HomeMy WebLinkAbout01-0691
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of t=vC(.. 111. Roc..k, No. a-I- 0 L.=..b.5J
also known as To:
Register of Wills f9r the
Deceased. County of c.1.\ '1\\.10 ~ ,... ( d.....{ in the
Social Security No. I q 7 - 0 7 - S-.$ (;"( Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who i81"are 18 years of age or older ardhe executcrr~
in the last will of the above decedent, dated ,T4.A-IL 8'
ami eeaieil(s) dated
named
, 19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in
her last family or principal residence at
Lot-.... -, 'L S h ' -e oS
Decendent, then cr I y'ears of age, died
at .,.-tt 0/'(\ u.)d u- ( cL ~
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: ~c -......L
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
o ~ ..:2 ( , t9: ~ol ,
'"3>6 6 DO
,
$
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters --4-~ So +~ "" e.f\ tn. r'1
(testamentary; administration c.La.; administration d.b.n.c.La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF C-~ fW\ B IE ~LA .u h
/h'~~S~(~__.
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will we~minister the estate according to law.
Sworn to or affirmed and subscribed. '/J1L~ {; ~
before me this 24 t h day of ~ ~
ul ~
s:::
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N 21-2001-691
o.
Estate of
EVA M. ROCK
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW J u I y 24 t h ~ 20 q tn consideration of the petition on
the reverse side hereof; satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated June 8 th, 1979
described therein be admitted to probate and filed of record as the last will of
EVA M. Rock
and Letters TESTAMENTARY
are hereby granted to HELEN M. KOUGH AND MERLE E. SNOKE
FEES
Probate, Letters, Etc. ......... $ ~ 0
Short Certificates( 'P . . . .. . . . . .. $ J '2--
Renunciation ................ $
rc..t> ~ $ ~
oWAL - $ r1.~%
Filed. .July. .2.4th,200.1..... ~1.8.'S:
e.
egister of Wills Mary C.
~
lS ro ~..i () J' ++- ~ 2.1cf
ATTORNEY (Sup. Ct. I.D. No.)
V )J. ff~,\ ever Sf, Cdrl/sle ,P11
ADDRESS IrOI"]
'7/7- 2. f{3 -Ij!:'-7Y
PHONE
Call Attorney Broujos 243-4574
REGISTER OF WILLS OF CU.M~€"~LA IJD COUNTY
OATH OF NON-SUBSCRIBING WITNESS
21-2001--6Ql
/-I-<-(ef\. ~,.f(ou~ ~ r'Y\e,..le... t. 5Vl~~ ,
(each) a subscriber hereto, (ea~) being duly qualified according to law, depose(.8f and sayW that
~ e. y ~ familiar with the signature of E va. f?t t ~l) <L
o;~
testat~ of (one of the subscribing witnesses to) the ~ presented herewith and
codicil
that ~ believe~ the signature on the will is in the handwriting of
E V a. !l1. R 0 <:...k
to the best of ~~~nowledge and belief.
Sworn to or affirmed and subscribed before
me this 24 th day of
July ~ ~2001
M~~---- - /~!5f
I~ /n(~a!fIL
/51;;L r (0a(t\u t- 8o-Ht:J~ ~-_ Mewv,'lf-e
~ f' (~~ flIT 1/2'/1
(Name)
']00 W. ~Q.,''l. ST- III )e.r"v...i Bc~, PA
(Address) I 7 "'L(o ~
REGISTER OF WILLS OF Cu."",-ber/Q~q COUNTY
<:: OATH OF NON-SUBSCRIBING WITNESS
'.....
'"
"'-.,.
_ol "',
" (~ "'. "
(each) a subscriberhereto, (eac"h) being duly qualified according aw, depose(s) and say(s) that
"-'~amiliar with the signature
", . / codicil
testat of (one of the subscri 'ng witnesses~) the will presented herewith and
/' codicil
that b 'e~ the signature on the will is in the handwriting of
"
"'-".
to the best of
Sworn to or affirmed and subs
me this /
'~,
"', (Name)
(Address)
Register
(Name)
(Address)
IOS.80S REV 9/86
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
Fee for this certificate, $2.00
p
7498830
L.<3 ?e9.t7/
V Date /
21-2001-691
.... 2JV
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT IF.... _. L_
EVA
ROCK
I'ltI ~ *-II
SOCIAl. SECUllfTY ~
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- 1 o.y.
Cumberland
...
DE DENT'S USUAL ClCC\lfIIVlON
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" Head cafeteria Cook
DECEllENT'S MAIUNG AODAESS (SIr...~. Sl*.lipCode\
Lot 1172
Shippensburg Mobile Estates
~ Shi ensbur Pa. 17257
-"''bh: ;ie':"li l._1 J ami 80n
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"~sl~(T11':""" Kough
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I, Eva M. Rock, of R. D. #8, Box 76, Chambersburg, Pennsylvania 17201, being of
sound and disposing mind, memory and understanding, do make, publish and declare the
following to be my last will and testament, hereby revoking all former wills and
testamentary papers by me at any time heretofore made:-
ITEM 1. I direct my executors, hereinafter named, to pay all my just debts and
funeral expenses as soon as possible after my decease.
ITEM 2. All the rest, residue and remainder of my estate, real, personal and
mixed, of whatsoever kind and wheresoever situate, I give, devise and bequeath to my
children, Helen M. Kough and Merle E. Snoke, in equal shares.
ITEM 3. I make, constitute and appoint my children, Helen M. Kough and Merle E.
Snoke, executors of this my last will and testament, and direct that letters testa-
mentary in my estate be granted without the requirement of bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my last will and
testament, tyPewritten on one (1) sheet of paper, this 8th day of June, 1979.
rS~ 7r}
d( B-C~ (SEAL)
Signed, sealed, published and declared by the above named testatrix, Eva M. Rock,
as and for her last will and testament, in the Presence of us, who, at her request,
and in her presence, and in the presence of each other, have hereunto subscribed our
names as witnesses thereto.
Rr4efh.~
~iJ)9. ~Q/P/l~~)
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CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Eva M. Rock
Date of Death: June 21,2001
Will No.: Admin. No.: 21-01-0691
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
July 26, 2001:
Name
Address
Helen M. Kough
Merle E. Snoke
1825 Walnut Bottom Road, Newville, P A 17241
300 W. Main Street, Walnut Bottom, P A 17266
Notice has now been given to all persons entitled thereto under Rul
Date: July 26, 2001
none
John H. Broujos, Esquire #06268
4 North Hanover Street
Carlisle, P A 17013
(717) 243-4574
Capacity:
Personal Representative
X Counsel for Personal
Representative
Family Settlement Agreement
THIS is an agreement entered into this c2 3 day of April, 2002, by and between Helen M.
Kough, of 1825 Walnut Bottom Road, Newville, PA 17241 and Merle E. Snoke, of300 W. Main
Street, Walnut Bottom, PA 17266, Beneficiaries and Co-Executors of the Estate of Eva M. Rock,
Decedent, whose names are set forth as signatories at the end of this agreement.
WITNESSETH:
A. Eva M. Rock of 172 Shippensburg Mobil Estates, Shippensburg, P A 17257, died on June
21,2001.
B. On July 25,2001, Letters Testamentary were granted to Helen M. Kough and Merle E.
Snoke at File No. 21-01-00691 in the Register of Wills Office for Cumberland County,
Pennsylvania.
C. Executors have administered the estate until the present time and have paid all debts of
the estate, including inheritance tax owed.
D. Decedent died testate, copy of will attached hereto, providing for the residue of
decedent's estate to pass to her two children, whose names are subscribed hereunder.
E. The assets of the estate are set forth in Exhibit A attached hereto and made a part hereof.
F. Executors have paid the debts of the estate as set forth in Exhibit B attached hereto and
made a party hereof.
G. There remains to be distributed to the beneficiaries the assets set forth in the Schedule of
Distribution in Exhibit C attached hereto and made a part hereof.
H. The parties desire to forego a formal account and schedule of distribution and desire to
conclude the estate by virtue of filing of this agreement.
NOW, THEREFORE, the said parties intending to be legally bound set forth the following:
1. Executors of the estate of deceased need not file a formal accounting or schedule of
distribution.
2. Inheritance Tax was paid.
3. The parties agree to distribution of the assets in accordance with Schedule C.
4. The said beneficiaries designate this statement as a "satisfaction of award" and hereby
authorize and direct the Clerk of Orphans' Court to mark satisfied of record any award which
may subsequently be made by the Court with respect to the distribution made to the distributees
in this Agreement.
5. The said beneficiaries acknowledge that this Family Settlement Agreement shall be filed
with the Clerk of Orphans' Court in final settlement of the estate of decedent Eva M. Rock.
IN WITNESS WHEREOF, the said beneficiaries, intending to be legally bound hereby set their
hands and seals the day and year first above written.
WITNESS:
J~~\J ~~r:f-
~)1..K~L
Helen M. Kough
1825 Walnut Bottom Road
Newville, P A 17241
~t -4,LdL
Merle E. Snoke
300 W. Main Street
Walnut Bottom, P A 17266
COMMONWEAL TH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
On this, the J 3",.( day of April, 2002, before me the undersigned officer personally appeared
Helen M. Kough and Merle E. Snoke known to me (or satisfactorily proven) to be the persons
whose names are subscribed to the within instrument, and acknowledged that they executed the
same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal.
L~_(}rco~
Notary ubhc
Notarial Seal
Bridget Ann Corcoran, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires June 10, 2002
EXHIBIT A - ASSETS
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. 1980 Derose mobile home 14' x 70'
Shippensburg Mobile Estates, Lot # 172, Shippensburg, P A
(net after costs when sold)
2. 1990 Oldsmobile Ciera S Sedan, VIN: 2G3AJ54NOL2316697
3. Household furnishings (net after auction)
TOTAL
INHERITANCE TAX TREATMENT
Joint with Helen M. Kough, daughter:
1. CD#61084, M&T Bank
2. CD#72629, M&T Bank
3. *Checking Acct. #968048, M&T Bank
4. *Savings Acct. #1500420010929
M&T Bank
Date of Death
Value of Asset
$ 6,700.00
20,000.00
1,460.85
14.860.98
%of
Decedent's
Interest
50
50
50
50
TOTAL
$43,021.83
* Used by co-owner to pay decedent's expenses
$ 6,983.29
1,200.00
995.80
$ 9,179.09
Date of Death
Value of
Deed's Int.
3,350.00
10,000.00
730.43
7.430.49
$21,510.92
EXHIBIT B - DEBTS AND DEDUCTIONS
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
FUNERAL EXPENSES
1. Fogelsanger-Bricker Funeral Home
2. Rev. John Scheir-Hanson - funeral service
3. Centerville Memorial Garden - digging grave
$ 6,913.00
100.00
400.00
B.
ADMINISTRATIVE COSTS
1. Personal Representative Commissions
2. Attorney Fees - Broujos & Gilroy, P.C.
3. Family Exemption
4. Register of Wills - Probate Fees
-0-
1,500.00
-0-
78.50
C.
MISCELLANEOUS EXPENSES
1. Register of Wills - Inventory
2. Register of Wills - Inheritance Tax Return
3. Register of Wills - Family Settlement Agreement
10.00 -
15.00
17.00 -
D.
MISCELLANEOUS DEBTS
1. Thornwald Home - nursing care
2. Carl Ocker - appraisal of household items
2,178.43
75.00
E.
MOBILE HOME EXPENSES PRIOR TO SALE
1. Kough's Oil Service - heating oil
2. Sprint - phone
3. Adams Electric - electricity
4. Aquameter - water bill
5. Shippensburg Mobil Estates -lot rent
157.43
101.66
131.39
16.51
386.00
TOTAL
12,079.92
Inheritance Tax
837.45
TOTAL DEBTS AND DEDUCTIONS
$ 12,917.37
EXHIBIT C - DISTRIBUTION
Assets
$ 9,179.09
Debts and Deductions
12,,917.37
Deficit. Insolvent Estate
( 3,800.00)
Estate Checking Balance as of 1.31.02 = $9,188.45
(from sale of mobile home, car, and household furnishings and interest)
(available to divide since $16,000 in DOD ckg and savings was used to pay $13,000
expenses)
DISTRIBUTION OF INTEREST IN CD'S
2 CD's as set forth in Exhibit A:
Minus advance distribution of matured CD, divided equally
Balance - maturity June, 2003, to be divided equally
Interest. As accumulated to date of distribution, divided equally
$ 26,700
20.000
$ 6,700
In accordance with joint ownership of CD's in decedent and Helen M. Kough, with right of
survivorship, all funds pass to Helen M. Kough. By agreement, Helen M. Kough conveys (of
her interest) to her brother, Merle E. Snoke, one-half of the principal and interest as a gift.
. .
I, Eva M. Rock, of R. D. #8, Box 76, Chambersburg, Pennsylvania 17201, being of
sound and disposing mind, memory and understanding, do make, publish and declare the
following to be my last will and testament, hereby revoking all former wills and
testamentary papers by me at any time heretofore made:-
ITE>! 1. I direct my executors, hereinafter named, to pay all my just debts and
funeral expenses as soon as possible after my decease.
ITEM 2. All the rest, residue and remainder of my estate, real, personal and
mixed, of whatsoever kind and wheresoever situate, I give, devise and bequeath to my
children, Helen M. Kough and Merle E. Snoke, in equal shares.
ITEM 3. I make t constitute and appoint my children, Helen M. Kough and Merle E.
Snoke, executors of this my last will and testament, and direct that letters testa-
mentary in my estate be granted without the requirement of bond.
IN WITNESS WHEREOF', I have hereunto set my hand and seal to this my last will and
testament, typewritten on one (1) sheet of paper, this 8th day of June, 1979.
($th:u 7-r)
dr ~lo-/ (SEAL)
Signed, sealed, published and declared by the above named testatrix, Eva M. Rock,
as and for her last will and testament, in the presence of us, who, at her request,
and in her presence, and in the presence of each other, have hereunto subscribed our
names as witnesses thereto.
f2 L1h.~
~Jv9. U-'~/L~~)
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
BROUJOS JOHN ESQ
4 N HANOVER ST
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 197-07-5351
FILE NUMBER: 21-2001- 0691
DECEDENT NAME: ROCK EVA M
DATE OF PAYMENT: 09/21/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/21/2001
NO. CD 000296
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: HELEN M KOUGH
C/O JOHN BROUJOS
CHECK# 4273
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
$1,000.00
MARY C. LEWIS
REGISTER OF WILLS
/i-~L/$"-/~~
\ BUREAU OF INDIVIDUAL TAXES
\I INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG I PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT I AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-29-2002
ROCK
06-21-2001
21 01-0691
CUMBERLAND
101
JOHN H BROUJOS ESQ
BROUJOS & GILROY
4 N HANOVER ST
CARLISLE
.02
1\iIAY -3
f,:I."
,i-d J
:~zo
*
REV-lS41 EX AFP (01-02>
EVA
M
c;:,
P A Q.'l!t)fl~
Allount Reid tted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
R"Ey=is4j-i3fAFP--foi-:02i--NOi"-ici-OF-YNHEifiTiNCi-YAX-jrpPRAIsii'-ENT~--AirowANci-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ROCK EVA M FILE NO. 21 01-0691 ACN 101 DATE 04-29-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
9,179.09
21.510.92
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage liabilities/liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
9/033.50
3.046.42
Ul)
(2)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this form with your
tax payment.
30/690.01
12.079 92
18/610.09
.00
18/610.09
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of line 14 at Spousal rate
16. Allount of line 14 taxable at Lineal/Class A rate
17. Amount of line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
US) .00 X 00 = .00
(6) 18/610.09 X 045 = 837.45
(7) .00 X 12 = .00
(8) .00 X 15 = .00
(19)= 837.45
TAX CREDITS:
. ~.. ._n . IU:"'I:.Lr I " {+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-21-2001 CDOO0296 41.87 1/000.00
TOTAL TAX CREDIT 1/041.87
BALANCE OF TAX DUE 204.42CR
INTEREST AND PEN. .00
TOTAL DUE 204.42CR
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
/b-2//S-/~
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-1607 EX AFP (01-02)
'OZ JUL-1
:U7
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-28-2002
ROCK
06-21-2001
21 01-0691
CUMBERLAND
101
Allount Rellitted
EVA
M
JOHN H BROUJOS ESQ
BROUJOS & GILROY
4 N HANOVER ST \.,
CARL ISLE PAC1'1lJ!3
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=i61fj-ix-AFP-fol-:02i-------...--iNHERITANc'E--fAx-s;-;ffEMENf-oF'-ACCOliiff--...---------------------
ESTATE OF ROCK EVA M FILE NO. 21 01-0691 ACN 101 DATE 05-28-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARV OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAVMENTS1 THE CURRENT BALANCE1 AND1 IF APPLICABLE I
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-22-2002
P R I NC I PAL TAX DUE: ...........................................................................................................................................................................................................................
837.45
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
09-21-2001 CDOO0296 41.87 1,000.00
05-06-2002 REFUND .00 204.42-
TOTAL TAX CREDIT 837.45
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IE IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00
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" (CRJ1
YOU MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
CJ/
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Eva M. Rock
Date of Death: 6-21-01
Will No.
Admin. No.
21-01-0691
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account/statement with the
Court? Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes X No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be
attached to this report.
Date: 5/28/02
f'''''l
John H. Broujos
4 N. Hanover St., Carlisle, PA 17013
717-243-4574
r-
fr)
Capacity:
Personal Representative
.~.-
~~
C'-J
P
- --
.,,) c~:
~ Counsel for Personal
Representative
REV1SOOE)l+(t-97)~
COMMON:~~YLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG PA 17128-0601
OECEQENrS NP.JJ,E \lAST, FIRST, AND MIDDlE INlT\.lIl) use a blank bIoCklD)~~.~~.
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
2 1
COlwrv
I-
Z
W
o
W
()
W
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R 0 C K E V A M
SOCIAl. $ECURIlY NUMBER DATE OF DEATH
1 9 7 -0 7 -5 3 5 1 o 6( 2 1/2 0 0
26/1910
lH1S REnJRH MUS"! BE FIlED IN 1lUPUCA1E W1TlllHE
REGISTER OF WILLS
S 1. Original Retum D2.SupplementalRetum o 3. Remainder Retum (dalllddeatllpriorto 12.13-82)
o 4. Limned Estate 0 4a. Future Interest Compromise t""'~""''''''12.12~21 0 5. Federal Estate Tax Retum Required
W 6. Decedent Died Testate (Attach copy of Will) 0 7. Decedent Maintained a Living Trust (AIla:h copy ofTrusij ..Q 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 010. Spousal Poverty Credit tll*ofdeath belween 12-31-91 and '.1-95) 011. Election to tax underSec. 9113(A) (Attach SchO)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND;cONfIDENT1AL TAX INFORMATION SHOU\-D BEPlRECTED 10:
NAME CC>>.lPlfTE MAlUNG ADDRESS
4 N. Hanover Street
Carlisle, PA 17013
(IF APPLICABlE) SURIJMNG SPOUSE'S NAME (lAST, FIRST, AND MIOOlE IMTlAl) SOCIAl SECURITY NlJ.lBER
v
/ 6-c:Jy:5-- /~
o 1
o 0 6 9 1
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1. Real Estate (Schedule AI (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation,Partnership or Sole-Proprietorship (31
4. MOrlgages & Notes Receivab", (Schedu", D) (4)
5. Cash, Bank Deposits & Misce\laneous Personal Property (5)
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6)
~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
,.J (Schedule G or LI (7)
::l
I- B. Totat Gron ~a..ts (lotll Lines 1-7)
ii:
<l: 9. Funeral Expenses & Admin~trative COSls (Schedule H) (9)
0
W
0:: 10. Debls o! Decedent Mortgage Liabilities. & Liens (Schedule I) (10)
11. Total Deductions (totll Lines 9 & 10)
c
.
9 1 7 9 0 9
2 1 5 1 0 9- 2
9
3
(B)
0 3 3 .5 0
0 4 6 ,.,4 2
(11) ,,< . '(
",.,.,
(12)
(13)
d
N
3:
"'-,
;0
U1
-0
l.J-J
-""
30,690.01
,]!,
')i
1 2 0 7 9 9 2
1:,..,
1 8 I 6 1 0 9
J'
1 0 !l.' 0 9
12. HelValue of Estate (LineB minus Line 11)
13. Charitable and Govemmentall3equeslslSec 91131rusls for which an election to tax has not been
made (Schedule J)
14. NeI Vatue Subject to Tax (Line 12 minus Line 13)
15. Amounto! line 14 laxeble
at the spousal tax rate
See instructions on
16. Amount 0lline14 taxable
at 6% rate
17. Amountolline14 laxeble
at 15% rate
(14)
(15)
.o'tS"'
.all
.15
(16)
(17)
(18)
4 5
x
x
St., Carlisle, PA 17013
Decedent's Complete Address:
STREET ADDRESS
172 Shippensburg
CITY
Shipp ens burg
I STATE
PA
I ZIP
17257
I
I
I
Mobile Estates
Tax Payments and Credits:
1. Tax Due (Page 1 Line 18)
2. Credits/Payments
A. Spousai Poverty Credit
8, Prior Payments
C, Discount
(1)
837.45
1. 000.00
41.87
3. InteresVPenatty if applicable
D, Interest
E. Penalty
Total Credits (A + 8 + C} (2) 1,041. 87
4,
Totai InteresVPenalty (D + E) (3)
If line 2 is greater than line 1 + line 3, enter the difference, This is the OVERP.'" YMENT.
Check box on Page 1 Line 19 to request a refund (4)
It line 1 + ilne 3 is greater than iine 2, enter the difference, This is the TAX DUE, (5)
A. Enter the interest on the tax due, (5A)
8, Enter the total of Line 5 + SA, This is the BALANCE DUE, (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1 , Did decedent make a transfer and: Yes
a, retain the use or income of the property transferred; """", """""""""""""""",,,,, """""..,0
b, retain the right to designate who shall use the property transferred or its income; ",,,,,,,,,,,,,, 0
c, retain a reversionary interest; or.."""""""..""""""""""", ..""..""......""..."""..",,,,, ,,,,,,,,,,0
d, receive the promise for life of either payments, benefits or care? "....""""..""""""......."",, 0
2, If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death occurred
alter December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ""''''''''''''''''''''''''''''''''''''"""""""""",,,,,,,,,,,,,,,, """,,,,,,,, 0
3. Old decedent own an "in trust for" or payable upon death bank account or security
at his or her death?"""""""",,,.,,,,..,,..,,,,.,,,,,,,,,,,,,,.,,,,,,,,..,,,,,,,,,,,,,,, """",,,,,,,,,,,,,,,,,,,,,, 0
4, Did decedent own an individual retirement account, annuity, or other non-probate property? "" 0
204.42
5.
No
G'
@
G-
[3'
(M-
~
72 P,S. ~9118 (a) (1.1) (i) prOVided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or alter July 1, 1994 and before January 1, 1995,
72 P,S. ~9116 (a) (1.1) (iI) provided for the reduction of the rate imposed on the net value of transfers to or for the use olthe surviving
spouse from 3% to 0% for dates of death on or alter January 1, 1995. The statute does not exempt a transfer to a surviving spouse
from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse
is the only beneficiary,
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Please answer the followin9 question by placing an "x" in the
appropriate space,
Did the decedent create a trust or similar arrangement which is solely for the surviving spouse's benefit for his or her entire
lifetime? Yes 0 No ~
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second
spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on
Schedule J, Part II, in order to remove it from the calculation olthe tax due in this estate. You may wish to file Schedule 0 in order to
make the election available under Section 9113, If the election is made, the trust or similar arrangement is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies), If you choose to make the election, you must
attach Schedule 0 to a timely-filed tax return, along with Schedule(s) K and/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies),
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Estate of Eva M. Rock
File Number 21-01-00691
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
1980 Derose mobile home 14' x 70'; VIN: C21333
Shippensburg Mobile Estates, Lot #172, Shippensburg, PA
(Sold for $8,500. Net after costs attached)
$ 6,983.29
2.
3.
1990 Oldsmobile Ciera S Sedan, VIN: 2G3AJ54NOL2316697
(Kelly Blue Book value and copy of deposit record attached)
Household furnishings (appraisal attached with net after expenses)
1,200.00
995.80
TOTAL
$ 9,179.09
~
U.S. DEPARTMENT OF 110USING AND URBAN DEVELOPMENT
A. HUD-1 UNIFORM SETTLEMENT STATEMENT
B.. Type of loan
1.( I FHA 2.1 I FmHA 3.[ I Cony. Unins. 6. File Numher ,. lo.:m Number
4.lIVA 5.[]Conv.lns. -.-.. -~- I I f n Ilemsmarked
C. NOTE: This form furnishes 9 slatement 01 setllemenl costs Amounts paid 10 And by !he sell,lemen agen are ~\10W -
fl(p 0 C r were paid outside Ihe closing; they are shown 10f inrormati~_'_~rposes and ene Ilollnc~~ded In Ills 1011'1 s. .
o NarTJ6 & Address or Borrower: E N~letAdr:lrer ~ l1N olSeller: F, Name & Addre!\s 01 Lender.
. Erln R. :,t1~~f'] 1 ~s a f' 0 ,va HOCK
~Tohn '''. RU8fH'll l~fii~~nSbUrg ra 17257
":\10 "'-. ('r8n",;(,-:::t ':;hr.g. r - . .
I ,"r-SeUlemenl Agen!'
G. Property location:' I1N or Seller" __=-=--=-.___
172 SME r'1;:Ice of Selllemenl
Shipp('nsbUrfr, Fa 17257 Sai1hamf'r Rr>a1
(OMB'2502.0165)
6. MOIlg~ge Insurance Case Number'
109.
110.
111.
112.
113.
120. Gross Amounl Due from Borrower
200. Amoun18 Paid by or In Behalf of Borrower:
201. Oeposils or earnes! money
202. Prindpal amount or new loa"(s)
203. Existing 108n(s) laken subjed 10
204.
205.
206.
207.
208.
209
Adjustments for Ilems unpaid by seller
aid by seller In advance
10
10 12131/
10
10
t t Sailhamf'r R~a1.F.sta.~p, Inc.
F~ a ~,Inc ,,', "", '.: " ,
L SelllelTlenl Dale: l August 2h, 2001
K. Summary of Seller's Transaction
400. Gross Amount Due to Seller:
."""".,.~.~."..._ __ -'-_ . j""O" eo
'102 Personal Propelly ____
- ;j~~--- - - - ----= --- ' ~
_>10>1 ___ _ _
'05
- ~_ ~dj~~ents'foritm~ajdbyseilMiiiadvance
OC >106. Cilynownlaxes e/~ 10
POC ' ~O'.- Counly lal(es B/Zlf701 1012:31 0
.108. ^ssessnmnls 10
.109 10
-----,------_._-
"0
----------
"11.
~1r.---
- --- ~13--
1r;)'nrr:-niT' 420.--GroS9 Amounl Due to Seller
500'Reducllolls iI1Amount Dugto'SCller: -
-Ino. no- 50T Excess-deposii.('See1risiit,cikinSj-----
502, Sel1lernent charges to seller (line 1400)
OO:lExl5ling loan(S} laken subjeclto
-"------..--. - .....--- 50::f- Payorr of Ilrst morlgage
505. Payorr of second morlgage
506 -.---.~ ---
507
------..-..-..-.-
500
--------- -------.----.-
509
Adjusllmmls ror ilems-unp;ld by sello;---
510. Ciiy/lowll !a~es __m_ 10
511'CoUllly'\flxe;-'-' -~-~------ I~----~=
512.-^~s;ssmer;T;;-- 10 H
--------.-..-
10
J. Summary of Borrower's Transaction
100. Gross Amount Due from Borrower:
101. Contracl sales prke
102. Personal Property
103. Borrower's setllement charges 0ine 1400)
104.
105.
Adjustments for Items
106. Cily/lown laxes
107. Counly lal(es ~/211l01
108. Assessmenls
POC
POC
<f.Jou:<J1J
T-555~
>","'"
'-...
210. Cllyllown laxes ~-. -1--'
10
2 f I. County lal(es 10 ----
212_ Assessmenls 10
213. ..- -
10
214 ------
215.
216.
217
2IB
219. ~----
220. Total Paid By"or Borrower llO:rm
300.
301.
302.
303.
513
51>1
515
51fi
51,'-----.-------.-'. ..-----.-
-.._----- --------.----,,'.
516
519
--- 520. TolalReducuon Amount Due Seller ,_..~
Cash at Settlement From/to Borrower 600. Cash'it SeUlementTo/froll1 Seller --
Gross amount due from borrower (line 120)~B' 500:'00 60T Gross amounl due 10 seller (line >120)
less amounts paId bylfor borrower (line 220) - '--=~.oo~'n. a G.02.--.iess.reduCIiOn? in amount due seller (Hne 520)
Cash ~ from UtoBorrower ---n.~__~~~.:._7i~_6~~~~~!___E__.'.?_D!~om Sel~__~
_".5550 00
rr;)OD.OO-
1 . 5)):7)0-
IS.<lrr--
Substitute Form 1099 Seller Statement
The inronnallon In Blocks E, G, fl, I g line <t01 (or. if line >10 I is flslerisked. line <t03 and <11)1) is hnporlanl I,,~ inrormation and is being
rurnished to Ihe Internal Revenue Service. If YOII elf! reQlliled In ~h'! f1 relurn. a !<<Indion will 1m imposed 011 YOII ir this ilem Is feqllif~d 10 be
reported and Ihe IRS delermines Ihal if has no! been repoded If Ihis lell! 8!;:lalp, is your Ilrillcfrml re!;:ideilce. file Form 2119. SnlR or
Exclu:mge of PrillCipRf Residence, for any gain. wilh YOllr incollle lax relurn: for olher IranSBclion!\. complele Ihe applicable pllll!> of Forrn
4797, Form 6252 and/or Schedule D (Form 10>10). You are required 10 provide Ihe Selllernenl Agenl (named above) wilh your coned
lal(payer IdenlJncation number. If you do nol provide Ihe Selllemenl Agp,nl willi your taxpayer Idel1lffic"Uon nUl11bm. you may be sllbJedlo
civil or criminal penalties Imposed by law. Under renallies oJ perjury. f cellify IIml Ihe number shown on III;s slatemenl Is IflY cOffed
taxpayer ideflli~caUon number
-.- -. (SeHe~:s Signalure,-
,
L. Settlement Chal'fln '/. Paid from PaId from
700. Total SalesfBroker's CommIssion: (based on prl(:e) Effort @
Bookmark not
defined.
Division of Commissioo nine 7001 as follows: Borrower's Seller's
701. a llham~r Rpa1 Fstatf'. TnC Funds at Funds 81
SeUlement Selllemenl
702. 1.'00 00
703. Commission naid at Seltlement
704.
800. Items Payable In Connection with Loan
801. loan Onalna\ion Fee %
802.. loan Discount %
803. Aooraisal Fee
604. Credit Report
805. Lender's Inspection Fee
806. Mortgaoe lnsurance APPlicallon Fee
607.
808. -
809. --
610.
81l. ..
812. -
613.
814.
900. Items Required by lender to Be Paid in Advance par day
901. Inlerest Irorn to all $
902. Mor1gaQe Insurance Premium for months 10
903. Hazard Insurance P'emlum faT years 10 ,
904. ye~'ITs \0
905.
1000. Reserves Deposited with lender
1001. Hazard insurance monlhs @ $ per month
1002. Mor1!:lage insurance monlhs @: $ per monlh
1001. City property taxes .(."(,, monlhs @l $ , per month
1004. County prooerty tal(eS ~,. months @J $ per month
1005. Annual assessments ," months~ $ Jl:61 month
1006. months@$ .~mont!\
1007. SC h oor1l'151l.79
~arry N~g.J..{'Y- Tax t;ol.JJ'C'"tor . Poe
1009.
1100. TItle Charges .00
110 I, SeUlemenUclosing fee
1 102. Abslraclllilfe search
110:t Ti\le examination . .
1104. 1ille inS\lfance binder -
1105_ Document preparaUon -. .
1106. Notary fees .
. 1107. Allorney's fees .- .
(includes above item numbers
1108. 1i\le Insurance -. _.
(includes above Item numbers -- ..
1109 Lender's coverage .. .
1110, Owner's coverage
1111,
1112
1113.
1200. Government ReCordl" and Transfer Charges
1201. Recording fees; Deed Mortgage Release
1202. Cily/county tax/stamps; Deed "'.- C.!..':'.I, , Mrntgage
1203. Stale tax/stamps: Oeed ,~.", Morlgaae -
1204. -.
t205. Commonw~alth 01 pa 2 .SO poe
1206. Sollf'nbElre:E'.rs F~E'! ; 2 .00 . poe
1300. Addit!?n_I_Se~l~~f!'!!..fh.rql!=!' ----,-----.-- ------ ..
1301 Survey -
1302. Pesllnspection -
1303.
1304,
1305.
1306.
1307
1308. f--..
1-400. Total Settlemtmt Charges (This Number Transfers to lines 103 & 502 Ab~ I, ,S.,.OO
CERTlFlCA TlON
r l1ave carefully levlewecllhe HUD-l Setuemenl Slalemerll and 10 the best of my l<:"owled~ ami bel\e-l it is a true ;on" accur;lte statement of all receipls find
d;~X-mez a On my aceD r by m~n lhis tr3nsac\lQn I further cartilY lh..ill ~ve rl!Ce;~.~ ~o~~he HIIO-l Sf!Ulement Slatemenl
_ ~. Se"er ~~ _~_",-----____Borrower
o Sellel ~~^ fV) (LO __ 80"0_1
T(llhe best of my knowfedge lhe HUO.! $elllemenl Slaleme....l whi<:h I hitvOi!! P'0i!!1l9fed i~ tl\lf'! and accutate ar;coufll or 'he funds whicl1 were received and
h:!l'll! \reen 01 <Ni" be diSbursed by lhe undersigned as part of the selllemenl of this t'llnsac\;on
Se111emenl^genl
Dale
WAAN\l'<<3 "'" 8 ",1m" lo~"""""'V, """'.. r_ ~81...-.,o 'hor u...,"" 518'''' "'" 0." 0< 8"" _ ..~"'" ""'" r~n~n;~" 'If"'" "",>vIr;l;",,'..n """'.o:ln. 0.-- ~"" '......t.......""". r",
....,.~...... '''''' '~\l $
Corlf!5<Od"" '00' """S8d'''''' '010
.",
....2.- 2-fi -() I
;~
"
D
ij
;~
:j~
"
~
PLEASE BE SURE TO DEDUCT CHARGES THAT AFFECT YOUR ACCOUNT
~
PLEASE- BE--SURE TO -oE"()UCfcHA)::lG-ES - THAT AFF-Ecr-Y-OUR ACCOUNT
------------------- ----._-_._-
;-I~~ -~;-(.j;lT-.---- ]1------ ------.- - -------
:;~~..:' ~ofJi I. ().11r 1\ ,.,U\;.', Iii', Cb(R:PW~!J
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Page I 01'2
tI'
" JteUey Blue Book
. ... 'bu.rom - ....'" ,,, ON buY"
~#~
5/tU;7 /l' kfVA- tF~
1.1 t11 C t-Ic-V flq L r.;:7'" Copyright C 2001 by KeHey Blue Book Co., All RIghts ReserlecI. lu....lwg 2001 EdItIOn. The Informatlon In this report was printed
r' from the Kelley Blue Book Web site (www.kbb.com) and Is Intended for the personal use of the customer only and may not be sold
or transmttted to al\Other party. We assume no respon$lblllty for errors or ornlsslons.(v.Ol070)
My Blue Book
New Car Pricing.
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~~::~~a~ll~;:'~;yjr'~~
ClidtontheimaQ8ablwE1tovisltthiS~
Blue Book Trade-In Report
Pennsylvania. July 25, 2001
1990 Oldsmobile Ciera S Sedan 40
Engine: V6 3.3 Uter
Trans: Automatic
Drive: Front Wheel Drive
MIIeege: 61,300
~. a New Car
Flo<:1 a New GM Vehide
Buv a Used Car
List YOJJ.I CaLfor Sale Online
Financina Quote
1l1.surance Quote
Warranty Quote
PqYrn~nt~!!l\':JJlatPI
Equipment
Air Conditioning
Power Steering
Power Door locks
Tilt Wheel
Cruise Control
AM{FM Stereo
Cassette
ABS (4-Wheel)
Consumer Rated Condition:
Good
"Good" condition means that the vehicle Is free of any major defects. The paint, body and Interior
have only minor (If any) blemishes, and there are no major mechanical problems. In states where
rust Is a problem, this should be very minimal, and a deduction should be made to correct it. The
tires match and have substantial tread wear left. A clean title. history is assumed. A "good" vehicle
will need some reconditioning to be sold at retail; however major reconditioning should be
deducted from the value. Most recent model cars owned by consumers fall Into this category.
Trade-In Value
$1,400
Trade-In value represents what you might expect to receive from a dealer for thiS consumer owned
vehicle. Keep in mind that the dealer must then absorb the cost of making the vehlde ready for
sale, advertising, sales commissions, arranging financing and Insurance and standing behind the
vehlde for any mechanical or safety problems.
Now get a ,1JJ>.\"Ll&L.mk.r: report of the car
you are thinking about purchasing next.
http://www.kbb.oomIkblki.d1l/kw .kc.ur'lkbb;203355&;t&278;Oldsmobile; I 99O"/o2OCiera& 12:0L;ffi
7/25/01
CARL E. OCKER
AUCTIONEER
4401 Philadelphia Avenue
Chambersburg, PA 17201
(717) 264-6578
Personal Property Appraisal fur
Eva Rock Estate
Lot 172 SME
Shippensburg, P A ] 7257
4 PC MAPLE BEDROOM SET".. ,
JEWELRy"".........,....".".."".."........ ..
DRESSER W/2 MIRRORS"."..,...
3 SWEEPERS ..................
6 DRAWER CHEST.."....
POTSlPANS".... ..,,,...,,,,'......
2 PC LIVING ROOM SET
RECLINER.. ........ ...."....... ...".. ..
LAMP STAND. ........ "......".
2 POLE LAMPS ....
COLOR
2 END TABLES .... ........"..."..
WALL SHELF & CURIOS...
COLOR TV."... ...."......,,,,
STEREO. ..."... ..........
CHINA CLOSET ......."....
GLASSWARE & CURIOS."..."
3 PC BEDROOM SET...."..."..".
CEDAR CHEST..... ........".......
LAMPS ......"..... ... .............."..
,.."".".....200,00
...........20,00
..."..25.00
......,,,.........5.00
..........15,00
..10.00
.... ........."...".... .. ................100.00
.. ...."....... ..... "...... ... .................75.00
.....5.00
".10,00
15,00
,.. ".."........... ....... .........."........ ...10,00
......... ....,.. ,,,..,,... .............10,00
."...... ............. .... .......,15.00
......"....... ,.., ........... ...15.00
..... "........... ...25.00
-~.....~_ _ROO
..... ....".... .. .. ........".....100.00
........."...".................... ... ........." ..50,00
...."...... .. ....".. ...10.00
TOTAL...._"."....,,,,,,,.,,,.,,,,.,,...,,,,..,,....,,.............,,,,..,,..............,,""""""""""'"'''''''''''''''''''''''' $750.00
I, 00 HEREBY CER 11FY that I have examined the tangible personal
property of Eva Rock Estate, Lot 172 SME, Shippensburg, PA
And do value and appraise the same at $750.00 as being litir rnarl<et
Value of said property on this date oOuly 30, 2001
'IlgUlol CarlE.Ocker {L(J~~
Appraiser
Date
. ~~:~r~~J~~~,...~~.,_._~?'.-:>:?:~:~:,~;:_~.'-:~--:~'"'.
CARL'E.<.QGKER':" OWNER,.
Ct-lAMB.E~SBUAG. PAH201
qATE.
.'-~-':,/<'<F.r'~'-^r.;.,:---,"::".~_..~~-'~._--- ~~:';";;':'-_' .-.-: -:_-: . ,:;', '
"'.:; -,-:OET4CH 'AND RETAIN THIS SrArEMENT
. , . ~D,cKEckis 1M P,""""ENT OF I"TEUS t>ESCRIBED bELOW
IF-r:t~t~RA,",r;f. 'PlEJ.sE NonFY us PROMPTl. 'f. NO ~ECEIPT DESIRED
_ _..__..~~. _,..c.-......-,,-._ ,__,--'_-~,~"".
4c~-.A '-~~6'W
DESCRIPTION
AMqUNT
CA-~
,
gross
less 35%
net
1532.0p
536.20
995.80
SCHEDULE F
JOINTL V-OWNED PROPERTY
Estate of Eva M. Rock
File Number 21-01-00691
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Helen M. Kough
1825 Walnut Bottom Road
Newville, PA 17241
daughter
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NO. TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
'Io0F
DATE OF DEATH DECD'S
VALUE OF ASSET INTEREST
DATE OF DEATH
VALUE OF
DE CD'S INTEREST
2.
3.
A
50
$ 3,350.00
10,000.00
730.43
1.
A
6-24-85 CD#61084, M&T Bank
10-11-87 CD#72629, M&T Bank
$ 6,700.00
20,000.00
50
A
1975 Checking Acct #968048
M&T Bank
1,460.85
50
4.
A
1975 Savings Aeet #15004200109294
14,860.98
50
7.430.49
TOTAL
$21,510.92
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Estate of Eva M. Rock
File Number 21..01..00691
ITEM
NUMBER
DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES
1. Fogelsanger-Bricker Funeral Home
$ 6,913.00
2. Rev. John Scheir-Hanson - funeral service
100.00
3. Centerville Memorial Garden - digging grave
400.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions -0-
2. Attorney Fees - Broujos & Giiroy, P.C. 1,500.00
EIN 23-2267691
3. Family Exemption - 0-
4. Register of Wills - Probate Fees 78.50
C. MISCELLANEOUS EXPENSES:
1. Register of Wills - Inventory
2. Register of Wills - Inheritance Tax Return
3. Register of Wills - Family Settlement Agreement
$ 10.00
15.00
17.00
TOTAL
$ 9,033.50
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
Estate of Eva M. Rock
File Number 21-01-00691
ITEM
NUMBER
DESCRIPTION
AMOUNT
1. Thornwald Home - nursing care $ 2,178.43
2. Carl Ocker - appraisal of household items 75.00
MOBILE HOME EXPENSES PRIOR TO SALE
3. Kough's Oil Service - heating oil 157.43
4. Sprint - phone 101.66
5. Adams Electric - electricity 131.39
6. Aquameler - waler bill 16.51
7. Shippensburg Mobil Estates - lot rent 386.00
TOTAL
$ 3,046.42
SCHEDULE J
BENEFICIARIES
Estate of Eva M. Rock
File Number 21-01-00691
NUMBER
NAME & ADDRESS OF PERSON
RELATIONSHIP
TO DECEDENT
AMOUNT OR SHARE
OF ESTATE
A.
TAXABLE DISTRIBUTIONS
1.
Helen M. Kough
1825 Walnut Bottom Road
Newville, PA 17241
daughter
y,
2.
Merle E. Snoke
300 W. Main Street
Walnut Bottom, PA 17266
son
y,
B.
NON-TAXABLE DISTRIBUTIONS
None