HomeMy WebLinkAbout01-0805
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Scott A. Hake
also known as
No.
, Deceased
Social Security No. 179-44-7595
Bobbette L. Larson
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
D A. Probate and Grant of letters Testamentary and aver that Petitioner(s) is/are the execut
the Decedent, dated and codici~s) dated
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
[!] B. Grant of letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name
Beverl Roxanne Hake
Danielle Nicole Hake
Dau
Dau
Residence
107 E. Front St., Lewisberr
107 E. Front St., Lewisberr
(COMPLETE IN All CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with hislher last family
or principal residence at 9 Railroad Avenue, Borough of Shiremanstown, Shiremanstown, PA 17011
(list street, number, and municipality)
Decedent, then ~years of age, died 06/21/2001 at Borough of Shiremanstown , PA
(location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl 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
s
s
s
s
500.00
situated as follows:
Bobbette
826 Acri
T ed or rinted name and residence
L. Larson
Road, Mechanicsbur , PA 17050
Prepared by the Pennsylvania Bar Association
rrr~96~73tware only CPSystems,lnc.
Form RW-1 (1991)
..
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
~~~-~~~
e L. Larson
No.
~ , -- 0 t::1lJ)S--
Estate of Scott A. Hake
Deceased
Social Security No: 179-44- 7595
A1A6.u~ T L.. g
Date of Death:
06/21/2001
AND NOW,
, 1100/
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary 09 Of Administration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Bobbette L. Larson
in the above estate and that the instrument(s) dated
Letters. . . . . . . . .
$
described in the Petition be admitted to probate and filed of record as the last Will of De
~.OO
$_15 OC)
/5 DO
FEES
Short Certificate(s). ~
Renunciation.
3--.
$
Attorney:
James D. Bogar, Esquire
Affidavits ( $
Extra Pages ( ) . $
Codicil . $
JCP Fee . $ \5 .00
Inventory. $
Other $
TOTAL. $ 5300
I.D. No:
PA 19475
Address:
One W. Main St.
Shiremanstown, PA 17011
Telephone: 717 /737 - 8761
Prepared by the Pennsylvania Bar Association Copyright (e) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
T_"n".~n.; T),T:'\' C'I~(,
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fIling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7387134
No.
~~ J!,Jo~ i
Local Registrar ~ (
9/J.u.L4 ~{)(} (
Date
HI05144Aev 1/91
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
TYPE/PRINT
IN
PERMANENT
BLACK INK
~
w
fa
u
w
o
i)
w
,.
"
z
~I~/.J.I
SEX
.. Male
A
Hake
STATE Fl\..f NUMBER
SOCiAL seCURITY NUMBER
3. 179 44
DATE OF DEATH IMonth. Da)', Yearj
June 21, 2001
BIRTHPlACE (Cilv and PLACE OF DEATH (Check only 008 see inSlfuctlOl1son OltlQ( SIde)
Stale or FOf&IQIl COllnlly) HOSPITAL:
Mechanicsbu.rg, 'Opal." 0
...
l&el and n\Kllber)
0Kl
_odO",
IIl/e In a
Cumberland _1 lld.12'l :.::::'':''.::::'.,
MOTHER'S NAME (Fifm, Middle, M8Id8n Surname)
It. Elnora E. Frey
INFORMANT'S MAJi.INQ ADDRESS (Street, Cilylbwn, State, Zip Code)
9 Railroad Ave Shiremanstown. Pa. 17011
PlACE OF DISPOSITION. Name 01 c.m.ery, Cremalory LOCATION. CiIyITown, Stale, Z-Ip Code
or OCher Place
9 Railroad
""'5 DECEDENT EVER IN
u.s. ARMED FORCES?
V.. 0 No !XI
1.
Pennsylvania
11b, Count
Jun 27,2001
1..
LICENSE NUMBER
FD-012662-L
Aesidenc:e M g-="YIO
AACE . AmeriCan Indilrn, Biadr., White, etc:
(SpecIfy>
White
'D.
MARITAl STATUS. Married
~ Married, Widowed,
DiwM"ced(Specily)
Divorced
SURVIVING SPOUSE
(II wile, grve maiden name)
17c.D V.I, dec<<lenllived in
'..
Shiremanstown
cilylboro
81. John's Cemetery
Camp Hill, Pennsylvania 17011
21d,
3b. 23c,
W'tS CASE REFERRED 10 MEDICAl EXAMINER/CORONER?
""iJ
Ap rx. DATE PRONOUNCED DEAD ~Monm, Day, Year)
'4. 11: 00 P. .. n. June 22, 2001
27. PART I: Entef Ihe diINIn, injunes or complicalione whICh ceused U'I death. Do not enter the mode 01 dying, such es cardiac or respiratory arresl, shock or heart lailure.
LiSt onl~ one cauM on each line
P n i n
DUE 10 (OA AS A CONSEQUEN OF):
DUE 10(00 AS A CONSEQUENCE OF):
DUE 10 (OA ~AS A C;:ONSEOUENCE OF):
d
WERE AUTOPSY FINDINGS
""'ILABLE PRIOR TO
COMPLETION OF CAUSE
OFOEATH?
MANNER OF DEATH
DATE OF INJURY
(MOIlm, Dav. Yea.)
Nalural
Homicide
o
)Q . ....
O PlACE OF INJURY. AI home, farm, IlrMl, laclory, otllCe
building, etc. (Spoclltl
3...
o
o
o
v.. ~ NoD
No Oil
Accident
Pending InvestigallOn
_0
Suk:ide
...
Could not be delelmlned
Da, alb.
CERTIflER (Ct'J8do;. only one)
-CERTIFYING PHYStcIAN IPhYSlCian ctHlitylllQ cause at death when another phySICian has pronounced Uoolh gIld ,,;olllp!elOO IIl;11l1 23)
To the.... of' Ift,~. death occurNd dull 10 the ell"M(') and manner.. .la1eCl, . , , , , . , , . .
.PRONOUNClHGAHD CERT6FYING PHYStClAN (PhysiCian both pronourcing death and certifying 10 cause 01 cJealh)
To 1M"'1 oIlD' kno...., dHIh occurred....... UInlt. date, and pleca, Ind clue 10 1M cauM{.) and mIInMr.. ....ed., .......,......".",..
-MEDICAL EXAMINER/CORONER
On tha buIa of ~n end/or Inv..Upl:Ion. In my op6nfon. d..u. occurred a1th.tlme. data, and plac.. and due to the clUM(.) end
fDanner a. aIaIed.. . , , , , , . . . . . . . . . , . . , , , , . . , . . . , , . , , , ,.. , . , . . , , . , , , , . . , , , , , . , . . , . . . . , . . . . . , . . . . . . . . . . . . . . . . , . . . , . . .
31a.
REG'
NoD
...
!==""
1001&1 and death
1
PART II:
Other 89'ilicant conditions contributing to dftIh, but
ROC relulling in the ~ying ca.... given in PART I.
INJURY AT WORK?
Coroner
o
OR'E SIGNED (Month, Day, Year)
o 3. . 31d. June 25 2001
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(ltem27)TypeorP,int Michael L. Norris, Coroner
~ 6375 Basehore Road, Suite #1
.,... 32. Mechanicsburg, Pa. 17050
ORE FIlED (Month, Day, Year)
34.
RENUNCIATION
o?t-OI-O~05-
In Re Estate of
Scott A. Hake
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Beverly Roxanne Hake, adult daughter
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Bobbette L. Larson, sister of deceqent
WITNESS
my
hand this
~
J.O day of
~~ . 19 2001
.......-----
(Signa
Beverly Roxa Hake
107 E. Front St., P.O. Box 357
Lewisberry, PA 17339
(Address)
(Signature)
(Address)
(Signature)
(Address)
2/-0t-Og05-
RENUNCIATION
In Re Estate of
Scott A. Hake
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Danielle Nicole Hake. adult daughter
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Bobbette L. Larson, sister of decedent
WITNESS
my
handthis ~ daYOf~~ ,~2001.
jjATiP~ ~
(Signature)
Danielle Nicole Hake
107 E. Front St., P. O. Box 357
Lewisberry, PA 17339
(Address)
(Signature)
----..--.- '-.-_.'._0_._-
(Address)
(Signature)
(Address)
~/-oI-OZ05-
RENUNCIATION
In Re Estate of
Scott A. Hake
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Elnora E. Hake, mother
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Bobbette L. Larson, sister of decedent
WITNESS
my
hand this c2(Jf~ day of Auqusf ,t9 20 0 ~
-e~J!(~
(Signature)
Elnora E. Hake
9 Railroad Avenue
Shiremanstown, PA 17011
(Address)
(Signature)
(Address)
(Signature)
(Address)
.r'
E
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Scott A. Hake
Date of Death: June 21, 2001
will No.
Admin. No. 21-01-0805
To the Register:
I certify that notice of estate administration required by
Rule 5.6(a) of the Orphans' Court Rules was served on or mailed
to the following beneficiaries of the above-captioned estate on
September 10, 2001:
Name
Address
Beverly Roxanne Hake
107 East Front st.
P. O. Box 357
Lewisberry, PA 17339
107 East Front st.
P. O. Box 357
Lewisberry, PA 17339
Danielle Nicole Hake
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except:
None
, Esquire
One West Ma n treet
Shiremanstown, PA 17011
(717) 737-8761
Capacity: Personal Representative
X Counsel for Personal
Representative
Date: September 10, 2001
E
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be
determined wholly or partly by the decedent's Will. If
the decedent died without a Will, whether you will
receive any money or property will be determined by the
intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Scott A. Hake, Deceased, Estate No. 21-01-0805
TO: Beverly Roxanne Hake
107 East Front st., P. O. Box 357
Lewisberry, PA 17339
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent, Scott A. Hake, died on the 21st day of June,
2001, at Cumberland County, Pennsylvania.
The Decedent died testate (with a Will); or
The Decedent died intestate (without a Will).
The personal representative(s) of the Decedent is/are:
Name
Address
Telephone
Bobbette L. Larson
826 Acri Road
Mechanicsburg, PA 17050
717-728-4626
If the Decedent died testate, the
the Office of the Register of Wills of
Courthouse Square, Carlisle PA 17013.
6345.
Will has been filed with
Cumberland County, One
Telephone No. 717-240-
If the Decedent died intestate, a Petition for the Grant of
Letters of Administration was filed with the Office of the
Register of Wills of Cumberland County, 1 Courthouse Square,
Carlisle, PA 17013. Telephone No. 717-240-6345.
If the Decedent died testate, a copy of the Will is
attached. A copy of the Petition may be obtained by contacting
the Register of wills and paying the arge for duplication.
~
oar, Esquire
One West ai Street
Shiremansto n, PA 17011
(717) 737-8761
Capacity: Personal Representative
X Counsel for Personal
Representative
Date: September 10, 2001
.
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be
determined wholly or partly by the decedent's Will. If
the decedent died without a Will, whether you will
receive any money or property will be determined by the
intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA
In re Estate of Scott A. Hake, Deceased, Estate No. 21-01-0805
TO: Danielle Nicole Hake
107 East Front st., P. O. Box 357
Lewisberry, PA 17339
Please take notice of the death of decedent and the grant of
letters to the personal representative(s) named below.
The Decedent, Scott A. Hake, died on the 21st day of June,
2001, at Cumberland County, Pennsylvania.
The Decedent died testate (with a Will); or
The Decedent died intestate (without a Will) .
The personal representative(s) of the Decedent is/are:
Name
Address
Telephone
Bobbette L. Larson
826 Acri Road
Mechanicsburg, PA 17050
717-728-4626
If the Decedent died testate, the
the Office of the Register of Wills of
Courthouse Square, Carlisle PA 17013.
6345.
Will has been filed with
Cumberland County, One
Telephone No. 717-240-
If the Decedent died intestate, a Petition for the Grant of
Letters of Administration was filed with the Office of the
Register of wills of Cumberland County, 1 Courthouse Square,
Carlisle, PA 17013. Telephone No. 717-240-6345.
If the Decedent died testate, a copy of the Will is
attached. A copy of the Petition may be obtained by contacting
the Register of Wills and paying the arges for duplication.
~~
Ja es D. B g r, Esquire
One West i Street
Shiremanstow , PA 17011
(717) 737-8761
Personal Representative
Counsel for Personal
Representative
Date: September 10, 2001
Capacity:
x
Register of Wills of
CUMBERLAND
County, Pennsylvania
INVENTORY
Estate of Scott A. Hake
No. 21- 01- 0805
also known as
Date of Death 06/21/2001
,Deceased Social Security No. 179-44-7595
Bobbette L. Larson,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I !We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of James D. Bogar Esquire
Attorney:
I.D. No.: 19475
Address: One West Main Street
Shiremanstown, PA 17011
Telephone: 717/737-8761
P'~o",1 R'pco"n..'" ~
Signature~ g 1..( ~
Bobbette L. Larson
Signature:
Address:
826 Acri Road
Mechanicsburg, PA 17050
Telephone: 717 /728-4626
Dated:
03/14/2002
Description
-->
Ul
0:1
(See continuation page(s) attached)
i"-'
(Attach additional sheets if necessary)
Total:
2,393.33
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form#RW-7 (1992)
..
INVENTORY
Estate of:
Date of Death:
County:
Scott A. Hake
06/21/2001
Cumberland
CASH:
Allfirst Financial Inc. -
Checking Account No.
0940050024
1.81
64 MetLife Inc. - Sixty-four (64)
Trust Interests, date of
death value per interest
$31. 20
1,996.80
Prudential Financial - Mutual
company to stock company
conversion compensation
369.72
2,368.33
PERSONAL PROPERTY:
------------------
1980 Pontiac Coupe - VIN
2K37SA2524905, sold at
private sale
25.00
25.00
TOTAL RECEIPTS OF PRINCIPAL...............
2,393.33
----------------
---------------
-1-
I"'}- .3 - )..:3
\ BUREAU OF INDIVIDUAL TAXES
/
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, AllOWANCE OR DISAllOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JAMES D BOGAR
ONE W MAIN ST
SHIREMANSTOWN
'02 l'IIlY-3
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-29-2002
HAKE
06-21-2001
21 01-0805
CUMBERLAND
101
nl!} :::;0
ESQ
P~~i. 7011
l,n.
'*
REY-1547 EX AFP (01-021
SCOTT
A
Allount RelliUed
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 =is4-j-i3f-AFP--fOl-:02Y-NoTici--oF-YNHiifiTAifcE-TAx-jrppRA-isiMENT:--ALi-owAircE-'(fri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HAKE SCOTT A FILE NO. 21 01-0805 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)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
2,393.33
.00
.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 Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
(9)
(10)
11,173.05
.00
Ul)
(12)
(13)
(14)
(Schedule J)
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Allount of line 14 at Spousal rate (15)
16. Allount of line 14 taxable at lineal/Class A rate (16)
17. Allount of line 14 at Sibling rate (17)
18. Allount of line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
2,393.33
11.]73 05
8,779.72-
.00
8,779.72-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
TAX CREDITS:
n....~.... ToFT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
.OOXOO=
.00 X 045=
.00 X 12 =
.00X15=
(19)=
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
.00
.00
.00
( 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.)
IN RE: ESTATE OF SCOTT A. HAKE
LATE OF THE BOROUGH OF
SHIREMANSTOWN,
CUMBERLAND COUNTY,
PENNSYLVANIA,
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-01-0805
NOTICE OF FILING ACCOUNT
NOTICE IS HEREBY GIVEN that Bobbette L. Larson, Administratrix of the
Estate of Scott A. Hake, deceased, has this date filed her First and Final
Account in the above-captioned Estate in the Cumberland County Register of
Wills Office where the same is filed as public record and may be inspected.
Enclosed herewith is a copy of the First and Final Account as filed.
YOU ARE FURTHER notified that any exceptions or objections to said
Account must be filed in writing at the Cumberland County Clerk of the
Orptans' Court Office not later than the audit day of said Account sched-
uled as set forth below.
UNL2SS written exceptions or objections are filed thereto, said
Account will be presented to the above-captioned Court at 9:30 A.M. on
T~esday, June 18, 2002, at which time said Account will be audited.
T"'.-....o.
J.-c:.~~.
May 1 7, 2 002
, Esquire
he Esta:ttre~J
One West Main Street
Shiremanstown, PA 17011
(71 7) 73 ;V-fa 7.1~1 ZZ A V'I ZO.
cc: Beverly Roxanne Hake
Danielle Nicole Hake
GE/First USA Bank
Boscov's
Choice/CitiBank
Sears
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-01-0805
ESTATE OF SCOTT A. HAKE, DECEASED
LATE OF THE BOROUGH OF SHIREMANSTOWN, CUMBERLAND COUNTY, PENNSYLVANIA
---------------------------------
---------------------------------
FIRST AND FINAL ACCOUNT
AND STATEMENT OF PROPOSED DISTRIBUTION OF
Bobbette L. Larson, Administratrix
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Date of Death:
June 21, 2001
Date of Administratrix's Appointment:
August 29, 2001
Date of First Advertisement of Letters:
September 11, 2001
Accounting for the Period:
June 21, 2001 to
May 14, 2002
--------------------------------------------------------------------------------
--------------------------------------------------------------------------------
Purpose of Account: Bobbette L. Larson, Administratrix, offers this account to
acquaint interested parties with the transactions that have occurred during this
administration.
It is important that the account be carefully examined. Requests for
additional information or questions or objections can be discussed with:
James D. Bogar Esquire
Attorney Identification No. 19475
One West Main Street
Shiremanstown, PA 17011
717/737-8761
SUMMARY OF ACCOUNT
Estate of Scott A. Hake, Deceased
For Period of 06/21/2001 through 05/14/2002
Page
Current
Value
Fiduciary
Acquisition
Value
PRINCIPAL
Receipts:
This Account
1
20,389.84
Net Gain (or Loss) on Sales
or Other Disposition
2
(40.95)
20,348.89
Less Disbursements:
Debts of Decedent
Funeral Expenses 2
Administration Expenses 2-3
Federal and State Taxes
Fees and Commissions 3
Family Exemption
0.00
6,998.36
1,139.51
0.00
3,300.00
0.00
11,437.87
Balance before Distributions
Distributions to Beneficiaries
8,911.02
0.00
Principal Balance on Hand
4
8,911.02
INCOME
Receipts:
This Account
4
15.51
Net Gain (or Loss) on Sales
or Other Disposition
0.00
15.51
Less Disbursements
0.00
Balance Before Distribution
Distributions to Beneficiaries
15.51
0.00
Income Balance on Hand
4
15.51
COMBINED BALANCE ON HAND
8,926.53
Proposed Distributions
to Beneficiaries
5
0.00 8,926.53
--------------- ---------------
--------------- ---------------
SCHEDULE A
RECEIPTS OF PRINCIPAL
CASH:
06/21/01
Allfirst Financial Inc. -
Checking Account No.
0940050024
06/21/01
MetLife Inc. - Sixty-four (64)
Trust Interests, date of death
value per interest $31.20
10/10/01
prudential Financial - Death
claim/Contract No. D42872189
10/10/01
Prudential Financial - Death
claim/Contract No. 25468479
01/31/02
prudential Financial - Mutual
company to stock company
conversion compensation
05/07/02
U.S. Treasury - Personal
income tax refund
PERSONAL PROPERTY:
10/10/01
1980 Pontiac Coupe - VIN
2K37SA2524905, sold at private
sale
1. 81
1,996.80
12,694.27
4,792.24
369.72
510.00
25.00
TOTAL RECEIPTS OF PRINCIPAL.......... .....
-1-
Fiduciary
Acquisition
Value
20,364.84
25.00
20,389.84
--------------
--------------
02/06/02
02/26/02
10/10/01
01/17/02
10/10/01
10/10/01
10/10/01
SCHEDULE B
GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL
Gain
Allfirst Financial Inc. -
Difference between date of
death balance and closeout
balance
Net Proceeds
Fid. Acq. Value
0.00
1. 81
MetLife Inc.
Net Proceeds
Fid. Acq. Value
1,957.66
1,996.80
TOTAL GAINS AND LOSSES/PRINCIPAL....... ....
0.00
LESS LOSS.............................
40.95
NET GAIN OR LOSS. . . . . . . . . . . . . . . . . . . . . . . . . . .
(40.95)
--------------
--------------
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
SCHEDULE C-2
FUNERAL EXPENSES
Myers Funeral Home - Funeral
bill
5,986.00
Gingrich Memorials -
Gravemarker
1,012.36
TOTAL FUNERAL EXPENSES.... . . . . . . . . . . . . . . . . . . . . . . . . . .
SCHEDULE C-3
ADMINISTRATION EXPENSES
Cumberland Law Journal -
Legal advertising
75.00
Patriot News Co. - Legal
advertising
80.52
Register of wills - Probate
fee
53.00
-2-
Loss
1.81
39.14
40.95
6,998.36
03/14/02
04/05/02
TO BE PAID
03/18/02
TO BE PAID
TO BE PAID
Register of wills - Filing
fee for PA Inheritance Tax
Return and Inventory
23.00
Greenawalt & Company, P.C. -
Preparation of 2001 Personal
Income Tax Returns
230.00
James D. Bogar, Esquire -
Reimbursement for costs
advanced as follows: Register
of wills - Short Certificates
($12.00) i Certified mail to
Mellon Investor/MetLife
($4.17) i Certified mail re
transmittal of Personal
Income Tax Returns ($11.82)
27.99
RESERVES: Costs to conclude
administration of Estate
including preparation and
mailing of Fiduciary Income
Tax Returns and filing fee
for First and Final Account
650.00
TOTAL ADMINISTRATION EXPENSES.... ......... ..........
SCHEDULE C-5
FEES AND COMMISSIONS
James D. Bogar, Esquire -
Attorney's fee for
representation of Estate as
per agreement (partial
payment)
930.00
Bobbette L. Larson -
Administratrix fee
500.00
James D. Bogar, Esquire -
Attorney's fee for
representation of Estate as
per agreement (balance due)
1,870.00
TOTAL FEES AND COMMISSIONS...... ......... ...........
TOTAL DISBURSEMENTS OF PRINCIPAL....................
-3 -
1,139.51
3,300.00
11,437.87
--------------
--------------
PRINCIPAL BALANCE ON HAND
# Units Description
MetLife Inc.
01/14/02
Commerce Bank
04/30/02
# Units
Commerce Bank
Allfirst Financial Inc.
Current Value
or as Noted
8, 912 . 83
Fiduciary
Acquisition
Value
8,912.83
(1.81)
8,912.83 8,911.02
--------------- ---------------
--------------- ---------------
SCHEDULE G
RECEIPTS OF INCOME
SCHEDULE G-1
DIVIDENDS
TOTAL DIVIDEND INCOME.....................
SCHEDULE G-2
INTEREST
Interest earned in estate
account 2/28-4/30/02
TOTAL INTEREST INCOME.....................
TOTAL RECEIPTS OF INCOME..................
INCOME BALANCE ON HAND
Description
Commerce Bank
-4 -
Current Value
or as Noted
15.51
8.90
8.90
--------------
--------------
6.61
6.61
--------------
--------------
15.51
--------------
--------------
Fiduciary
Acquisition
Value
15.51 15.51
15.51
--------------- ---------------
--------------- ---------------
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
or as Noted
Fiduciary
Acquisition
Value
Current Value
Beverly Roxanne Hake
4,463.27
0.00 4,463.27
Danielle Nicole Hake
4,463.26
0.00 4,463.26
0.00 8,926.53
-------------- --------------
-------------- --------------
AFFIDAVIT
Bobbette L. Larson, Administratrix of the Estate of SCOTT A. HAKE, deceased,
hereby declares under oath that she has fully and faithfully discharged the duties
of her office; that the foregoing Account is true and correct and fully discloses
all significant transactions occurring during the accounting period; that all known
claims against the estate have been paid in full; that, to her knowledge, there are
no claims now outstanding against the Estate; that all taxes presently due from the
estate have been paid; and that more than four months have elapsed since the first
complete advertisement of the granting of letters in this estate.
.~ 3 ~A~_
-. ette L. Larson,' Administratrix
Subscribed and sworn to by
Bobbette L. Larson, Administratrix
before me this 15th day
of May, 2002.
~
1-.~
Notary Public
My Commission Expires:
Notarial Seal
Joan E. BrotherS, Notary Public
Shiremanstown Boro. Cumbelland County
My Commission Expires Feb. 12.2006
Member, PennsYI'JaIli8 AssocIation Of NotarieS
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STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Scott Pl.. Hake
Da te of Death: June 21, 2001
Will No.
Admin. No. 21-01-0805
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes 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
Cerk of the Orphans' Court and may be attac ed to this report.
Date: 9/3/02
James D. B a , Esquire
Name (Please. type or print)
One West Maln St.
Shiremanstown, PA 17011
Address
(717) 737-8761
Te 1. No.
Capacity: Personal Representative
( MAH : rm f / AM 3 )
x Counsel for personal
representative
/
..
"
V..,
./
C
H
E
C
K
OFFICIAL USE ONLY
REV-1500EX +(6-00) REV-1500 /1-3 .~ 1.1
INHERITANCE TAX RETURN FilE NUMBER
COMMONWEALTH OF PENNSYLVANIA 21-01-0805
DEPARTMENT OF REVENUE RESIDENT DECEDENT
DEPT. 280601 COUNTY CODE YEAR NUMBER
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
0 Rake Scott A. 179-44-7595
E
C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
E
0 06/21/2001 06/16/1952 REGISTER OF WILLS
E (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST,AND MIDDLE INITIAL) soaAL SECURITY NUMBER
N
T
X 1. 2. Supplemental Return tj 3. . L~ate of death
- Original Return I-- Remainder Return prior to 12-13-82)
APB 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 5. Federal Estate Tax Return Required
pRl - I--
plO 6. Decedent Died Testate 7. Decedent Maintained a Living Trust a. Total Number of Safe Deposit Boxes
- '-- -
RAC (Attach copy of Will) (Attach copy of Trust)
OTK 0 9. 010. D 11. Election to tax under Sec. 9113(A)
ES litigation Proceeds Received Spousal Poverty Credit
(date of death between 12-31-91 and 1-1-95) (Attach Sch 0)
g.....'THIS$E<:j'ION'Ml.JSj'.Elg.c;QMet.ETEOU.AI.t..eQaij'e$~tiDetic;g:~t:'Q'ti~jpel\ij'I'j.lj;mAX.jl\iJ:\'(1Rp"f'j.mj()I\i..SJ.lotifi.j)'.al;:pjaE<;l'EI).l'(1:"ui'
p NAME COMPLETE MAILING ADDRESS
C
0 0 James D. Bogar Esquire
R N FIRM NAME (If Applicable)
R 0 One West Main Street
E E Shiremanstown, PA 17011
S N
T TELEPHONE NUMBER
7171737-8761
1. Real Estate (Schedule A) (1) None OFFICIAL USE ONL Y
2. Stocks and Bonds (Schedule B) (2) None
3. Closely Held Corporation. Partnership or (3) ~ d
t
Sole-Proprietorship -' l"-.J
4. Mortgages & Notes Receivable (Schedule 0) (4) None
R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2,393.33
E (Schedule E)
C -,
A 6. Jointly Owned Property (Schedule F) (6) None ',Ji
p
I 0 Separate Billing Requested
T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None ' ,....
U
l (Schedule G or L) -'
A 1'-:-
T a. Total Gross Assets (total Lines 1-7) (a) 2,393.33
I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 11,173.05
0
N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) None
11. Total Deductions (total Lines 9 & 10) (11 ) 11,173.05
12. Net Value of Estate (Line 8 minus Line 11) (12) (8,779.72)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) (8,779.72)
c
0 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
M
T P 15. Amount at Line 14 taxable at the spousal tax
U
A T rate, or transfers under Sec. 9116(a)( 1.2) X .0 0 (15) 0.00
X A 16. (8,779.72) 45 (16) 0.00
T Amount of Line 14 taxable at lineal rate X .0
I -
0 17. Amount of Line 14 taxable at sibling rate X ,12 (17) 0.00
N 1a. Amount of Line 14 taxable at collateral rate X .15 (la) 0.00
19. Tax Due (19) 0.00
20. n m:.~)ill$qJi(!BI$~I$:~f:X99'AR!;flJSq~#!;$1.1.~g,Ai!Reffi~t.<<~:qf;:A"'!:Pvr;RP~YME.f,jT'1
." .,. .....;;:>.>.BE SURETOANSWERAU;QUESTIO~S'ON; REVERSE'SIOEAND TO RECHECK MATH<:<U
Copyright (c) 2000 form software only The Lackner Group. Inc,
Form REV-1500 EX (Rev, 6-00)
..
Decedent's Complete Address:
STREET ADDRESS
9 Railroad Avenue
CITY I STATE I ZIP
Shiremanstown PA 170n
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits ( A + 8 + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4) 0 . 00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (SA) 0 . 00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 0 . 00
.~~ke Check Paya~le to: REGISTER OF WILLS, AGE~T.,,,,,,,.,.,,,,,,,,,.". .
':::~['~i~~!:~~~~~FFfAg!!#:gtL6Wt~d~G~~~i8!~~"~~r~Litt~rii~":f;:~:!! :~~!'f:A!gL~~~~!6~.~t~fg':~(6:gR'~r'
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; . . . . . . . . . . . . . ~ ~~x
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . , . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . D []]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ...... D []]
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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
51 Bobbette L. Larson
826 Acri Road
-----------------------------------------------------
Mechanicsbur , PA 17050
James D. Bogar Esquire
One West Main Street
-----------------------------------------------------
Shiremanstown PA 17011
DATE
03/14/02
DATE
03/14/02
For dates of death on 0 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"10 [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (iil]. The statute does not exempt a transferto a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2)
[72 P.S. 9116(a)(1)].
The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% [72 P.S. 9116(a)( 1.3 )]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Scott A. Rake
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
SS1ft 179-44-7595
06/21/2001
FILE NUMBER
21-01-0805
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
DESCRIPTION
Allfirst Financial Inc. - Checking Account No. 0940050024
VALUE AT DATE
OF DEATH
1. 81
2
64 MetLife Inc., CUSIP #59156RI0 - Sixty-four (64) Trust
Interests, date of death value per interest $31.20
1,996.80
3
Prudential Financial - Mutual company to stock company conversion
compensation
369.72
4
1980 Pontiac Coupe - VIN 2K37SA2524905, sold at private sale
25.00
TOTAL (Also enter on line 5, Recapitulation) $ 2,393.33
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
!) allflrst
Allfirst Financial Center N.A.
PO. Box 900
tvlillsboro. DE 19966
December 13,2001
James D. Bogar
Attomey At Law
One West Main Street
Shermanstown, PA 17011
RE: Estate oC Scott A. Hake
Date oCDeath: June 21, 2001
Social Security Number: 179-44-7595
Dear Mr. Bogar:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type......... .................. Checking Account
Account Number. ............... . ...... 0940050024
Ownership (Names of).............. Scott A. Hake
Opening Date......................... ..03/10/00 (account closed 09/12/01)
Balance on Date of Death....... ..$1.81
Accrued Interest
$0.00
Total. . .. . .. . .. . .. . .. . . . . .. . . . .. .. .. . . . . .. .. $1. 81
TIlls letter does not include any accounts in which the deceased may have been listed as power of attorney,
custodian of uniform transfers, representative payee, or trustee under a written trust agreement.
For any additional information on these accounts, please contact our branch at:
5219 Simpson Feny Road
Mechanicsburg, PA 17055
Phone: (717) 255-2031
Sincerely,
{lunLtJ1L; Ml.tIZ~L
Charlene Warrington, Associate I
(302) 934-2722
REV-1511 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Scott A. Hake
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
SS/I 179-44-7595
FILE NUMBER
21-01-0805
06/21/2001
DESCRIPTION
AMOUNT
1
FUNERAL EXPENSES:
Gingrich Memorials - Gravemarker
1,012.36
2
Myers Funeral Home - Funeral bill
5,986.00 .
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Bobbette L. Larson
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 826 Acri Road
City Mechanicsburg State PA Zip 17050
500.00
Year(s) Commission Paid:
2.
3.
Attorney's Fees James D. Bogar Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
2,800.00
City
Relationship of Claimant to Decedent
State
Zip
4.
Register of Wills
Probate Fees
53.00
S. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Cumberland Law Journal - Legal advertising
75.00
2
Patriot News Co. - Legal advertising
80.52
3
Register of Wills - Short certificates
12.00
4
RESERVES: Costs to conclude administration of Estate including
filing fee for PA Inheritance Tax Return, Inventory and First &
Final Account; preparation of Personal and Fiduciary Income Tax
Returns
650.00
5
U.S. Postal Service - Certified mail
4.17
TOTAL (Also enter on line 9, Recapitulation) $ 11,173.05
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
REV -15 13 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Scott A. Hake SS# 179-44-7595
SCHEDULE J
BENEFICIAR IES
06/21/2001
FILE NUMBER
21-01-0805
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS [include outrlghtspousal distributions, and
transfers under Sec. 9116(a){1.2)]
1 Beverly Roxanne Hake
107 E. Front St.
Lewisberry, PA 17339
Daughter One-half (1/2)
of rest,
residue and
remainder of
Estate
2 Danielle Nicole Hake
107 E. Front St.
Lewisberry, PA 17339
Daughter One-half (1/2)
of rest,
residue and
remainder of
Estate
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE. ON REV 1500 COVER SHEET
II. NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Copyright (e) 2000 form software only The Lackner Group, Inc.
0.00
Form REV-1513 EX (Rev. 9-00)