MECH. PA 17055 JERRY M,OERSON l.jANAGER (717)795-9002 SALE 4120 00012 69547 11 308 08/24/01 08:27 PM i'''~' S; I"~' ~~~.@ 043156989065 KEYEO KN08 043156989065 KEYED KNOB 043156989065 KEYEO KNOB SUBTOTAL 65.61 TAX PA 6.000 TOTAL XXXXXXXXXXXX2021 OISCOVER AUTH conE 02453711120700 21. 87 21.87 21.87 65.61 3.94 $69.55 69.55 TA 1111111111111111111111111111111111111111111111111111111 4120 12 69547 08/24/01 9449 ORIGIONAL RECEIPT REQUIRED FOR REFUNO APPLY IN PERSON OR CALL 1-877-WORK-4HD SHOP ONLINE! AT WWW. HOI.\EDEPDT. cor., =- .- == - =-- . - ....... ~ TransactIons """""" trans. post date date - ~ Payment. and Credits Ap'23 Ap'25 CRACKER BARREL 340 JONESVtLLE t~C $ -23.87 ;;;;!!II Apr 29 Mayl CRACKER BARREL 431 CARLISLE PA .32.00 AI" 30 Ap,30 PAYMENT. THANK YOU -873.86 Merchandlse/Ratall AI'" 17 Ap,17 ECKERO DRUGS #2930 TALLAHASSEE FL 40.00 Ap'19 Apr 18 ECKERD DRUGS #2930 TALLAHASSEE FL 98.10 Apr20 Apr20 WAlMAfH STORE 001223 TALLAHASSEE Fl 13.92 Ap' 29 Ap,28 MECHANICSBURG AGWAV MECHANICSBURGPA 29.23 Apr28 Apr 28 MECHANICSBURG BEVERAGE MECHANICSBURGPA 18.50 May4 May4 PETSMART #0325 TALLAHASSEE FL 45.61 ol May5 May5 SMOKER'S EXPRESS CARLISLE PA 27.01 ~ May 14 May 14 SMOKER'S EXPRESS CARLISLE PA 28.68 ~ "q Re:ltaurants Ap"5 Apr 17 SONNY'S REAL PIT BRC TAl.LAHASSEE FL 10.82 ~ Apr 15 Apr17 APPlEBEES #85932295925 TALLAHASSEE FL 13.21 '" Apr 17 Apr17 APPLEBEES #95932285925 TALLAHASSEE FL 11.07 ~ Apr 18 Apr 18 AMERICAN CAFE #9999 TALLAHASSEE FL t 13.33 ." Apr 19 Apr19 SONNV'S REAL PIT BBO TALLAHASSEE FL 10.82 ... ~ Apt 20 Apr20 OUTBACK #1035 TALLAHASSEE FL 15.56 Apr2~ Apr22 CRACKER BARREL 044 TALLAHASSEE FL 109.18 AI'"23 Apr23 CRACKER BARREL 340 JONESVILLE NC 10.35 MayS May 5 OUTBACK #3921 MECHANICSBURGPA 32.21 Mav13 May 13 DENNY'S#1411 YORK PA 17.23 Gu/Automotive Apr14 Apr 17 TEXAC01 0524579220070 THOMASVILi.E GA 30.17 W,avelif'nwrtainmerrt May 11 May1' DEL TA00621 560142743 HUNTSVillE AL ! 5S6l11 AUTOMATIC FLIGKT INSURANCE NO COST SUpermarlcels Apr29 Apr29 GiANT FOOD #120 SI8 MECHANICSBURGPA 26.83 May5 MayS GIANT FOOD #112 SI8 CARLISLE PA 16.64 May 14 May 14 GIANT FOOD #112518 CARLISLE PA 17.31l Pt9aS. SN fof/OVling page fOr idoiticnal lnfotmaMcn.OuI.tlDRI' can 1~aaa..DIICOVl:R(1..'DG..U7~:!.'11 ar tDg an ta DI.r:ovllrcard.com C.hr\"t>n~"'c:> -\? \"~.\. ~~>\ll.~\ \ ~ ~ '" ~i~) .--rI STAPLE ~ +- - \ ~ ~ ~ \-IERE \ , \:i ~! ~ m . ~ ,~ (....cc~I-.., ~ ... ~~!t n"tlVlVl\:\ Iii .....S6i ~ C!,~" J)' ~~~ ~ ~!~ ~~ ~..~ :Pgj ~ Ud;'~ ~~ ~\o"IOWO ~ C ~\~~ ~~ '!'';''~~c ~~ ~ c ~ .,. ~i m OCIllI>lV;~i. ~~ r- ....r- ppQl~< ;:! ... ",iil", n '" ",,, . I ~ ~ Ilin'iilli e el l ~~ :Po -I -i - . ... % .. ",,, :P ..... I :<l' ,. m m ~~\~ ~ ~~ ! _ i ~ ~ ~ '" "l ....r- \::; \::; ,... ~, ;a ~ !Ft lfI -<jIfi i -I ';., ~ \ m '" '" ",'" ~ ~ ~ ~ ~ i ~ ;;l p ~ ~ , 0 1\~ il'" il'" ~ :;:; tl , \:\ 0 ...... ~, ~i .. -< ::l ... III ~i ;::'1< im i ! ~ ~l ~~ 0 ... !i ell i- ~;: .. '" g ell ~.. ... '" 0 ~ 1:\-0 '" 1" \i .... 1Il "~ - ..rn "'" ll\~ ~ <:!' ~ ~-; .!> -< ~ Iii r- ,... ... g ~ :;~ ~ ...1Il III - "'" im ell it r- ... ~-o ?! ~ .!> ...~ ... .. ~ 0 i~ .. ..., g21 ..., "'.... "'" - .... ..:I>' I>l ~~ ~!i6 ~ ~~ ~m .!> ~ ~ .,,11> i:C N ;j ...11> 14 '" ~S "'" 5 "'m ... m ~.... .. .!> S !" m ~z: -l ~ !l ~ C'l ~.... I>l Ii ... -m r> n % C!'! ~2 ~ ~ "':C ~ ~ g~ ~~- .. , i ~ 15;:t1 ~ ~m ;Ii jj\C"l -< .. ",rn- \ I '" ~l , i -.. rf.-' I ." ,n -0 0'" ~ -I ~~ .i4CS i '" r-lS :4. ~ ~ ... ." n~ C -. ~ !dS ~?~ I ~~ Ii! t;;l ... ~: r-1iI ~ m ... m n~ ~iiI m 6PLATINUM . ym.en .!leceiVed av July 6, 2~OI 1S'181 Q527 03 ll\ Make check. payable 10: AMOCO VISA Account Statement CUSTOMER SERVICE 800.254.9695 our c:oun um r InlmUM P"Yhlenl $19.00 asa :er moun 01 Pay...ent l!ncloM<l $ 'lour ,o'la. Balan.... $984.41 4271 1200 11699691 1\ 14 4271120011699691009844100019001120000 RICHARD E COBLE 006181 CHRISTOPHER R. COBLE . 2508 BEDFORD W'/ TALLAHASSEE, FL 32308-3802 1"/1",1;1"/1.11,,,1"1,,,11,1"1,11,",,1,111,"1,,1,,,11,1 Prlnl acIdr... ehanQ_ abov.. 6PLATINUM 05-11 05-13 05-16 05-17 05-17 , 05-20 05-20 05-20 05-20 05-24 05-30 06-01 06-01 06-04 06-06 05-12 05-13 05-16 05-17 05-17 05-20 05-20 05-20 05-20 05-24 05.30 06-01 06-01 06-04 06-06 ASSOCIATES ~ATIONAL BANK (DELAWARE) PROCESSING CENTER DES UOINES, IA 50363.2200 1,1.1,11"11111"11,",11'1,101.,1,11111111,,,1,1,,1 . PIUMdtlachh".. CUSTOMIR IIRVICIIOO.254.86H AcC:Ollnl: 4271 120011699691 SIlilm,mC10all"lgDltl: 00/1112001 CayslnSI!lirrgC'IC1.. 31 2 DALLAS CITGO 7 ELEVEN 32301 OVIEDO FL RUTTER'S FARM STRE #53 ETTERS PA BOILING SPRINGS GETTY BOILING SPRI PA BOILING SPRINGS GETTY BOILING SPRI PA TURKEY HILL 240 MECHANICSBURG PA KINGS MOUNTAIN TRUCK STOP KINGS MOUNTAI EXXONM08IL75 24331423 STAUNTON VA TEXACO INC 20641220252 KINGS MTN NC TEXACO INC 91002230785 MACON GA CITG07361 HOGLY WOGLY B TALLAHASSEE FL EXXONM08IL91 04716569 ORLANDO FL TEXACO INC 24679220070 THOMASVILLE GA PAYMENT - THANK YOU UNITED AIR 016216621B716 CHICAGO IL BIG TEN TIRES 37 ORLANDO FL $657. DO- $26.70 $20.70 $18.00 $16.69 $14.80 $44.50 $21.00 $20.00 $20.21 $25.50 $21.51 $15.50 $394.91CR $357.00CR $19.60 Prer 6...... $1.75 I Redeemed This I S""*"'" $0.00 Rebate Summ. E8lnedThia I ~IedThi8 Statement stalemenl $0.00 $0.00 AebA&esEarnedSil'lCfl 05/04 $371.38 ReboI, AvUblt $1.75 Amoco purchases or. your next statement wjJl haIJIi no financa charge jf yeu pay: $19.00 Aceount:Summ.ry QUick Reterence-., 07/06/2001 Prevoos BaIao<e 5751.91 +Pulchases lAdvll'I(:fIs 984.41 I .p,,,,,,,,, I 394.91 - Cledils I + FINANCE I CHARGE 357.00 0.001 Minimum Payment Due. $19,00 Due Date Fin.nee Cherg. Inform.tion I SamnctSubiecl Tcfln8l1C9Ch8rg4l METHOD; E' PUlCMsas CuhAdIWl:*! Dei. Penodic RIie- 0.035580 0,023280 Cctresponding I Annual PefC8fllageAllli 12.99\ 8.5Q1l,; $5,000,00 New Balance . $984.41 FilllftC8 ChIlIQ8 ANNUAL PERCENTAGE RATEt 12.99" Periodic Fil\llllCe Charge Talal Credit line Available Credit Line. $3,998.00 Available Cash U/1El . $3 ,750.00 -s~r~$l6I1lelQJ'CCl.TollllIBhcninlo~maIion. ""RallImII~wry CCFRM1 '12 YOtJrilCOOUlllhllllagriCQllOliod.$GQI'1I.....Suida. t Lr.;:il.ll. Pl!lilIdiCI Finaru Charge ard TrlW'A.Cbcn Chat9M (llIllJ!11bblel 64.293<1 REV1512EX.(19i1 ~ ~".. , - . . " COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ;( / C 1-/ Ill( j) /J1. FILE NUMBER CO{]LE1 ;2./-01- 4'95" Include unreimbursed medical expenses. ITEM NUMBER 1. :.I. 3. 1. s, {. 7 s: 9. ItI. If. 12. /3. /'I. IS, I'. 17. If'. 11. ~. ..2.1 :I~. DESCRIPTION &mt!psf &61e t!omctlst f1,/JteAst fAble &b1e AMOUNT 71 S. 3'1 1/9.,S"; ~ 3:1.93 .,. 78.37 ? 8"0.32- .,. '10. 33 JfI:1 'f. oJ' If S'IO.OO ~S4. 173 ?/of.75' " .:J.12.1!JD ".71.5. 0tJ " '13.0D ~ :2.'1.11 " 017. $lf , S<. 71 ? 3/.7/ ,. 7.12 It //.117 ,It 1'7.,ry 'Jfl/~.DO '/7=l.ti'h G-P U liE nerff ~ S.4.;oIe'y Eller:; y G-PU Ener1:! !J7tJnr(Je /P"N/l.fh'/1, Sep/er f?Prfer Iv. r;'cKe I/; /)'1.1 ;ns f,d/ seUler /,'ne, h()()k-~ e-ie. SJ1trlfl/T - tJhMe .so-n'u Nesf Shore E mUi'ency me"!"c",! Sery,'ca fJ. S. 7rUJ ur.J lor 7.....es dtu.;;'r .:<~O tI. S. -"Tru.JUI'Y fi,r 7.Ll< a due;;'r I q "f 9 I(,S. fn!ASItI'J Irfhcf'edh :In>f; of 1''''''''4. tk,d. ~f rebUts '" ff;v'J7, l"~ser"f1h'(Wi Sp'.;nt 41Mte /lltih'7ellent pf 6111ra/ ,4'WI'l. Wa!",.! /PDIIo", I?tid,'(JIi!JIJ YeU""" 4nu/'es NPu'Iy fl"Achee mollflt flell'f " f'tr,se"kr c;,.o"fJ H~C5 m...d.t:atS NI6 cS /J/...e/;cals TOTAL (Also enter on line 10, Recapitulation) $:2., 5fo 1. .;c. (If more space is needed, insert additional sheets of the same size) ""''''''.".:' ~ .~.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIV!NG PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMour,T OR SHARE OF ESTATE 1. Pafr"d< A. fubfe 5"7 N. LeW;5htrr.l ,f"ttd lYJuh4tIl'C$"U~!, ;?~ 17"S~ 56> Y7 Y.3 ~. /l,.c.ltllrel E. {';b1e /1./5 3 ~ckltys /J1etld"w LJrt"l/e Atu'!:, 5,0/'/1/5.. ~;tf /7t!>07 3. 2)41' __ "" Lee &.61e Son /:5 $"'..., )/3 /OO;? /~M A-I/~. E Iblscn, /JtT S9J'bo ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON.TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed. insert additional sheets of the same size) . CODICIL I, RICHARD M. COBLE, of the Township of Monroe, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this the First Codicil to my Last Will and Testament. 1. Inasmuch as my wife, PATRICIA J. COBLE, has predeceased me, I hereby revoke the appoint of an Executor and/or Executors as stipulated in my Last Will and Testament, and I do hereby nominate, constitute and appoint my son, PATRICK A. COBLE, Executor of this my Last Will and Testament, and in the event that my said son should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, RICHARD E. COBLE, Executor of this my Last Will and Testament, in his place and stead, and in the event that he should also predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, DAVID L. COBLE, Executor of this my Last Will and Testament, and in all instances, I direct that my - 1 . . '. said personal representatives be excused from posting bond or other security for the faithful performance oftheir duties in this jurisdiction or any other jurisdiction. 2. I hereby ratify and confIrm my Last Will and Testament dated January 18, 1974, in all other respects and to all intents and purposes not inconsistent herewith. IN WITNESS WHEREOF, I have hereunto set my hand and seal this I/o .#J day of February, A. D. 2001. d:rL_i rft/ ~ Richard M. Coble Signed, sealed, published and declared by the above-named, RICHARD M. COBLE, as and for a Codicil to his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. A-M__/ /2. 717 - 2 - .' CQDICIL I, RICHARD M. COBLE, of the Township of Monroe, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this the First Codicil to my Last Will and Testament. 1. Inasmuch as my wife, PATRICIA J. COBLE, has predeceased me, I hereby revoke the appoint of an Executor and/or Executors as stipulated in my Last Will and Testament, and I do hereby nominate, constitute and appoint my son, PATRICK A. COBLE, Executor of this my Last Will and Testament, and in the event that my said son should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, RICHARD E. COBLE, Executor of this my Last Will and Testament, in his place and stead, and in the event that he should also predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my son, DAVID L. COBLE, Executor of this my Last Will and Testament, and in all instances, I direct that my - 1 - , " said personal representatives be excused from posting bond or other security for the faithful performance of their duties in this jurisdiction or any other jurisdiction. 2. I hereby ratify and confirm my Last Will and Testament dated January 18, 1974, in all other respects and to all intents and purposes not inconsistent herewith. IN WITNESS WHEREOF, I have hereunto set my hand and seal this I/~ .#j day of February, A. D. 2001. d:rlu.~j eft! ~ Richard M. Coble Signed, sealed, published and declared by the above-named, RICHARD M. COBLE, as and for a Codicil to his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. x1M <'~/ /2- 717 -2- LI\ST WILL I\ND TESTAMENT OF RICHARD M. COBLE I, RICHARD M. COBLE, of the Township of Monroe, 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. All the rest, residue and remainder of my estate, real, per- sonal and mixed, I give, devise and bequeath unto my dear wife, Patricia J. Coble, absolutely and in fee simple. 3. In the event that my said wife should predecease me or should she die at about the same time as I do, such as in an accident common to both of us, then in such event, I give, devise and bequeath my entire estate, of whatsoever nature and wheresoever situate, to my three sons, to wit, Richard E. Coble, Patrick A. Coble and David L. Coble, share and share alike. 1,I\STLY, I nominate, constitute and appoint my wife, Patricia J. Coble, Executrix of this my Last Will and Testament, and in the event that my said wife should predecease me or should she for any reason be unwilling or unable to serve in such capacity, then in such event, I nominate, constitute and appoint my three sons, to wit, Richard E. Coble, Patrick A. Coble and David L. Coble, Co-Executors of this my Last Will and Testament in her -1- place and stead and direct that they be permitted to serve in such capacity without posting bond or other security. " IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,I S' day of January, A. D. 1971,. 0' .. " , ",;';~..c.c4~./': ;)t/ {/;:.I,6 L~ Richard M. Coble (SEAL) Signed, sealed, published and declared by the above named Richard M. Coble, as and for his Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence of each other. '-I 1/ ./:' /',/'/ / /' ./ t'r,--{)-r."l.,-/F- !' I t.V...A...... ./ [' , ~ (- .. j)<<~--kI1 , j-'j c_.' (-r:..~:;L..,'t.......- ,/ -2-