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HomeMy WebLinkAbout01-0866 Register of Wills of CUMBERLAND County, Pennsylvania PETITION FOR GRANT OF LETTERS No. ~I-QJ- ~lo{P Estate of MABEL L. GRAHAM also known as \N1A ~d b. 6-v?k~ , Deceased Social Security No. 161-34-0679 Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) G] A. Probate and Grant of Letters and aver that Petitioner( s) is/are the execut L?#- named in the Last Will of the Decedent, dated MARCH 5,1985 and codicil(s) dates NONE CO-EXECUTORS, KENNETH 1. GRAHAM AND SHIRLEY M. CRAMER HAVE RENOUNCED AS EXECUTORS AND APPOINTED ERNEST C' GRAHAM. 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 incapacitated: o 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 has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 83 SOUTH HIGH STREET, NEWVILLE, P A 17241 (list street, number and municipality) Decedent. then 93 years of age, died FEBRUARY 25 ,19 ill.-, at CARLISLE HOSPITAL, CARLISLE PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ 500.00 (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ 40 ,000.00 Total.................................. ............. ....... ........ .......... ..... ......... ............................... $ 40,500.00 Real Estate situated as follows: 83 SOUTH HIGH STREET, NEWVILLE, PA 17241 Wherefor, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: J Typed or printed name and residence RNEST C. GRAHAM 17 SAN JUAN DRIVE MECHANICSBURG P A 17055-5572 RW-1 , 1-q-1 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner( s) above-named swear( s) and 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 administe~~~lawL Sworn to and affirme~ a~~ubscribed .. ~ before me this , q day of ~c~~ DECREE OF REGISTER Estate of MABEL L. GRAHAM also known as W1 kl, ~.A l:::>. (Hz/r "'/h-.. , Deceased No. JJ.:Qj-- ~ Uu, Social Security No: 161-34-0679 Date of Death: FEBRUARY 25,2001 AND NOW, ~T. 21 ~2OC?i~ consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary Cl of Administration are hereby granted to ERNEST C. GRAHAM ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... Short Certificates( s) .,(.?).... Renunciation ..,( b!................ Extra Pages ( L ) ............... I. T. R. ...................................... JCP Fee ................................. Inventory ................................ Other ...................................... $ io.CD 10.00 iO.co l.o . C() $ $ $ $ $ $ $ $ 5.00 TOTAL .............................$ -1.LLP .00 MLt rJ- Attorney: HAMILTON C. DAVIS J.D. No: 10264 Address: P.O. BOX 40 SHIPPENSBURG, Telephone: 717 532-5713 DATE FILED:~r. ZI J 7JJD I , PA 17257 )5.805 REV 9/86 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. No. 21.~~. ~~~~ Local Registrar Fee for this certificate, $2.00 p 6948451 FEB 2 7 2001 Date H1OS.143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEAL TI-I- VITAL RECORDS CERTIFICATE OF DEATH fPElPRINT IN 'RMANENT ...ACKINK CI 161 _ 34 _ 0679 2001 irIl. 1. Mabel L. Graham AGE(l.oot -" UNDER' YEAR I 0)'1 I UNDER 1 D.\V D.\T! Of' IlRTH (Month, De" V..., Olllor (Spoclfy) 0 I. 93 VIS. ~\ .... Cumberland DECEleHT'8l1SU1\l. OCCUPIITION Ie. Carlisle KINO Of' _INESSIINOUSTRY CENnoricon Indian, BlIck, _e, etc. (8pedIy) ,.. Whi te SURYMNG llPOUSe ~I_. oNe _ n.me) 01....... lie: do ""UII _.) .1I"U-Wana-Wash- laborer ".. DE MAIUNG AIlClAEsa (_. Cly/T-., _. Zip COdeI Widowed :l '" I) ::> I) ~ ~ 83 So. High St. ~Newville, PA 17241 A THI!R1I NI\ME CI'hI. _. UlII) 11. Geor e Deshon 1NF0RI0WlT'S _ IT 8LMrs Shirle Cramer MEn100 Of' DISPOIlITlON . -IX! 0 ~ 0 0IIlet /SllIdfJl 11.. - DECEDEHT'S IICTIJAL RESIDENCE (SM- ..._-) na. St... PA 17"~ VeI,__1n Newville HI. CaunIJ DId - ...In. Cumberland ~? Hd.O :':Kt~l'=:oI MOTHER' NAME (Fill, Mldclll, M_llum_) II. Rosella oS < \ \~~ MI\IUNO ADDRE8S (-. CIJIT-. SUIle. COde) ~26 Kou h Rd. Newville, PlACE Of' DISPOSITION. Nome 01 c_.,." CtetnotOl'/ at 0IIler_ elly-' COde NoIKI PART.: OltIer~_-..gto_. but 'n~~.~ \: e. _ VFINOINGS IIVI\ANIU, PRIOR TO ~ Of'c.wsl: Of' CEII'IM? MI\NNeR OF CEIl TH T! Of' INJURY (MOIWl. 0eJ. Veer) TIME OF INJURY INJURY liT WORK? DESC IBE HOW INJURV OCCURRED. V- 0 No IX! V-O No/XI -. ~ o o - o o 0'" - =.c:..~-.1ImI.-.-0I'/.- ... Vel 0 No 0 NIlunlI - PenclIng -.g1l1On ~ noI III deI_ M. -. I~ \ IdJ \ ,n M. m. .",. ~~E:~::'~::=U::~~:==':t~===~~~~~~~~~I~_It~_2~) _ _ _ __ 'PRONOUNClNG AND CERTIFYING PHYSICIAN (PIlys;a., bolh pronouncing d.elh end certifying to C8UII of dNth) To 1ft. _ of my knowIedgft. deeth occurr.d ellfte lime. del., end plec., end due to the ceu.e(.) end ......n.. ~ !tIIJ~ _ _ _ _ _ _ _ _ 0 n. 'MEDlCAL EXAMINERlCORONER ~~:r ,,::,:~~~~_n~~_~~o~I~\'~~lI~tl_~. ~ ~ ~1~I~n~ d_.~Ift_ ~c~~ ellh~ tl~. ~e~e~ e~d_~e~.~ e~d_~._ ~ ~.C~~)_~d o Register of Wills of CUMBERLAND County, Pennsylvania Estate of MABEL 1. GRAHAM RENUNCIATION No. ~ I ' also known as I Deceased The undersigned, KENNETH J. GRAHAM, SON AND SHIRLEY M. CRAMER, DAUGHTER (Relationship) (Capacity) of the above Decendent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters TESTAMENTARY be issued to ERNEST C. GRAHAM Witness .....1 hand this 1'1 t1.-~~t..,.. ~'" I. ~~-~~~ , (Signature) KENNETH 1. GRAHAM 14602 BENSON STREET, OVERLAND PARK, KS 66221-2213 (Address) (Signature) SHIRLEY M. CRAMER 26 KOUGH ROAD, NEWVILLE (Address) PA 17241 (Signature) (Address) Sworn to or affirmed and subscribed before me this day of ,19_. Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 Register of Wills of CUMBERLAND County, Pennsylvania Estate of MABEL 1. GRAHAM RENUNCIA TION ~(-Ol- ~l1LR No. also known as , Deceased The undersigned, KENNETH 1. GRAHAM, SON AND SHIRLEY M. CRAMER, DAUGHTER (Relationship) (Capacity) of the above Decendent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters TESTAMENTARY be issued to ERNEST C. GRAHAM Witness Mvl f hand this \ T}-\! day of ~L,MI~A' ~2.U\)'. \ (Signature) KENNETH J. GRAHAM 14602 BENSON STREET, OVERLAND PARK, ~ ~ (Address) ~ ~. __~~L (Signature SHIRLEY, . CRAMER 26 KOUGH ROAD, NEWVILLE (Address) KS 66221-2213 PA 17241 (Signature) (Address) Sworn to or affirmed and subscribed before me this day of ,19_. Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 ~ 1 ~ ~ ~ l ~J HAMILTON C. DAVIS LAST WILL AND TESTAMENT I, MABEL L. GRAHAM, (a/k/a MABEL D. GRAHAM), of the Borough of Newville, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I devise and bequeath all of my estate of every nature and wherever situate to my three children, ERNEST C. GRAHAM, KENNETH~RAHAM and [ _1 7.- SHIRLEY M. CRAMER, in equal shares. ITEM III: Should any of my said children predecease me or die on or before the thirtieth day following my death, I devise and bequeath such predeceased child's share of my estate to his or her issue, per stirpes, living on the thirty-first day following my death. ITEM IV: I appoint his or her respective parent, guardian of any property which passes outright either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including ATTORNEY AT LAW secondary, college education, both graduate and undergraduate, professional NEWVILLE & SHIPPENSBURG PENNA. and other education) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility to the minor or to the minor's parent or to any person taking care of the minor. ITEM V: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM VI: I appoint my three children, ERNEST C. GRAHAM, KENNETH~RAHAM {; and SHIRLEY M. CRAMER, executors of this my last will. and Testament, written on three (3) sheets of paper, dated this M~~ IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will S ~ day of , 1985. hz~ 'I-A~^- (SEAL) Mabel L. Graham The preceding instrument, consisting of this and two (2) other typewritten pages, each identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by the testatrix therein named, as and for her Last Will, in the presence of us, who at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. ~fw. ('. V~ J!,Rdtt 'rlr- ~~ residing at -1Je,...bJ; lit' ) ~~. s1; ffJe/1shCAr)! ;0". residing at HAMILTON C. DAVIS ATTORNEY AT LAW NEWVILLE & SHIPPENSBURG PENNA. 2 COMMONWEALTH OF PENNSYLVANIA SSe COUNTY OF CUMBERLAND I, MABEL L. GRAHAM (a/k/a Mabel D. Graham), the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. hz. a 1.J t ~J~ (SEAL) Mabel L. Graham Sworn to or affirmed and acknowledged before me by 1l#,.,JG'l L. CK.I9L4M , the testatrix, this j~ day of ~/2ttL , 1985. ., "~'.:;{ f".';;zUC _,;;:;:::'~;;:L!~~D COllinv >,) o.L .:';rs s(n. 12. 1987 Member, r8n~?;~<;f~~:~!i 1t~~~}~:~.Ji;Jt1~ O.~ ~iot~7jas COMMONWEALTH OF PENNSYLVANIA : SSe COUNTY OF CUMBERLAND We (or I), yjp~/j7iA) (/ d~;.s and i/E/h /Y! ~~5C- , the witness(es) whose name(s) are (is) signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were (I was) present and saw the testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our (my) knowledge the testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. _~L:~.~~~. ~~ ~/)t- ~.. HAMILTON C. DAVIS tary Public J WiP;H~J n. vEnT1\!, ~OT:U'~V r!,!~t WEST Pf~m::;'SDt!) r,w.. C~~BE!1~f~~m COUNTY t'iiY Ct:iSii\.!tS::W)'j tX?E'\tS StPT. 12. 1~a7 lW~rn~r. r-enr.$;;h'iili~ tiszcci~tion of Not.rk:,; ATTORNEY AT LAW NEWVILLE & SHIPPENSBURIi PENNA. 3 ..-' 4-' ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MABEL L. GRAHAM Date of Death: February 25. 2001 Will No.: 21-01-00866 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on November 12. 2001 : Name Address Ernest C. Graham 17 San Juan Drive. Mechanicsburg. P A 17055-5572 Shirley M. Cramer 26 Kough Road. Newville. P A 17241 Kenneth J. Graham 14602 Benson Street. Ovelrand Park KS 66221-2213 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Ii Ji ~ /0 I I I Signature: ~ (1. ",4 ~ none. Name: Hamilton C. Davis Address: P.O. Box 40. Shippensburg. PA 17257 Telephone: 717-532-5713 Capacity: _ Personal Representative Capacity: ~ Counsel for Personal Representative 2 ;..t ~ ~ Q rc, ." .-\ t\eC'~',. s 00:. '"" ,""Y, cI) ~ " .. I'"'!!, ~~~~ i~~~ 'ci\' Ij~ ~~~Q ~$~1\ iPC:II .. ~ '""'= -0 ~e ,. ~ ~ ~~ ~ ~ce \ 'a~ ~ 'jt(" c:. .-\ ~ ~ ~ '"O~~ ~Of"'~ ~~~~ ~, ,c.,~,~ ,.. ,tf\ ~~,o('\ ~ \~)'? n i6 \I' ~ ~t~ '"0 .\)~ ~ ~ '"0 ? ~ \,"0{i'V',r...\ .:. ~ ~ c.\\\'''''''- -l !O ~ -0 S ~-e. d~ d~... ~~ ~~~ ~(t\ ~~'6 ~~ ~~tn "t!;. \,;~ ~Q ~ '" 'Co ~ 0'" ~ ~~~ "'~ ~ li!\; ~\ d 'AQc~ ~~ tQ d ~ ~ 'C... 'il ~': ~ a ~ ~... '" l,~.... ~.. ~ ~ Q (" '" ~ ~~"l< , ~~'" 0'" 0';- \ ~ "'~"'o "'0 . o it. ..(. e. '" .... \. .~ ~ \'$, ~~ .~ ~~ ~...q, "So .. 1\ ("l <J. ~ \C! .. ~ ~ ~ ~~~9:. ('I~~~~ ..(. <;. l1l ~ ~ ... e, to 1'! \ o "'<=- '.jO '1 - r. 'eo ~ 'eo ~ os ~ ~ .~\~.. ~ - ~ '; ~';. <;. ... O;io(\" ~ ''''''_ ~ ... 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"',..11"'..:1 ("...1 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 DAVIS HAMILTON C POBOX 040 SHIPPENSBURG, PA 17257-0040 -------- fold ESTATE INFORMATION: SSN: 161-34-0679 FILE NUMBER: 21-2001- 0866 DECEDENT NAME: GRAHAM MABEL L DA TE OF PAYMENT: 12/05/2001 POSTMARK DATE: 11/29/2001 COUNTY: CUMBERLAND DATE OF DEATH: 02/25/2001 NO. CD 000601 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,381.97 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: HAMILTON C DAVIS CHECK# 0282 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $1,381.97 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 DAVIS HAMILTON C POBOX 375 SHIPPENSBURG, PA 17257 -------- fold ESTATE INFORMATION: SSN: 161-34-0679 FILE NUMBER: 2101-0866 DECEDENT NAME: GRAHAM MABEL L DA TE OF PAYMENT: 02/26/2002 POSTMARK DATE: 02/25/2002 COUNTY: CUMBERLAND DATE OF DEATH: 02/25/2001 NO. CD 000891 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1.37 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: HAMILTON C DAVIS ESQUIRE CHECK# 0297 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $1.37 MARY C. LEWIS REGISTER OF WILLS i 1- Cj -I BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z8D6Dl HARRISBURG, PA 171Z8-D6Dl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE"ENT1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESS"ENT OF TAX Reco;u? DATE ESTATE OF DATE OF DEATH (I FILE NUMBER i\10 :48 COUNTY ACN 02-04-2002 GRAHAM 02-25-2001 21 01-0866 CUMBERLAND 101 ..) .02 FEB 13 HAMILTON C DAVIS ZULLINGER DAVIS PROF qlj;erk PO BOX 40 CWnbE '< SHIPPENSBURG PA 17257 . C/ * REV-1547 EX AFP U2-0D> MABEL L AMount R...itted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y:is4j-ix--AFP--fi'2-:ooi--NO;--icE-OF-.rNHERifANCi-;--Ai-APpiAisEifENT~--ALi-oWANci-oR-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GRAHAM MABEL L FILE NO. 21 01-0866 ACN 101 DATE 02-04-2002 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 36,637.72 .00 .00 .00 2,178.84 300.60 .00 (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 Tex 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: 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 NOTE: (9) (10) 81073.00 (19)= NOTE: To insure proper credit to your accountl subMit the upper portion of this forM with your tax paYMent. 391117.16 8.406 77 301710.39 .00 301710.39 .00 11381.97 .00 .00 11381.97 TAX CREDITS: PAYnENT Rt:CEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 11-29-2001 CDOO0601 .00 11381.97 BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-30-2001 TOTAL TAX CREDIT 11381.97 BALANCE OF TAX DUE .00 INTEREST AND PEN. 1.37 TOTAL DUE 1.37 . IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 333.77 (11) (12) (13) (14) .00 X 00 = 301710.39 X 045= .00 X 12 = .00 X 15 = ( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR) 1 YOU nAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) \ ,;"/- 9- / 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 *' REV-l'87 EX AFP Ul-02) HAMILTON C DAVIS ZULLINGER DAVIS PROF CR PO BOX 40 SHIPPENSBURG PA 17257 '02 f\PR-1 DATE ESTATE OF DATE OF DEATH FILE NUMBER PI2cliUNTY ACN 03-25-2002 GRAHAM 02-25-2001 21 01-0866 CUMBERLAND 101 Allount Rellitted MABEL L He\., G::.; , Gvmtk 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, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=i'6o-j-ixAFP--foi-:ozi-------...--iNifERITANc'E-Tix-Si'jrfEMENT-ifF-iccou'Nf--...--------------------- ESTATE OF GRAHAM MABEL L FILE NO. 21 01-0866 ACN 101 DATE 03-25-2002 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SU""ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-04-2002 PR I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 1,381.97 PAYMENTS (TAX CREDITS): PAVMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-29-2001 CDOO0601 .00 1,381.97 02-25-2002 CDOO0891 1.37- 1.37 TOTAL TAX CREDIT 1,381.97 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) ()0- STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mabel L. Graham Date of Death: 02/25/2001 Estate No. 21-01-00866 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No_ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did 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 the Orphans' court and may be attached to this ~ port. Date:~~ loc I ~r -:";". N Capacity: _ Personal Representative XX Counsel for Personal Representative .3 ._~ '-"J ~ ,. ~ ",.""I ';,..__ STATUS REPORT UNDER RULE 6.12 ~ ~. Name of Decedent.: HELEN L. ROGERS Date of Death: 9/5/01 Will No. 2001-00886 Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate : 1 . State whether administration of the estate is complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans' Court No. (if any) for the personal r~presentative' 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 the Orphans' Court and may be attached to this report. Date: 8/13/03 ~ ~.~/~ Signature . "':::J r'-', . ,. GERALD J. BRINSER Name (Please type or print) 6 E. MAIN STREET, P,O. BOX 323 PALMYRA PA 17078 Address {J', C) ,-,-"J rr: f:::;l ( 717 ) 838- 6348 Tel. No . - -- 1 ,- -. ..... "'-"' Capacity : Personal Representative X Counsel for personal representative ... ~ ~ ~ L' !"!' _I ,i Il"M . f'..... " U. ~ ' ", ' .', ~1C1 ~'~'; , ,," ~;v, ~ r~'.' "''' :(... , "" ~ ~.-' ::::~ '~::J <~ _~. c""::-'l! Q. i';t f;tt:1 - "i ~ ~ ;t 1l,,;>~) ~' i{i \1 J "" ~,; ~.6, ~-.) a~ \5:, tJt. ~ '.;.! ~""","".; -fIl ~1 (~) ;~ -- ~ tIJ tIJ ~ o ..... ~ -- I.L ~ '~. ~. . ~ ~ .~ ~ \ ---- Q \ ~ r- '-- ...- LAW OFFICES OF ZULLINGER - DAVIS PROFESSIONAL CORPORATION JOEL R. ZULLINGER 14 North Main Street Suite 200 Chambersburg, P A 17201 717-264-6029 Fax: 717-264-1884 zulngrlaw(Q?supemet.com Dale F. Shughart, Jr. of counsel HAMILTON C. DAVIS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, P A 17257 717-532-5713 Fax: 717-530-5222 davislaw(Q?supemet.com November 28,2001 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 11 {,-)y ;f Re: Estate of Mabel L. Graham Estate No. 21-01-00866 Dear Sir or Madam: Enclosed herewith please find inheritance tax payment in the amount of One Thousand Three Hundred Eighty-One and 97/100 ($1,381.97) Dollars, as payment on account of the above estate. Also enclosed is the Inheritance Tax Return, filed in duplicate. A check for filing fee in the amount of$15.00 is also enclosed. Sincerely, A/ ,AI !J Ia-, · ~n C. VIS ---- 00 - -. =<t' ::1~ 0": q~ '. d - :025' (PO coo """""""""'-1; ~!~ 9 {1J (g ..""'/ ~~',,,) for Zullinger - Davis Professional Corporation ('''':1 ~ N \0 ~~,~' a --" HCD/njk Enclosure ~'fJ )> i.J1 ~ . REV -1500 ex .1'~1 ~;~ I . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ---y~_...." OFFICIAL U::;t: UNL Y /7- 9~ / . FILE NUMBER . .'. .m. 21 01 -.-' I i I COMMONWEALTH OF PENNSYLV"'N'''' DEP"'RTMENT OF REVENUE DEPT 280601 H"'RRISBURG. p", 17128-0601 _..._.__m_______.__"_~O~NTY ~O.E.~__Y.l'.A~ .____~B~___ .----- ..... ..-----.SOCIALSECURITYNUMBER- _._. ---- 00866 .... z w o w u w o .-oECEOENT'SNAMETU>.sf'-FIRST:ANO Mi150LE-INITIAlj---- . GRAHAM, MABEL L. [nATE1JFDEAT~(MMCOO-VEARI-- .-....- DATE OF B1RTR(MM'DD~ARr-.-.----.- t 02/25/2001 I 08/22/1907 I w .... ,,:$Ul 00:" wQ.O :cOO 00:..J Q.1Il Q. <C (jFAi'P[lcABIE)SURViViillGSPOUSE;SNAME. (i..AsrFIRS.TANO.MlDDlE INWiA[)' 1 I 161-34-0679 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS . -_.---:----socIAL SECURITY-iIIUMBER.-.------- o X 4. Limited Estate o X2:-S-u-pplemeiitalReiu~_m - ----.- - ----EfX3:-ReillainCfer R'elUmTaatBofooatnpilor to 11'13=B2!-- .-lllI X i~6rl9i':;a1ReiUm--. o x5. Federal Estate Tax Return Required o X 4a. Future Interest Compromise (dale of death afte< 12-12-82} o X 7. Decedent Maintained a Living Trust (Allach copy of Trust} o X 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) - .\THi$.sECTiON-MUSTaE.~OMPiliEO'-ALL:COAAE$ti()NDENCE ANt) ~-()NFiDl:NftA4TAX)NFORMAlioijSl_iOUiJjBEp'Re-C_reo_fo:~0~~ NAME I COMPLETE MAILING ADDRESS I Hamilton C Davis 1 FTRM NAllllinlfapplicat,T"f. ------- n -----. . -----. I. Zullinger-Davis Professional Corp. L.~_____.___~__,..,____~._~.____. .--------~--- .--~-----.,- JElEPHONE NUMBER 717/532-5713 ..... "'z Ww 0:0 Itz 00 UQ. lllI x 6. Decedent Died Testate (Attach copy of Will) o X 9. Litigation Proceeds Received ~_._~----~-----------_._~-~-----------_._-~_._~-~-~------- 8. Total Number of Safe Deposit Boxes o X 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 20 East Burd Street, Suite 6 P.O.Box 40 Shippensburg, P A 17257 ----------------.---. - ---.-.-----.----- .---.....------.----.----- 36,637.72 .._...>_..._-_._._----~-----~.__.__._.._..__.--~--- -----------.. ~.._-~--~-------_.- OFFICIAL USE ONLY 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o >= :5 :::l .... ii: <C U W It 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o '!Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1 ) (2) (3) (4) (5) 2,178.84 (6) 300.60 r (7) None "1, i. J;!. ;:, (9) 8,073.00 -_._-- (10) 333.77 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x .00 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) z o >= ~ :::l Q. ~ o o >< ~ 16.Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 30,710.39 x .045 x .12 x .15 20. 0 .CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. c:::3 - :0 CD (j a (\) >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << ....,.. I ;,..._r ~ ..::: t?3 a .-... '-'l, ....... 6) Q. iJi ~ (8) 39,117.16 (11 ) 8,406.77 30,710.39 (12) (13) (14) 30,710.39 (15) (16) 1,381.97 (17) (18) (19) 1,381.97 Copyright 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 83 SOUTH HIGH STREET crty----. - NEWVILLE -------- -:STATE PA~-----;-in)--17241 I Tax Payments and Credits: 1_ Tax Due (Page 1 Line 19) 2_ Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 1,381.97 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty A. Enter the interest on the tax due. 8. Enter the total of line 5 + SA. This is the BALANCE DUE. (3) (4) (5) (5A) (58) 0.00 Total Interest/Penalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 1,381.97 1,381.97 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 No 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 after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................................................................................ 0 ~ o ~ o ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..... ........................................................................................... ............... under penalties Of perlurY,TdeclarethalTha'ole el<aminedlhisrelllrn. including accompanying schedules and statem"nts,-andlothe best of myki'iowledge and belier,llis ~c:orrectand complete:-- Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SiGNATURE O-"PERSON RE-SPONSIIlLeFOR-"i-UNG RETURN-- ADDRESS ---------~-------- L~ 17 SAN JUAN DRIVE MECHANICSBURG, PA 17055 4u~f;; n FlDNGRE~m~V:''' ADDRESS--- DATE / J - /~ - Z. Od I ---OAre------- SrGNlffiJRf OFPREPAREROmERTF1AN"RE?FSENT ATlVe- / l r~ ,: - ADDRESS--;:---~------ . . 20 East Burd Street, SUite 6 P.O.Box 40 Shippensburg, PA 17257 .---~_.~-~----DATr---' It/zl/o' For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (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. *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAHAM, MABEL L. ! FILE NUMBER 21 - 01 - 00866 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 whicli is jointly-owned with right of survivorship must I)e disclosed on schedule F. ITEM NUMBER ."._-------~_._-- I VALUE AT DATE OF DEATH 8-3 SouthHrgh--Street, Newville, P A 1724-r;-Decendant's]lus6arid~--Kenn-ethGrafiam dTe,fonP-ebu-rary- --~-36,6-3-7:J2 21, 1958, thereby vesting full fee ownership in Mabel L. Graham, his wife. The property was sold to an unrelated third party in order to pay Inheritance Taxes and settle the Estate. (See attached copy of Deed and HUD-I Settlement Sheet). Net value reported because estate was otherwise insolvent and could not be settled without sale of real estate. Net from HUD-l plus add back of escrow for inheritance taxes and attorney fees (deducted elsewhere). DESCRIPTION -----~---~-~-----~---_.__.__.._.._--_._-._-- ----_.-._--_._.__._~_.._~--..._~-_._,----~--, ----------------- TOTAL (Also enter on Line 1, Recapitulation) 36,637.72 A. Settlement Statement U.S. Department of Housing and Urban Development ~ ,r OMS Approval No. 2502.0265 B. Type of Loan 1. D FHA 2. 0 FmHA 3. 0 Conv. Unins. 6. Fiie Nurr.ber 4. 0 VA 5. 0 Cony. Ins. "1, loan Number 8. Mongage Insurance Cne N~ C. Note: This form is fumisned to give you a statement of actual settlement costs. Amounts paid to and by tihe settlement agent are shown. Items marl<ed "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not .,-nclud_edln the totals. u ______ ____.u____.___ D ~al'l"!e and A.ddress .,f Borrower E. Name and A~dfess :If Seller F, Name and Addre$S of LenlMr Thomas W _ Seidel Estate of Mabel L. Graham NA G. prccer.y location H. Setllemerll Agel'll 'Gerald K. Morrison, Esquire ~-,._----_.._-----.- Place of S~!lIemenl I. Semernent Oata Borough of Newville, Cumberland County, Pennsylvania New Bloomfield, PA 9/28/01 105 __~ ___~_ ~~__~~umma~.!.-~eller's Tr~!a..:!lon 400. Gross Amount Due To Seller u--'--46;ooo-:oO'~01,.C;';;~~sales pri~u=- __ _ _. __ ~9~~~~~1 prop~__ ~__" 958.00 403 _~_____________~ 404 405. J. Summary of Borrower's Tr~nsaction 100. ~ross A,!,ou~~ Due ~~O!T' Bo'!.o!-,er__ ____~ 101 _ Contracl sales.pnce 102. Personal proe~~t. 103 _ Settlement chaT~es to 'cxltTower (line 1400) 104 __~.OOo.OQ Adjustm!ffits_1or _i~~~SJ1~id_b~_s!ne~.i!,~~~n_c.e_____n__~___ ___ __. ___~~just"!enlS f~~ltems pa!~ by s.l~er In ad~__ 106. C~/!~~ t~~_es_ _ ._____ __~to_______._>_____~__ 4QL~{town t~!~____~~~ 107. Coun.y'_'.' 9/28/01. to 12/31/01 39.61 407. Counly'_'.. 9/28/01 '012/31/01 '\0&,- As~essm~;;;-"-~ --.. --. - - to--- _-~ -~==~-_~~ ~~_ _ _ _49;-~-;~s~nts ----- ~ --to----~- 109 - Schooi u_ 9/28;()1 '0 6/36i02--- 297.25 409. S~o~I___?!2.8/0 I .to 6/3_0/02 _~_n .---u-3'9-:6 I 297.25 110 111 112 '0 '0 10 410. 411 412. to 10 10 120. Gross Amount OlJe From Borrower 41,294.86 420. Gross Amoun! Due To Sener 40,336.86 200. _ Amounts ~3!d ~y 9r In ~ehalf.of B~',!~,!,!~r_ 201 DepOSll or, ea~est money_ 202. Principa~ amount of new \oants) 203 EXisting loan(s) taken subject to 204 2115 206,,__ 207 208 209. 500:.~ ~~~uctlons 1~~mQ~_!\~QU~)"o Se~_._.~___. I ,000.00 SOl".E:~E".~d~sil (see i~,,!,,-b2!'.&.___ 59_2.~!tle~enl cha~_~'!p~lle_r (lin~2QL____ 5Q.~:~jng loan(s) ~ker't SIJ?j~~t to _~Q4~yott of firs~~e loan ______ _ __'- __._ _~~ .__< ..?~5 Payoff of second mortgage loan 506 Hamilton C. Davis - Escrow for Inh. Tax 507 .508c_______. .' 509 3;699.14 3,000.00 _ . ___.A~~5~~~~~O!...~~_'!'~ --'!11_j:.lCl,id_ by_ s_~I~~ ~_. 2.19.:-.9~y/_t(3~~~a,-,,~_ ______ lO__ .__.___._ 211 Counll'..i<1xes._ 10_._____ 212 Assessments to 213. ~ _A~~.st!!!~nts f~!...!~~.!..~~p~ seU.r _____h 5~q._..g,~wn taxes to 511. County taxes to ~'2. Assessmen~_ to 2!~. '0 215,__ _ to 2'5. . to 217. 10 2'8. '0 2'9. to _ '_U_ 513,_______ 5'4 -------- __ .~!L.... 518 to to 10 to 5'7. 10 10 to _ 518'-_________ 519 2.20. Tatal Pilla BylFor Borrower 1,000.00 520. Total ReductJon Amount Due Seller 6.699.14 300. Cash A.t Settlement FromfTo Borrower - ~ -- ---- 301. Gross ArT!ou~t due from borrower (line !..~Ol~.____~ __ _._.___._ 302, Les. smounl paId by/for borrower (line 220) :( 600. Cash At Settlement To/From Sener 4I,294:.8? 60;(;;;;~-;;;;-;'d~e-;;;-;'-;r(ij~420) 1,000.00) 602. _Les'redu,,-,i~n!.'!'~,-,-d~~.seller (line 520L-_J. - -4O,TI6.86 _ ___ _6!~9~,_~ l 33,637.72 303. Cash 00 From o To Borrower 40,294.86 603. Cash 00 To o From Sene, The underSIgned hereby acknowledge toe receipt of a comp~eted copy of pages' &2 of thIS statement & any attachments referred to herein. I HAVE CAREFULLY REVIEWED THE HUD., SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF. IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE RECEIVED A ~OPY <it THE HUD.' SETTLE NT STATEMENT /) ..IJ. _ . / /.. /.. BORROWER \. X)~~ Ll.l SELLER 'l-C"~~u ex BORROWER SELLER TO THE BEST OF MY KNO. W~.6 E~D~' T E HUD." SETT.' LE.MENT S..TATE. MENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATEACCOUNT OF THE FUNDS WHICH WERE RECEIVE~'l'/ j L {~7~ 'JNDERSIGNED AS A PART OF THE SETTLEMENT OF THIS TRANSACTION. WARNING. IT IS A CRIME TO KNOWINGLL7MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR PoNY SIMILAR FORM. PENAL TIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE TITLE \8 U.S. CODE SECTION 100' & SECTION 1010 Previous Edition Is Obsolete HUD.l (3-86) RESPA, HB 4305.2 l: _~!..ttlem~n_t ~h.J!.~es lE~--.!otal SaJe-!!~!.~~~(s f()~'!1_issi~~~.!!!~".~~~~ ~ __ Division or COn1m;ss~on _ {line 700'---~s fOltow~: 70;--$=~~~~~~_=_~. _ _ 2:86.2.:~~_\0 702 $ 10 --~------~.- .---- ~._----- u__40,OOO.00 @ 7.00._ .-=- .;:~-=~,80~OO---;'a'd ;,;,~. Borrower's Funes At Settlement Paid From Seller's Funds At Settlement _ ~.~!i-.:~~~~?~?:' GMAC Re~!__~~ate-~~-~_ __. 703. C.E~miSsio~J?a;d a-.!. ?~l~eml!'~_t. _ _._ ____ _ . 704 ~O~~tem5 ~_~y~~~!~_g()!'1!!_c:.ti~_n ~i~h ~~PI~~ 8_0_!~~o~n _O~9~~~i9_~ _~_~~ -.--2-:800.00 % ~9~._~~~n _O\~OlJ~'__ ~?12PDr~~~~~~_ ____ % ---------- ----~-- '.~~ 10 ~~~EJ~____ ______~__.1o 605 lender! \nSpectlonY:~ _ __ ______._ ~~~onQi3.9_~~~~~_A.EE!~t.i~!1f~~__!~_ ___ ___ ~Q.7~__A:~~UrT'_P.tlon F,=~ 808 80S ------ 810 -.---...-.---. 811 900. Items_.I!!!qYlred~end.r To Be Paid In Advance ~~~from__~__ 10 @S 902 Mortgage Insurance PremIum for 903. Hazard Insurance Premium far S04 u_.l'pa:i_~___ months to _....1'~~<rs to years_t.P _ 905 1~_~~_'!.e.~erves Oepo~!t~_~_~~_l_e~~4!! !9Q!_'_I-f~~.~!P J~~~~~~ ___~____.l!1onth~_@L~__ ~~~~~~r:~~~~.!:._____._____~!~S 1003. Ci'1:i'~~a~s____u monl.~~__.___ 1004. County propert.Y.!~~__ manths@S 1005. ~n~al assessm~_l'!~____ _ _ mon_~~_.__ '.9~~. _ u ____-"'onlh"~t 1007 _-",onlhs@$... 1008 110~!i!le.f.h!!9!~ ._.. 1101. Sertl~~~~~closin~ 1 ~02. Abstract or t~~_~arch _____ 1103. Title examln~..!!9-~__.____._ . ~04 Title insurance ~~~._ __-.e.~!. month_____ per month ._ _ __per month -.Ear month 2.e!..!!!~___ ~~~_ _month l?~r ~onlh 75.00 ___.__ -,,,--_Qerald -K~MolTis?n"~~uire_ to .--------;0- Gl:raj(nCMo~!Is~n~E~quire 250.00 ~_____~o____ ~} 05. Document preparation "06 Nota~s__._____ .__ _._ 10 1.2.07 Attorney's fees _deed, :.t.c::. {Includes above Items numbers '!..~~~_~e__~~~~~.._____~.._.____ _"_, _(I~_~I.u~~_ a~_~~ Jt~~~_ num~,~s:__ . __~ ~~I~'~~~!,de1"'_S_~~!!,~9'e ~ .____ ~.:-9.w...!!~E!~_~~ _ 1111 --------.- ."--,- 10 . 10 H.a~liion .t:. Davis, Esquir~:}OC'::'===-_ . ;;--~l~ahe!!;. Qu-ig:le}:~E_sq':liI'~- lS7.s0 ~._.._-- 111J ~~Q.:...~.~~~'!'!!'t..~!~or~i!!i ~~~_ ~~a_'!.s.!er Charges 1~.1,_~0~n9Ie~s Dee~_ $_ _', 25.50 11.01" f!,ty/~u."!Y ~a~l~mE! geed $ ~~~Ie ta~Sta!"E.s De~d_ $ 1204 -----.--.-., 25.50-----. Mort.g~._S_ 400.0~-,-!.\"":ila~ .$ 400.00; Monll.age $ . Releases 400.00 400.00' '205 1300. Additional Settlement CharS!!..- ~1. Survey to 1302_ Pest inspection to ~30J Bel'lLL. Iio~kensmTt~~~~Ol School-Tax. __._ 1304. Newville Water & Sewer Authority. water .& sewer -. ;305 Perin Pest~nsect insiJection ..--- . --~94._s-3 ----10,4:61 50.00 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 958.00 3,699. ]4 T~l~~0~~~~~t~~eWE~~~~~~g~t~~6:~'~'Eii.~M~~+e~{~tb~:{~r~N'J'~g'+~~ s:;r;'6'~ ~f~~~~6~~r!~ge~~~I~r~~IS A TRUE AND ACCURATE STATEMENT O~ ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION 12FURTHE C=zERTlr.v THAT I HAVE RECEIVED A COpy OF THE HUD-, SETTLEM NT STAT-ME T ...L P r-/ BORROWER ~~ I r SELLER ~ V-- ~ BCRROWER _ _. ._ _____. SELLER. _____ TO THE BEST OF MY KNO~EDGE THE HUD-l SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACCURATE ACCOUNT OF THE FUNDS WHICH WERE REC~~V~=RWILL BE DISBURSED BY THE UNDERSIGNED AS A PART OF THE SETTLEMENT OF THIS TRANSACTION. WARN1NG 'T IS A CRIME TO KNCWINGL Y MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENAL TIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT FOR DETAILS SEE: TITLE 16 U.S CODE SECTION 1001 & SECTION 1010. Public Reporting Burden for this collection of information is estimated to average 0.25 hours per response, including the bme for reviewing instructions, searching exisbng data sources, gathering and maintaining the data needed. and completing and reviewing the collection of informabcn. Send comments regarding thiS burden estimate or any other aspect of this collection of information. including suggestions for reducing thiS burden. to the Reports Management Officer. Office of Information Policies and Systems. U.S. Department of Housing and Urban Development, Washington. D.C 20410.3600; and to the Office of Management and Budget. Paperwork Reduction Project (2502-0265). Washington. D.C. 20503 U.S GQ'JEIl,*UT "'~CH\tE; '..........;:45 . 201-BT - Wa.rranty Deed. Henry Hall. Inc.. Indian.&. PL .. ~bi~ 1!leeb, :.fl'1atJe tue Twenty-sixth day of April in the yea-r of Ollr Lord one tho7lsand nine hundred & fortY-1'1i1'1e Jiet\uefll lHlu ~;.Deshone (wirlo'R lar'ly living in He......ville .Pen1'1a.) County cf ~umberl~.rl-i, Re pRrty of the first part (hereinRfter c&11e1 the Grantors l Kenneth GrR.halIl & i.4able Deshong GrR.ham his Wife of Eewville ~~hty of Cumherlan-i,State of PenneylvRnia,party of the 6econ1 pHrt, (hereinnfter called parties Df (ee~on1 part) millI[t ~!(I'th th tin c nsirlp-ration of One (;;Pi, no) Dollar, ?nrJ 0 the r ~!'O or! a'Y1t1 "h1r~PH.e ~one18eratl one, Dollars, in ~~nd paid, the receipt whereof is her~by acknowledged, the said llrantor do hereby grant and convey to the sa~d grantee B the i r he i rs 8nrJ a8sifTlS,ALL that rlertai1'1 trHrlt of lan-i with the improvements, sltu!3terJ in the South "ii'1.rrJ of the Ilorouf:h of Ne1TVille,Counto of Cumherll".n--l fw1 st?te of .f'enneylvRtlia,bounrJe1 a1'1rJ -leseribe"l ".'3 follows,to wit:- II bc;UIlDED O!I Tll~ West by South High Street; on the 1'1orth by property, now or formerly of Annie L. Dougherty; on the ea'3t by q private alley,qnr'l on the South by property of Martin Uiller. ,glJ1'AIl!Ll<l a. frontap:e on South High Street ot! forty-nine (49) feet,8,,'rJ extt'r,-lillF; a.t 8,n even wi-lth to trle aforesni4 ~lley on the eHst. )1 .d~IHG the sawe premises wrlir:h nonal-l Jarloh Hershey, p.n~ Mary Huth Hershey his wife,by their -iee'" bearing tia.ee the 10th "lay of l'ebrurary ,1943,:'1.l1rJ 1uly reeor-1e-1 in the office for the rerlor1ing of 1ee1s in anrJ for Cumberl8.1'11 County,State of .PennaylvPl1ia in TI"JEn BOOK (Q,) V()L.~12) .t'AGE (5). COllveye1 to Ceorge C.Deshong (1ecease':l)an1. Ella S.Deshong,hie wife,t~e herein callerJ Grantor, '<tub, the srtid grantor ,do e s hereby covenant and apree to anri with the ~l~~d grantee F' ,that 88.i1. , the grantor her he~rs, e;recutors a,nd ad71unls- trators. shall and will warrant Generally------------------ and forever defend the herein abol'e described premises, with the hereditalnents and nppu.rtenances, unto the said grantee D their heirs anti assigns, aga.inst the said grantor . and against every other person lnwfully clahning 01' who shall hereafter' claim the sa.lne 01' any part thereof. ]n il!ilitntS5 illBbereaf. said ffrantor ha 8 hereunto set 11er hand and seal ~::.:.l~.::~l~::::.:.:t abOl'ell:tr:''1t{l_~0.r:~:!j;'J~!J.:/'''''~' In tI,. ~....nn 01 ( ./ ~ ...-..---......-..-. ---~ ..::::..:..::.:.....::::.::::::::.:......:..:...:....::.:.....:'..:'.. \ _....n.............................m.... ~ ) .nm........._.nn..................... ~ State of i' 31ili~ Y L 'fAll I A }ss. clayaf April , 1949 . before me. County of CliLU:JGHLAlm 0" this, the Twenty-eie;hth the unci"rsiifned uf/icel', per:;onally nppeul'ed ~lla u. Deshong known tu J>M (01' satisfnetorily pr01'en) tu be the person who:;e n(trne sltbscriberl to the within in:;tl'ument, anrl aeknowledg'ed that 8}le e.vecuted the sllme lor the purposes therein contltinerl. ]\1 faitness mbereaf. I hereunto set my hanrlltlui oificiG;l iettl.! / '" . '-. .. I '/-'-':f:/k."'~?=n.~;Zf'-:.~:v: ~ JustiCe of the ~eao~ ............. ....n.Ti..ii~.~.ioii?;~;... ...n. ...... / do hereby certify that the precise residence of the within narned grantee is ~.tr t;treet lfewville J;'ennaylvalli..., . J ..;. ~ . .iL I ~ J" .;.~ 1.9 49 ..( ).-0:: k~r.-.-!!..<,-a ~_'- ~ "+ ;:.~./C~..;. I~' .... -'~ \. A. ttflrtt'-T.J.lftr. 'I &:J ~ ~ ~ g ,C?, ~A I=; <lJ .~ .... 't:1 ;:: l:: rr; .;.Q .... ::i! ,.;:::. ~.~ :~ C3 :~ .,~ u ( ~: \ \. ., '... , I ..' , \ ,- y. ! " ',"---' / ~~Y .. ~ '" 'd '" .. .. ~ '" 'd " f ~ , ,~ ,1 ~~ o h ~h ,,~ f'j''1 r.... ~ r7] ~~ ~....:i >- ~ Z -( c.:: c.:: -( ~ \OJ ~ '.~-..l "' ~:::o:~~~~.~~~.~~...... ~ss. RECORDED on this ............'1......................... day of ............-!:."'/..:.....m.m........ A. D. 19..;;,.i)., in the Recorde,'s offu,e of the said Cou"ty, in Deed Book J , Vol. ....It........, Page .........Lol.................. Given under my hand and the seal of the said office, the date above written. I...,.}~."o,l;.f{;....~, Recorder. *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT --- - --- ------------ ---- ----------------------------- __ _________ __________--1_______________ _ ________________ ___________ - ~---~---------_._.__. ----- ._----------_._----------------~----------~-------- --. -_._---------,'---.,------ ~-- --_._-~---------------- --'" .."-------.- .~_._---- ESTATE OF GRAHAM, MABEL L. I FILE NUMBER 21 - 01 - 00866 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 -- -r----- SavlngsAccounifor Funeral DESCRIPTION VALUE AT DATE OF DEATH --------- -r,67-S.84- 2 Miscellaneous Tangible Personal Property and Furnishings 500.00 --'--'-~_...._----- .._._--~---,---~- -_._~..._---_._----_.-._-_...~_._--~-_.- ..-------- TOTAL (Also enter on Line 5, Recapitulation) 2,178.84 . SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - ..---------."-.--- --. .- --- -----_.._-_._-----~_._-- _.~--- .__.~--_.._--_._--_.._-----------_.,--_._-~ -_._----_._._----_._---_.~----- ---.. --~--'---'--'--_. '------_._-~---~- - ..---.......-------.--.. ---------'....._---- - -----~- _._--_._---~---------------,._-~---_._---_._-_._----_.-.----------.--- -.._----- ESTATE OF FILE NUMBER GRAHAM, MABEL L. _~___________ _n_n_____________ ______ ____ _____L __2~_=_~1_~~~~~____ __ ___ If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. -- ----- ---------- - - --~---- SURVIVING JOINT TENANT(S) NAME A --Shrrleyn~.fCramern---_--- n ADDRESS RELATIONSHIP TO DECEDENT 26 Kough Road; Newvlfje-;-PA---~~-- --Daughter-- JOINTLY OWNED PROPERTY: ;---- .---r------lJESCRIPTIOI\rnFPRn~ ' ---------r--- LETTER' DATE I . . . . I I % OF DATE OF DEATH ITEM FOR JOINT MADE !Includ~ name ~ffinanclal institution and bank.a~count number! DATE OF DEATH DECD'S i VALUE OF NUMBER TENANT JOINT or similar Identifying number. Attach deed for JOintly-held real iVALUE OF ASSET ,INTEREST DECEDENT'S INTEREST estate. i ~. ~--- A = I Bank Account - See attachedSiatement. ,--- 601.19' --50%1 i 300.60 i - TOTAL (Also e~ter on lin~ 6~ Re~apit~l~ti~~)--n--T----~OO:6-0n CHAMBERSBURG F8M BOILING SPRINGS 0022 0015 2487 Y MARION MONT ALTO NEWVILLE SHIPPENSBURG STATEMENT OF ACCOUNTS TRUST WAYNESBORO 33-17331 X CARLISLE STATEMENT PERIOD FROM THROUGH 2-14-01 3-13-01 0 PAGE 1 OF 1 MABEL L GRAHAM SHIRLEY M CRAMER 83 S HIGH ST 8 ENCLOSURES NEWVILLE PA 17241-1405 5 1'111" '111111.1.1..111.1111.11.111111'1111.1111.1.1 REGULAR PERSONAL CHECKING PREVIOUS DEPOSITS/ STATEMENT BALANCE CREDITS 1 1.933.74 504.00 CHECKS/ DEBITS 8 1.332.55 ACCOUNT: 33-17331 SERVICE FEES .00 ENDING BALANCE 1,105.19 * INDICATES SKIP IN CHECK NUMBERS DEPOSITS/ CHECKS/ DATE ACTIVITY DESCRIPTION REFERENCE CRED:ITS DEB:ITS 02-14 BEG:INNING BALANCE 03-02 US TREASURY 303 00077900000 504.00 SOC SEC 030201 161340679A SSA 03-07 CHECK 00700702189 504.00 02-16 CHECK 1579 00202305216 15.44 02-14 CHECK 1580 00200100034 163.08 02-16 CHECK 1582* 00201703607 40.25 02-14 CHECK 1583 00101302780 318.45 02-21 CHECK 1584 00100700983 29.00 02-22 CHECK 1587* 00101002226 38.33 02-22 CHECK 1588 00201503461 224.00 03-13 ENDING BALANCE SERVICE FEE BALANCE INFORMATION FROM 2-14-01 THROUGH 3-13-01 AVERAGE LEDGER BALANCE 1.281.36 AVERAGE COLLECTED BALANCE MINIMUM LEDGER BALANCE 1,105.19 M:INIMUM COLLECTED BALANCE BALANCE 1.933.74 1.452.21 1.396.52 1.367.52 1.105.19 1.609.19 1.105.19 DATE 02-14 02-14 02-16 02-21 02-22 03-02 03-07 1.105.19 03-13 1.281.36 1.105.19 WANT TO SAVE ON YOUR TAXES? IT MAY BE A L:ITTLE LATE TO SAVE ON YOUR 2000 TAXES. BUT :IT'S NOT TOO LATE FOR 2001 ONE WAY TO SAVE :IS WITH AN F&M TRUST HOME EQU:ITY LOAN OR L:INE OF CRED:IT. YOU CAN CONSOLIDATE YOUR BILLS. LOWER YOUR :INTEREST AND GET A TAX DEDUCT:ION. AND ASK ABOUT OUR "NO CLOSING COST" HOME EQU:ITIES, SO YOU'LL SAVE EVEN MORE CONSULT YOUR TAX ADV:ISOR REGARDING THE DEDUCT:IBILITY OF :INTEREST. EQUAL HOUSING LENDER. DIRECT FARMERS & MERCHANTS TRUST CO INQUIRIES TO: NEWVILLE OFFICE 9 W BIG SPRING AVE NEWVILLE PA 17241-1301 TELEPHONE: 717-776-2242 *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAHAM, MABEL L. SCHEDULE H FUNERAL EXPENSES & ADMINISTRA TIVE COSTS FILE NUMBER 21 - 01 - 00866 Debts of decedent must be reported on Schedule I. ITEM : NUMBER. I -j..:--- ...---q=UNERACEXPENSES:-- I Egger Funeral Home 2 Eby Granit Works - Letter Stone B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. DESCRIPTION AMOUNT Social Security Number(s} I EIN Number of Personal Representative(s}: Street Address City State Zip Year(s) Commission paid Attorney's Fees Zullinger-Davis Professional Corp. -- Hamilton C Davis 2. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees State Zip 7. 1 Other Administrative Costs Reserve for Closing Costs and Contingencies TOTAL (Also enter on line 9, Recapitulation) 5,564.00 393.00 1,500.00 116.00 500.00 8,073.00 F CHARLES EGGER, Supervisor EGGER FUNERAL HOME, INC. 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 717-776-3414 FRANK C. EGGER, Funeral Director April 5, 2001 Funeral Bill for Mabel L. Graham Date of Death February 25, 2001 Professional Services $2,650.00 Black 18 Gauge Sterling $1,845.00 #5 Regular Burial Vault $769.00 Cemetery Opening $240.00 5 death certificates $10.00 Clergy Honorarium $50.00 Total $5,564.00 Amount in Savings $1,678.84 Total Due $3,885.16 I) AI 0 - J-/\ ru II '-"S t'" 0 I "_ I 3u 'y 'f C~Jr5 ~ Eby Granite Works P.o. Box 187, Newville, Pa. 17241-0187 Phone: (717) 776-5118 Shirley Cramer 26 Kaugh Rd Newville, Pa 17241 June 29, 2001 The MABEL LAURA GRAHAM memorial has been installed in NEWVILLE cemetery. Total Contract 393.00 Payments 200.00 Balance Due 193.00 ~ . L / 1/ {/ a ,j' ,'~" Ij~///.-' (7~~ /(..() I 7-J{1-C/ Thank you for your patronage. ~-- \---/:~ (;,-,{ (;/,< C L- / ..-7' ..,-../ TERMS: BALANCE DUE 15 DAYS. . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -- ., -~_.._----_...--_.- . FILE NUMBER 21-01-00866 ESTATE OF GRAHAM, MABEL L. Include unreimbursed medical expenses. m__'_______.__ ___..______ ___ ____.. ______..,. _________.._. _...__..__.___._._~_~______"__ ._________._~_______..____.__,. .____m____...'_________.____m ITEM NUMBER ---,.,,------- I DESCRIPTION AMOUNT ~._--- ~---------29.00 Electic 2 Telephone 32.37 3 Fuel Oil 117.13 4 Meals on Wheels 26.25 5 Real Estate Taxes Due 129.02 TOTAL (Also enter on Line 10, Recapitulation) 333.77 ~/ DESG; TAX PAYER OFFICE HOURS; U~.~~~.t;" . "'l;;.. " , ...... to FORWARD TO MORTGAGE CO. ..JNAL RECEIPTS. ,. ;< dETTY L. HOCKENSMITH 108 WEST STREET NEWVILLE PA 17241-1008 MAP NO: 28-20-1756-009 0081 S HIGH STREET DEED 141 I 101 LAND HOUSE RESIDENTIAL GRAHAM, MABLE 83 S. HIGH STREET NEWVILLE PA 17241 TUES 9AM-12NOON & 6-8PM THURSDAY 1-4PM CLOSED MAY & SEPTEMBER PHONE (717) 776-5511 TAXPAYER COpy Bill No: 181 Control No: 028 - 0001 06 2000 Statement of Real Estate Taxes Bil/Date: 3/01/2000 Assessed Land Improvement Mineral Total Values 410 1.920 0 2,330 COUNTY OF CUMBERLAND Discount Face Penalty Rates .02600 .02600 .02600 2\ 10 \ COUNTY R/E 10.66 49.92 59.37 60.58 66.64 Rates .00150 .00150 .00150 2\ 10 \ COUNTY LIB .62 2.88 3.43 3.50 3.85 BOROUGH OF NEWVILLE Rates .02900 .02900 .02900 2\ 5' HUNIC. R/E 11.89 55.68 66.22 67.57 70.95 TAX AMOUNT DUE -> ~ $131.65 $141.44 If Paid On or After 3/01/2000 5/01/2000 7/01/2000 If Paid on or Before 4/30/2000 6/30/2000 IF NOT PAID BY 12/15/2000 THIS BILL WILL B~~~ED TO TAX ~Mp~u;:~roR COL~IO' _ ~~~ Return Bill with Payment. For a Receipt I Enclose Seij.AQGr"~an:lp~~Q\UilOlJ&..~ ""'--~...~-~..-~.. ..._-__.~~""":;-.....:,~ ~~~~~ .-.:,~:~,<:,~-,!~~"'- ~'I.~~~ ~~~;,,_'''':'''l:,~' ;H.';:~ ~:.T~ .....,..'""-.. :;;:r......::::.~