HomeMy WebLinkAbout01-1044
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PETITION FOR GRANT OF LETTERS
2 - 11- C) a..
Estate of Russell P Wilson
No.
21-01-1044
also known as
Russell P Wilson
, Deceased
Social Security No. 172018769
Jane W Rosenthal
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
o
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated and codicil(s) dated
named in the Last Will of the
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:
Gl
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
Jane W Rosenthal dauahter Mechanicsbura. PA
(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 720 Elkwood Drive New Cumberland PA 17070 6
(list street, number and municipality)
Decedent, then 87 years of age, died November 5 ,2001, at Harrisbura Hospital, Harrisburo, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property ......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows: 720 Elkwood Drive, New Cumberland. PA 17070
Wherefore, 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:
46,500.00
90,000 no
136,500.00
Typed or printed name and residence
Jane W Rosenthal
5245 Strathmore Drive
Mechanicsbur PA 17050
717-731-9058
/7..02/"0/
- 6Gb
/7- ~/- 9
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 administer the estate aCCOrdi~ I~. . /
Swom to and affirmed and subsciibed (~/1Il t .-Jr. ~~/-
before me this 14th day of _J . "U .
NOVEMBER ~ tt H ~ !J) I ...:Jj,..'D S l "1 f k /
7~7~/N~u/g<:4'~ .
Estate of
DECREE OF REGISTER
AND NOW, NOVEMBER 15, 2001
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters Cl Testamentary lD of Administration
also known as
are hereby granted to Jane W Rosenthal
Deceased
No.
21-01-1044
, in consideration of the Petition on the
((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) .... 5......
Renunciation. .........................
Extra Pages (
) ...............
................................................
I.T.R.......................................
JCP Fee. ................................
Inventory... .............................
Other ......................................
TOTAL... .,. ............ ..... ......$
$
235.00
$
$
$
$
$
$
$
$
15.00
5.00
255.00
~r~~A/4~,,/~-
R' ster of Wills
~~~~
Attor~y: Jan L Brown
1.0. No: 67993
Address: 845 Sir Thomas Court
Harrisburg
Telephone: 717-541-5550
DATE FILED:
PA 17109
PETITION FOR GRANT OF LETTERS
Estate of Russell P Wilson
No.
21-01-1044
also known as
Russell P Wilson
, Deceased
Social Security No. 172018769
Jane W Rosenthal
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
GJ
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix
Decedent, dated 01/25/1991 and codicil(s) dated
named in the Last Will of the
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 720 Elkwood Drive, New Cumberland. PA 17070
(list street, number and municipality)
Decedent, then 87 years of age, died November 5 ,2001, at HarrisburQ Hospital, HarrisburQ, PA
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County.............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..............................................................;........................ _............................. $
Real Estate situated as follows: 720 Elkwood Drive, New Cumberland, PA 17070
Wherefore, 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:
46,500.00
90,000.00
136,500.00
Typed or printed name and residence
Jane W Rosenthal
5245 Strathmore Drive
Mechanicsbur PA 17050
717-731-9058
/?--y'/- 9
06T;:
/7 -c{2j- /
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 administer the estate according to law.
Sworn to and affirmed and subscribed
before me this 4th day of
FEBRUARY c' '"'t ~ 1k. ~~I
'>>y;.uyil !;r(h"'Y>'V</ ~/ /.~
Estate of Russell P Wilson
DECREE OF REGISTER
No.
also known as
Deceased
21-01-1044
Social Security No: 172018769 Date of Death: 11/05/2001
AND NOW, FEBRUARY 11 2002 ,in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters (XI Testamentary 0 of Administration
are hereby granted to Jane W Rosenthal
((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 .JANUARY 2 I) a 1991
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters .................................... $
Short Certificates(s) ...............
Renunciation ..........................
Extra Pages (
) ...............
I.T.R.......................................
JCP Fee ......... ......... .... ...........
Inventory. ...... ... ......... ..... .... ....
Other ......................................
TOTAL........................... ..$
25.00
I ~.
~Y'(? LL/~/~h) .I2t./ /;;;..";,,,
RegIster of Wills
$
$
$
$
$
$
$
$
(~J) X 6-1::14<.Vl / /4j.I.
Signature /
Attorney: Jan L Brown
I.D. No: 67993
Address: 845 Sir Thomas Court
HarrisburQ
Telephone: 717-541-5550
DATE FI LED:
PA 17109
25.00
,,; ':;':"<' ~"::''\. 0,'~r:,
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~~K~
Local Registrar
Fee for this certificate, $2.00
p
7745857
N OV 0 ~l 'LOO\
Date
21-01-1044
..... 2117
COMMONWEALTH OF PENNSVLVANiA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
SWE FilE NUMIII!R
=~OF~0SSEL.r' P.WLL~
SEX IY1
a.
SOCIAL SECUAlTY NUMBER
3. 1'Tl. - O/g - -:rtJ1
PI..-cE OF DEATH /CheCk QI1Iy ON - __ ",.,ucLonI on 0lIWIf "'*
~~~ m~~
lnpQnI 0 EA/OulcIeIienl ~ OM 0 ~ 0
ORE Of' DEATH ,McndI. 0.). ._,
.. November 5, 2001
_ AGE. (lallllotlt>daYl UNDER 1 YEAR
MonlIw o.ya
UNDER 1 DM
HouN 1 MinuIw
.
Dauphin
OECEOENl"SUSUAL 0CCUMl0N
iii I=~~::~:r
~1~ Banker l~.C.N.B. Bank
DECEOENT'S MAILING ADORESS (SIr"'~. sr.. l"opCodeI DECEDENT'S
720 Elkwood Drive ~~
New Cumberland,PA 17070 oo~
1..
FRltER.s NAME fFir1l. Middle. lMll
1 George Wilson
INFCIAUANT"S NAME (T ypeIPtinll
~ Jane W. Rosenthal
METHOD OF DlSPOSITIOH
O 8lnI18 CrelMIIan 0
DaMIiaft 0lMr (Spec:lIyl
1..
~~
(0-121
UAI'lIlAl STATUS. MMied
~........~
CoIIge ~1S'*"Yl
11.~!>+' 1..widowed
170.0 ....deeedInIlMditt
~lo
arrisburg Hospital
MS DECEDENT EIlER IN DECEDENT'S EOUCArION
U.s. ARMED FORCES?
... lit No 0
RACE - _1nclIM.1IIICII. WIIile. elC.
I~
White
SURVIVING SPOUSE
II..... ONe "**'........
1:1.
17.. s...
PA
i-=-
10,2001
DId
.....
.... in .
Cumberland 1l/lOlnIIlip? 17..[3:':=-=01 New Cumberland
MOTHER'S NAME (Fita MoOclII. MulIn SulMNl
1 Sudie Brinton
1NF000000S MAlUNO AOOAESS IS*'.... CilyIlOwn. SIaIa. Zop Codel
5245 Strathmore Drive Mechanicsburg,PA 17050
PlACE OF DlSl'OSlTlON . Nama oc CamaleIy. CtematlllY lOCJIl'lOH. ClIy(btn. 818. Zip Coda
fII 0lIlIr "'-
Olivet Cemetery 21J;Jew Cumberland,PA 1707C
NAMEANOADOAESSOFF.\CIUTY 17070
i.tone&Murra FH408 3rd St New CurnberlancL PA
LICENSE NUMBER Dft SIGNED
. D'Ilf=rJJ~ ~.~--' nlgol
\'WI CASE REFERRED TO MEDICAL EXAt.lINERICORONEA? c:I
...0 MoJO'-
21.
I Aponlximala PART I: 0IIIar 1igniIlcanl-.clliDna ~lOdHlII. but
: .........- _ --.gin lIIa undMlyWIQ _ gi-.lI\ twn I.
I oneaI_....
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1111.
~ICAUSI(FOO8I
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_. ~ UNIllIIILYING
c.-~ar "'lU'Y I c.
....----
..........~ILMT
d.
DATE OF INJURY
1-. Day. -I
TIME OF INJURY
INJUAY R WOfII<1 DESCfll8E tON INJURY OCCUAfllED.
....0
No~
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Accictanl
Suicide
~
o
Homic:ida
... 0 NoD
PenditIg~
Could _ be del__
~ za. 21.
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'C8ITIFYlNQ PHYSICIM (PhySIC*' c~ _ d ""'" ",.., anolhar physocoan has ll'ClIlOUfll:.cl daalll ana competed "ern 231
T...._of....,-......___.....1O...11auM(.I........_............ .................. .......... ................. ....
'P"ONOUNClNQ AHa CERTIFVINO PHYSICIAN /PhyIIaan l:loIIl ptOlQjocoog da8\tl and certlIylno 10 causa cI deallll
T. .... _ of ...., ~-......., ...lIt __ ...... ...... dale. .nd place. .fMI..... 10 lhe c.UU(.,..... m.nne, .. st...... . . . . . . . . . . . . . . . . . . . . . . . . .
-.DlCAl OAlllNERICOROMEA
On the buis of .norin.1Ion andIorln.....~Ion.ln my opinion. de"" OCCUff".' the time. d.t.. and plK., and due to Ule c.u"la' and
__ .....ated.................... .......................................... ....................................
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REG'ST~.i. ..', HRUAE ~\>>I9E~'.
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:M.~6 ~tJtJ /
LAST WILL AND TESTAMENT OF RUSSELL P. WILSON
21-01-1044
I, RUSSELL P. WILSON, of the Borough of New Cumberland, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding and realizing the
uncertainty of human life do make, publish and declare this my Last Will and Testament
hereby revoking and making void any and all Wills by me at any time heretofore made.
FIRST: I order and direct that all my just debts and funeral expenses be fully paid
and satisfied as soon as convenient after my decease by my Executrix hereinafter named.
SECOND: I give and bequest to Mr. Robert L. Fortenbaugh (son of Catharine) of
Arlington, Texas and Mrs. Carol J. Adey (daughter of Catharine) of East Petersburg,
Pennsylvania, share and share alike, assets issued in the names of Catharine B. Wilson
and Russell P. Wilson, Joint Tenants, Agway Subordinated Money Market Certificates due
October 31, 1991, aggregating face value of $30,000; CCNB, N. A. Money Market Deposit
Account with a variable balance; and Silver Advantage Checking Account with a variable
balance.
THIRD: I give and bequeath and devise all other property, real, personal, and
otherwise to my daughter, Jane W. Rosenthal of Mechanicsburg, Pennsylvania.
FOURTH: I hereby nominate, constitute and appoint my daughter, Jane W. Rosenthal, of
5245 Strathmore Drive, Mechanicsburg, Pennsylvania as executrix of this my Last Will
and Testament; to serve without bond for the faithful performance of that duty, with
full and complete authority to act in that capacity, or as Trustee, or any other
capacity in any jurisdiction in order to expedite the settlement of my est~te
efficiently and completely. In the event Jane W. Rosenthal is unable or unwilling to
serve as Executrix of my Estate, I then nominate, constitute and appoint Robert A.
Rosenthal of Mechanicsburg as Executor of this my Last Will and Testament.
IN WITNESS WHEREOF, I, RUSSELL P. WILSON, Testator, have to this~y Last Will and
Testament, writte~on this page, set in my hand and seal this ~~ aay of ~~
A. D. iq9/ II
,- '----~
C~~~/cT~~
Signed, sealed, published and declared by the above named Russell P. Wilson as and for
his Last Will and Testament in the presence of us who have hereunto subscribed our
names at his request as witnesses thereto in the presence of the said Testator and of
each other, and a Notary Public.
.37fcl~S1. ~
AFFIDAVIT
State of pennsylvania )
County of Cumberland )
Before me, a Notary Public in and for said State and County, appeared the above
persons, known to me, who stated that the above Last Will and Testament was executed,
signed and witnessed by them in the presence of each other and myself, in compliance
with the laws of said State and County
Notarial Seal
Shirley Y Rouzer, Notary Public
Lower ,"Uen 1 i.vp, Cur:;~r1and County
My Commission Expires Aug. 26. 1994
. PenllSYNlriaAsil:lddon of Nciaiee
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of test at in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
~\A.nb W__-~SQ..n\~R I Al'lo\ ..--l~~e~T A. -.-.~Se.Y)I'-U~ I
-{"~cb) · ,ub..rieer 1I...t&, (each) being duly quali fied accordi'!&-.f~ law, depose(s) and say( s) that
~ I I J4 Rt=' familiar with the signature of ~S5 <.?. \ l ~ L.. \ It Snn ,
J ceaic:i~
testat~ of (one sf tke ~tlb~e;riBiRg nitfttSStS 10) the will presented herewith and
codicil
believe\the signature on the will is in the handwriting of
that ----r-h-e If
----..----;---)
*~ sSe It
to the best of---r-hei R
V L. \ I Is(4)
knowledge and belief.
Sworn to or affirmed and subscribed before /' I ~t --Y-. ~.J ~ v.f.j
me this yUJ. day of L ameJ-.,.. t /"12J
~.~ ~C>..2/ 5~,/r ,Jf..A.~n ...Ll/.{ \Jbe4,..,<~'"'f\ ,v;q
_.~~/M/#dhM /4/,.,<,0' /.J, "? /} ~ U /10S'0
RegiS'/; ~U ~ ~
S2'1r J~''''' .1I&1t4JW~~ #
(Address) / ;itJrO
REVOCATION OF LETTERS
IN RE: RUSSELL P WILSON ESTATE
FILE ,NO. 21-01-1044
AND NOW, This 11th day of February, 2002, I Mary C Lewis, Register of
Wills in and for the County of Cumberland, do hereby revoke Letters of Admin-
istration on the Russell P Wilson estate that where issued November 15, 2001
as a will has been found and admitted for Probate.
'?fl~:r (2. c;~:)
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Jane W. Rosenthal
Page 2
January 18, 2002
Upon receipt of the Letters, we are required to send written notice to beneficiaries. In that
regard, please furnish us with the current address for Robert L. Fortenbaugh and Carol J. Adey. I
understand that you have already informally advised Robert and Carol that a distribution will be
made out of estate funds. Even though the items mentioned in Mr. Wilson's Will no longer exist, it is
in our best interest to make this formal notification, particularly since you are planning to make a
distribution.
Feel free to call the office if you have any questions.
Sincerely,
~
Brenda F. Kephart
Legal Assistant
bfk
Enclosure
~
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: RUSSELL P WILSON
Date of Death: 11/05/2001
Estate No.
SSN: 172-01-8769
File No. 21-01-1044
Date Letters Granted: 11/15/2001
Will or Administration No. 2001-01044
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 11/26/2001
Name
Jane W Rosenthal
Address
5245 Strathmore Drive
Mechanicsburg
PA 17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 11/26/2001
~~~
Jan L Brown
Name (Please type or print)
Jan L Brown & Associates
Address
845 Sir Thomas Court
co
Capacity: 'ow N :~:5 ,:t
!) ",:; CV"I ", ~:: :_
Pe rS0na I Rep~entativ~(~:1
-;" Lf'\ ' "."!
X COU11.se1 for Perlsonal r'~'
ReP.reSentati~ ::;,2
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() ,,)l' , .0
UG) .~~
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Go
Harrisburg
PA 17109
Telephone No. 717-541-5550
!""\
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,j
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6'a)
Name of Decedent: Russell P Wilson
Date of Death: 11/05/2001
Will No. 2001-01044
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 05/16/2002
Name Address
Robert L Fortenbaugh 2810 Whispering Trail
Arlinaton TX 76013
Carol J Adey 2260 E New St
East Petersbura PA 17520
Jane W Rosenthal 5245 Strathmore Drive
Mechanicsbura PA 17050
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date: 05/16/2002
---~ ~-
S;9i1 Jan L Brown
Name: Jan L Brown & Associates
Address: 845 Sir Thomas Court Suite 12
Harrisbura PA 17109
:J''.
.. '~
Telephone(717) - 541- 555
i'-
Capacity:
x
Personal Representative
Counsel for Personal
Representative
C--..J
P
---
.- 'I r ...--.
-..1'0....-....
~
FAMIL Y SETTLEMENT AGREEMENT AND FINAL RELEASE
IN
ESTATE OF RUSSELL P. WILSON, DECEASED
KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, RUSSELL P. WILSON,
late of Cumberland County, Pennsylvania, deceased, died testate on November 5, 2001, having
first made his Last Will and Testament, which was duly executed on January 25, 1991, and is
duly recorded in Cumberland County Courthouse, Register of Wills, Pa No. 2001-01044;
WHEREAS, the said RUSSELL P. WILSON, by the aforesaid Last Will and Testament,
named JANE W. ROSENTHAL as Executrix of said Last Will and Testament;
WHEREAS, Letters Testamentary on the estate of the said decedent were duly issued by
the Register of Wills of Cumberland County, and Letters Testamentary were granted to the
Executrix, hereinafter called Personal Representative;
WHEREAS, the said Personal Representative has gathered the assets of the estate of the
said decedent, and the assets consisted of real and personal property to a total value of
$148,158.36 as set forth in Exhibit A, which is a statement of account of the said Personal
Representative, and which is attached hereto and made a part hereof and marked Exhibit A;
WHEREAS, ROBERT L. FORTENBAUGH and CAROL J. ADEY, beneficiaries
named in Item Second of said Last Will and Testament, will not inherit the specific bequests in
Item Second because the said money funds are no longer in existence;
WHEREAS, ROBERT L. FORTENBAUGH and CAROL J. ADEY have signed a
Receipt and Release which is attached hereto and made a part hereof and marked Exhibit B;
- 1 -
WHEREAS, the balance for distribution as shown in the said statement marked Exhibit A
has been reduced to cash and has been distributed as herein indicated in accordance with the
terms of the Last Will and Testament except as noted above.
NOW, THEREFORE, KNOW YE, that I, JANE W. ROSENTHAL, being the sole
beneficiary of the said decedent and heir under the Last Will and Testament of the said decedent,
and being that person entitled to inherit under said Last Will and Testament, do hereby
acknowledge that I have this day had and received from the aforesaid Personal Representative, in
full satisfaction and payment, all sum or sums of money, legacies, bequests and devices as are
given, devised and bequeathed to me by the said Last Will and Testament, which amount I have
received this day, and which amount is set opposite my name in the table and schedule of
distribution in said statement attached hereto and marked Exhibit A;
AND, I do hereby stipulate that in order to avoid the expense and time involved in the
filing of a formal account and schedule of distribution, I agree that no account is necessary, and I
do hereby agree that I do consent to distribution being made without the filing of an account and
schedule of distribution, the same to be with the same force and effect as if it had been filed and
confirmed by the Orphans' Court Division of the Court of Common Pleas, Cumberland County
Branch.
THEREFORE, I do hereby remise, release, quit claim and forever discharge the said
Personal Representative, JANE W. ROSENTHAL, her heirs, executors, and administrators and
assigns, JAN L. BROWN & ASSOCIATES, attorneys at law, JAN L. BROWN, ESQUIRE
and MARIELLE F. HAZEN, ESQUIRE of and from the said estate and from all actions, suits,
-2-
payments, accounts, reckoning, claims and demands whatsoever for or by reason thereof, or for
any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent,
and I do further hereby covenant and agree that should any liability come due to the estate of the
said decedent after the signing of this agreement that I will satisfy any and all claims, demands,
suits or causes of action which may be successfully prosecuted against the said estate or the
aforesaid Personal Representative after the signing, sealing and delivery of this Family
Settlement Agreement and Final Release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 1% 'It. day of
October, 2002.
~/M/1/'1 ;{r~A.f;
WItness
~(JlI ~ ~~/
C ]ANt- W. ROSE HAL )
COMMONWEALTH OF PENNSYL VANIA
SS:
COUNTY OF DAUPHIN
On this the /~fA day of October, 2002 before me, a Notary Public,
the undersigned officer, personally appeared JANE W. ROSENTHAL, known to me or
satisfactorily proven to be the person whose name is subscribed to the within instrument, and
acknowledged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
NOTARiAl SEAL
miCA A. HOllAND, NOTARY PUBLIC
CITY OF HARRISBURG, DAUPHIN COUNTY
MY COMMISSION EXPIRES MARCH 4 2006
- 3 -
STATEMENT OF ACCOUNT OF THE
ESTATE OF RUSSELL P. WILSON
Assets
Real property
$100,500.00
Personal property
46,785.79
Interest income earned since date of death
872.57
TOTAL
$148,158.36
Expenses
Funeral expenses & administrative costs
$23,977.52
Debts of decedent
$429.81
Pennsylvania Inheritance Tax (4.5% lineal rate)
$5,367.89
TOTAL
$29.775.22
TOTAL AMOUNT TO BE DISTRIBUTED
$118.383.14
ASSET DISTRIBUTION TO BENEFICIARY
Name
Jane W. Rosenthal
Total
$118,383.14
$118.383.14
"Exhibit A"
In Re:
ESTATE OF RUSSELL P. WILSON,
Deceased
No. 2001-01044
RECEIPT AND RELEASE AGREEMENT
The undersigned, CAROL J. ADEY, does hereby:
1. Acknowledge that she is named in Item Second of the Last Will and Testament of
Russell P. Wilson, which item reads:
SECOND: I give and bequest to Mr. Robert L. Fortenbaugh (son
of Catharine) of Arlington, Texas and Mrs. Carol J. Adey (daughter
of Catharine) of East Petersburg, Pennsylvania, share and share
alike, assets issued in the names of Catharine B. Wilson and
Russell P. Wilson, Joint Tenants, Agway Subordinated Money
Market Certificates due October 31, 1991, aggregating face value
of$30,000; CCNB, N.A. Money Market Deposit Account with a
variable balance; and Silver Advantage Checking Account with a
variable balance.
2. Acknowledges that the money funds itemized above are no longer in existence, and,
therefore, no distribution will be made according to the terms of said Will;
3. Releases JANE W. ROSENTHAL, Executrix of the estate of Russell P. Wilson, and
her heirs and personal representatives, together with JAN L. BROWN & ASSOCIATES,
attorneys at law, and specifically JAN L. BROWN, ESQUIRE and MARIELLE F. HAZEN,
ESQUIRE, from all liabilities which they may have by reason of administration of the estate;
4. Declares that this instrument shall be legally binding upon her, her personal
representatives, successors and assigns.
- 1 -
Exhibit B
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
:</51
day of
~ Q, {/dpr
CAROL J.~DEY
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF LANCASTER
On this the $d- day of October, 2002 before me, a Notary Public, the undersigned
officer, personally appeared CAROL J. ADEY, known to me or satisfactorily proven to be the
person whose name is subscribed to the within instrument, and acknowledged that she executed
the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
IAL SEAL
HANNAH J. TRAN. Notary Public
East Hempfleld 1\Yp.. LanculIr Co.. PA
My Commission ExpIres Feb. 14,2008
- 2-
Exhibit B
..
In Re:
ESTATE OF RUSSELL P. WILSON,
Deceased
No. 2001-01044
RECEIPT AND RELEASE AGREEMENT
The undersigned, ROBERT L. FORTENBAUGH, does hereby:
1. Acknowledge that he is named in Item Second of the Last Will and Testament of
Russell P. Wilson, which item reads:
SECOND: I give and bequest to Mr. Robert L. Fortenbaugh (son
of Catharine) of Arlington, Texas and Mrs. Carol J. Adey (daughter
of Catharine) of East Petersburg, Pennsylvania, share and share
alike, assets issued in the names of Catharine B. Wilson and
Russell P. Wilson, Joint Tenants, Agway Subordinated Money
Market Certificates due October 31,1991, aggregating face value
of $30,000; CCNB, N.A. Money Market Deposit Account with a
variable balance; and Silver Advantage Checking Account with a
variable balance.
2. Acknowledges that the money funds itemized above are no longer in existence, and,
therefore, no distribution will be made according to the terms of said Will;
3. Releases JANE W. ROSENTHAL, Executrix of the estate of Russell P. Wilson, and
her heirs and personal representatives, together with JAN L. BROWN & ASSOCIATES,
attorneys at law, and specifically JAN L. BROWN, ESQUIRE and MARIELLE F. HAZEN,
ESQUIRE, from all liabilities which they may have by reason of administration of the estate;
4. Declares that this instrument shall be legally binding upon him, his personal
representatives, successors and assigns.
- 1 -
Exhibit B
l
/-
,---.,..
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~ov~'SEJ<..
Octfibct,2002.
~
day of
~i.~
ROBERT L. FORTENBA H
STATE OF TEXAS
SS:
COUNTY OF
On this the ~ A
Ala)1 Ont b -{ tL
day ofOcteeer, 2002 before me, a Notary Public, the undersigned
officer, personally appeared ROBERT L. FORTENBAUGH, known to me or satisfactorily
proven to be the person whose name is subscribed to the within instrument, and acknowledged
that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
7nu~~d ;/}/~~-I
Notary Pu c
- 2-
Exhibit B
j
INVENTORY
Estate of Wilson, Russell P
No. 2001
01044
, Deceased
Date of Death 11/05/2001
Social Security No. 172018769
also known as
Russell P Wilson
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 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. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Jan L Brown
Jane W Rosenthal
I.D. No.: 67993
Address: 845 Sir Thomas Ct Ste 12
Dated 8/1/02
HarrisburQ
Telephone: 717-541-5550
PA 17109
Description
PNC Bank; Certificate of Deposit #31300170794
Value
30,077.52
PNC Bank; Checking Account #5140069491
4,131.53
PNC Bank; Savings Account #5080599772
9,731.80
The Sico Company; account refund
244.00
Highmark Blue Cross Blue Shield; health insurance benefit
57.51
), ,
i...'
,"',
?>-
2,210.00
100,500.00
Household goods
Real estate: 720 Elkwood Drive, New Cumberland, PA 17070
Total
146,952.36
(Attach Additional Sheets if necessary)
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.
RW-4
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
BROWN JAN L
845 SIR THOMAS COURT
HARRISBURG, PA 1 7109
-------- fold
ESTATE INFORMATION: SSN: 172-01-8769
FILE NUMBER: 2101-1044
DECEDENT NAME: WILSON RUSSELL P
DA TE OF PAYMENT: 02/11/2002
POSTMARK DATE: 02/04/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 11/05/2001
NO. CD 000847
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,500.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JANE W ROSENTHAL
C/O JANE L BROWN ESQUIRE
CHECK# 119
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
$3,500.00
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
JANE W ROSENTHAL ADMR
845 SIR THOMAS COURT STE 12
HARRISBURG, PA 17109
-------- fold
EST A TE INFORMATION: SSN: 172-01-8769
FILE NUMBER: 2101-1044
DECEDENT NAME: WILSON RUSSELL P
DA TE OF PAYMENT: 08/02/2002
POSTMARK DATE: 08/01/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 11/05/2001
NO. CD 001474
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,922.91
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JANE W ROSENTHAL ADMR
CHECK#1027
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$1,922.91
MARY C. LEWIS
REGISTER OF WILLS
/7-1//- 9
\...
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-IU7 EX iFP CUI-02)
JAN L BROWN
J L BROWN & ASSOCIATES
845 SIR THOMAS CT 12
HBG PA 17109
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-15-2002
WILSON
11-05-2001
21 01-1044
CUMBERLAND
101
RUSSELL
P
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V :i60j-i:x--AFP-(01-.:02)-------...--iNiiiRi~.._ANCE--yiX--Sy'irfEME-riy-o-F'-iccouirf--.-..---------------- -- ---
ESTATE OF WILSON RUSSELL P FILE NO. 21 01-1044 ACN 101 DATE 10-15-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAYMENTS I THE CURRENT BALANCEI ANDI IF APPLICABLE I
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-24-2002
PR I NCI PAL TAX DUE: ...........................................................................................................................................................................................................................
51552.10
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-04-2002 CDOO0847 184.21 31500.00
08-01-2002 CDOO1474 .00 11922.91
09-30-2002 REFUND .00 55.02-
TOTAL TAX CREDIT 51552.10
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRll
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
\, .~
~ /?-1//- '7
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-25-2002
WILSON
11-05-2001
21 01-1044
CUMBERLAND
101
, 1 U
Ii
L.~.
JAN L BROWN
J L BROWN & ASSOCIATES
845 SIR THOMAS CT 12~
HBG PA 171U9
Allount Rellitted
'*
REV-iS9S EX AFP U2-DDl
RUSSELL
P
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 ~
RE-V = is9-i-i3c--AFP--fi"2-.:oo1------..-iNHER.rfANC-i-yjri-RE-CORD--AD:rUSyi.fiNy--..------------------------ -- - --
ESTATE OF WILSON
RUSSELL
P FILE NO. 21 01-1044
ACN 101
DATE
09-25-2002
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
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adllinistrative Costs/
Miscellaneous Expenses (Schedule H)
Debts/Mortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
ADMINISTRATIVE CORRECTION
10.
II.
12.
13.
14.
TAX:
15. Allount of Line 14 at Spousal rate
16. Allount of Line 14 taxable at Lineal/Class A rate
17. Allount of Line 14 at Sibling rate
18. Allount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
ll)
(2)
(3)
(4)
(5)
(6)
(7)
100,500.00
.00
.00
.00
47,287.39
.00
.00
(8)
147,787.39
24,407.33
123,380.06
.00
123,380.06
.00
5.552.10
.00
.00
5,552.10
. ....n...... n~...~...~. II (+ J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-04-2002 CDOO0847 184.21 3,500.00
08-01-2002 CDOO1474 .00 1,922.91
TOTAL TAX CREDIT 5.607.12
BALANCE OF TAX DUE 55.02CR
INTEREST AND PEN. .00
TOTAL DUE 55.02CR
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
1l0)
23,977.52
429.81
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIP' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
lll)
(12)
(13)
(14)
lIS)
(16)
(17)
(18)
.OOX 00 =
123.380.06X 045=
.OOX 12 =
.00x 15 =
(19)
.~
~
REV-1<470 EX (6-88)
'* INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME FILE NUMBER
RUSSELL P WILSON 2101-1044
REVIEWED BY ACN
SCOTT ELLISON 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
THE SETTLEMENT COSTS HAVE BEEN ADDED TO SCHEDULE H.
ROW
PaQe 1
/7-i"/- ~
"\,. BUREAU.IIF INDAIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
JAN L BROWN
J L BROWN & ASSOCIATES
845 SIR THOMAS CT la,
HBG PA :17109
..., '-,
iL_)
09-16-2002
WILSON
11-'05-2001
21 01-1044
CUMBERLAND
101
*
REY-1547 EX AFP (01-02)
RUSSELL
P
Allount Rellitted
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
(8)
146,952.36
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 ~
RE-V :i54-j-ix--AFP--(Ol-:021--No.~''-ici--oF-i:NHiifi;:AircE-TAirA-PPRjrisEMENT~--Ai:i-oWAirCE-O-R------------ - - ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WILSON RUSSELL P FILE NO. 21 01-1044 ACN 101 DATE 09-16-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
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)
~. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
l~. Net Value of Estate Subject to Tax
U)
(2)
(3)
(~)
(5)
(6)
(7)
1001500.00
.00
.00
.00
461452.36
.00
.00
15.451 71
131,500.65
.00
131,500.65
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line l~ at Spousal rate
16. A_ount of Line l~ taxable at Lineal/Class A rate
17. Allount of Line l~ at Sibling rate
18. Allount of Line l~ taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
(9)
UO)
15,021.90
US) .00 X 00 = .00
(6) 131,500.65 X 045 = 5,917.53
(7) .00 X 12 = .00
(8) .00 X 15 = .00
(19)= 5,917.53
429.81
Ul)
(2)
(13)
U~)
. .. In..... . "'.."'..... . II (+ J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
02-04-2002 CDOO0847 184.21 3,500.00
08-01-2002 CDOO1474 .00 1,922.91
INTEREST IS CHARGED THROUGH 10-01-2002 TOTAL TAX CREDIT 5,607.12
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 310.41
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.90
TOTAL DUE 313.31
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
-.
REV-1470 EX (6-88) ,,"
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
Russell P. Wilson
FILE NUMBER
Sheila Megonnell
ACN
2101-1044
101
REVIEWED BY
ITEM
SCHEDULE NO.
H 13, 20
& 21
EXPLANATION OF CHANGES
Repairs and Settlement Costs cannot be used as deductions against the decedent's estate
unless the real estate has been sold.
ROW
Page 1
STATUS REPORT UNDER RULE 6.12
(;tv
Oh
Name of Decedent: Russell P Wilson
Date of Death: 11/05/2001
Will No. 2001-01044
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 representative I s account is:
c . Did the personal representative state an
account informally to the parties in interest? Yes X No
Filed Family Settlement Agreement with Register
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.
of Wills.
Date: 11/1 8/02
d:t >.~1AI-YL I
, Signa re /
Jane W Rosenthal
Name (Please type or print)
5245 Strathmore Drive
Mechanicsbura PA 17050
Address
( 717 ) - 731- 9058
Tel. No .
Capacity :
X
Personal Representative
Counsel for personal
representative
.
*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I-
Z
W
C
W
U
W
C
Wilson Russell P
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
11/05/2001 07/27/1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
W
I-
:,::Sen
ult::,::
wll..U
J: 00
UIt:....I
Il..al
Il..
<(
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. DecedentDied Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrusl)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
\ l '2- ,FFICIAL USE ONLY\ ~~)
-~----
2 1 -0 1 1 0 4 4
""'COuNTYCOOE --vEAR- - - NuMBER- -
SOCIAL SECURIT'Y NUMBER
1 72- 0 1 - 8 769
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURIT'Y NUMBER
D 3. Remainder Return (date of death prior 10 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
COMPLETE MAILING ADDRESS
I-
Z
W
C
Z
o
Il..
en
w
It:
It:
o
U
NAME
Jan L Brown
FIRM NAME (If Applicable)
Jan L Brown & Associates
TELEPHONE NUMBER
717 -541-5550
845 Sir Thomas Ct Ste 12
Harrisbur
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
z
o
i=
<(
..J
::J
!::
c..
<(
u
w
a::::
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(8)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
i=
<(
I-
::J
c..
:!
o
u
~
I-
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
124,602.65 X .045 (16)
X .12 (17)
X .15 (18)
(19)
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
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
PA 17109
100..500.00
OFFICIAL USE ONLY
46,452.36
146,952.36
21 ,919.90
429.81
(11)
(12)
(13)
22,349.71
124,602.65
(14)
124,602.65
5,607.12
5,607.12
Decedent's omplete ress:
STREET ADDRESS .
720 Elkwood Drive
CITY I STATE 1 ZIP
New Cumberland PA 17070
C Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,607.12
3.500.00
184.21
Total Credits (A + B + C)
(2)
3,684.21
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,922.91
1,922.91
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 IZl
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. 0 IZl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 IZl
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 pe~ury, 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.
SIGNATURE OF PERSON RESPONSIBLE F R FILING RETURN DATE
08/01/2002
PA 17050
DATE
08/01/2002
ADDRESS
45 Sir Thomas Ct Ste 12
Harrisburq
PA 17109
ADDRESS
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 oflhe 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 oflhe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to orior 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.
t . REV-1502EX:+~1.97)
'*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
Wilson. Russell P 21 01 1044
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshin must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
720 Elkwood Drive, New Cumberland, PA 17070
See attached Agreement for Sale.
Property is scheduled to be sold 8/5/02.
VALUE AT DATE
OF DEATH
100,500.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
100500.00
'. -,~~:,," '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Wilson Russell P
FILE NUMBER
21 01
1044
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
PNC Bank; Certificate of Deposit #31300170794
VALUE AT DATE
OF DEATH
30,077.52
2
PNC Bank; Checking Account #5140069491
4,131.53
3
PNC Bank; Savings Account #5080599772
9,731.80
4
The Sico Company; account refund
:l44.00
5
Highmark Blue Cross Blue Shield; health insurance benefit
57.51
6
Household goods
2,210.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
46 452.36
, .
..,,"~.,"" .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Wilson. Russell P
FILE NUMBER
21
01
1044
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Stone & Murray Funeral Home 7,156.00
2 Funeral luncheon/family dinner 627.88
3 Funeral bulletins 30.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s} I EIN Number of Personal Representative(s}
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Jan L Brown & Associates 5,143.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills, Cumberland County 280.00
5. Accountanfs Fees
6. Tax Retum Preparer's Fees
7. PNC Bank; check printing fee 15.00
8 Cumberland Law Journal; legal advertising 75.00
The Sentinel; legal advertising 106.79
9 Executrix travel expense 142.80
10 Postmaster; postage 6.80
11 Register of Wills; filing fee Inher Tax Return and Inventory 2500
12 Register of Wills; filing fee Family Settlement Agreement 17.00
13 Clean-up costs; 720 Elkwood Drive, New Cumberland 165.00
14 Trash pickup/hauling; 720 Elkwood Drive, New Cumberland 650.00
15 Borough Of New Cumberland; sewer/trash 117.73
16 PAWC; water 99.19
17 PPL Electric Utilities; electric 195.96
TOTAL (Also enter on line 9, Recapitulation) $ 21 919.90
(If more space is needed, insert additional sheets of the same size)
" ."
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Wilson, Russell P
21
01
1044
PaQe 1
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
18
19
20
21
UGI Utilities Inc; gas
The Sico Company; fuel delivery
The Sico Company; furnace cleaning
Real estate closing costs; see attached realtor estimate
150.18
183.57
109.00
6,624.00
SUBTOTAL SCHEDULE H.B7
7,066.75
_""a."", .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Wilson. Russell P
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21
01
1044
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1. Ck 2964; check cashed after death
2 UGI Utilities Inc; gas bill
3 PPL Electric Utilities; electric bill
4 PAWC; water bill
5 Verizon; telephone bill
6 Borough of New Cumberland; sewer/trash
7 A T& T; telephone bill
8 Merck-Medco Rx Services; medicine
9 Lifeline; monitor
10 Spirit Physician Services; medical bill
11 Premier Eye Care Group; medical bills
12 David A Wiegand MD; medical bill
13 AARP Pharmacy Service; medical bill
14 Pinnacle Health Hospitals; medical bills
AMOUNT
12.00
36.20
24.18
14.92
25.06
57.43
7.66
20.34
10.00
3.02
5.52
4.52
139.75
69.21
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
429.81
. .
,
OEV.'''' "'. "*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 01
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
t ,.........11 P
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS Vnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
Jane W Rosenthal
5245 Strathmore Dr, Mechanicsburg, PA 17050
daughter
1044
AMOUNT OR SHARE
OF ESTATE
100% residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
.. .
ATTACHMENT TO SCHEDULE J
BENEFICIARIES
ESTATE OF
Wilson, Russell P
FILE NUMBER
21 01 1044
Note that the specific bequests in the Will to Robert L. Fortenbaugh, stepson, and Carol J.
Adey, stepdaughter, were of the following money funds that are no longer in existence:
. Agway Subordinated Money Market Certificates due 10/31/91
. CCNB NA Money Market Deposit Account
. CCNB NA Silver Advantage Checking Account
Jane W. Rosenthal is the sole beneficiary of the rest and residue of the estate.
: .
LAST WILL AND TESTAMENT OF RUSSELL P. WILSON
21-01-1044
I, RUSSELL P. WILSON, of the Borough of New Cumberland, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding and realizing the
uncertainty of human life do make, publish and declare this my Last Will and Testament
hereby revoking and making void any and all Wills by me at any time heretofore made.
FIRST: I order and direct that all my just debts and funeral expenses be fully paid
and satisfied as soon as convenient after my decease by my Executrix hereinafter named.
SECOND: I give and bequest to Mr. Robert L. Fortenbaugh (son of Catharine) of
Arlington, Texas and Mrs. Carol J. Adey (daughter of Catharine) of East Petersburg,
Pennsylvania, share and share alike, assets issued in the names of Catharine B. Wilson
and Russell P. Wilson, Joint Tenants, Agway Subordinated Money Market Certificates due
October 31, 1991, aggregating face value of $30,000; CCNB, N. A. Money Market Deposit
Account with a variable balance; and Silver Advantage Checking Account with a variable
balance.
THIRD: I give and bequeath and devise all other property, real, personal, and
otherwise to my daughter, Jane W. Rosenthal of Mechanicsburg, Pennsylvania.
FOURTH: I hereby nominate, constitute and appoint my daughter, Jane W. Rosenthal, of
5245 Strathmore Drive, Mechanicsburg, Pennsylvania as executrix of this my Last Will
and Testament; to serve without bond for the faithful performance of that duty, with
full and complete authority to act in that capacity, or as Trustee, or any other
capacity in any jurisdiction in order to expedite the settlement of my estate
efficiently and completely. In the event Jane W. Rosenthal is unable or unwilling to
serve as Executrix of my Estate, I then nominate, constitute and appoint Robert A.
Rosenthal of Mechanicsburg as Executor of this my Last Will and Testament.
IN WITNESS WHEREOF, I, RUSSELL P. WILSON, Testator, have to this~y Last Will and
Testament, writte~on this page, set in my hand and seal this ;2~ day of ~~;;
A. D. rq9/ tf
/-----~
C:~~~~
Signed, sealed, published and declared by the above named Russell P. Wilson as and for
his Last Will and Testament in the presence of us who have hereunto subscribed our
names at his request as witnesses thereto in the presence of the said Testator and of
each other, and a Notary Public.
~7fc/~S4.
AFFIDAVIT
State of Pennsylvania )
County of Cumberland )
Before me, a Notary Public in and for said State and County, appeared the above
persons, known to me, who stated that the above Last Will and Testament was executed,
signed and witnessed by them in the presence of each other and myself, in compliance
with the laws of said State and County
Noiarfal Ssal
Shirley Y. Rouzer, Notary PlilIic
Lower Ailen liNp, Cumoorand County
~ Commission Expires Aug. 26, 1994
.PennsyIvlnaMsrxidlon of N*ieI
'" '
: .
STANDARD AGREEMEN'P FOR THE SALE OF REAL ESTATE
This form recommended and approved for, but nOl restricted to use by, the members of the Pennsylvania Associadon of REALTORS- (PAR).
A/S-2K
Sj:LLER'S BUSINESS
BROKER (Company) ~
ADDRESS
BROKER IS THE AGENT FOR SELLER. Designated Agent(s) for Seller, If applicable:
OR
Broker Is NOT the Agent for Seller and Is alan: 0 AGENT FOR BUYER
LATlONSIDP WITH PA LICENSED BROKER
PHONE 7G. 3 -15"cCJ
FAX
o TRANSACTION LICENSEE
BUYER'S BUSINESS RELATlONSmP WITH PA LICENSED BROKER
BROKER (Company) ~ sd d-U.~ ~-JfJ1:- P. PHONE 714/-'1tg'oo
ADDRESS a"'J J."'\ ~ ~, ~ . A 1'7/'" FAX '1t.1-/~9!l
BROKER IS THE AGENT FOR BUYER. Designated Agent(s) for Buyer, If applicable:
OR
Broker is NOT the Agent for Buyer and Is alan: 0 AGENT FOR SELLER 0 SUBAGENT FOR SELLER 0 TRANSACTION LICENSEE
When the same Broker Is Agent for Seller and Agent for Buyer, Broker is a Dual Agent. All of Broker's Iicellllet!S are also Dual Agents UNLESS
there are separate Designated Agents for Buyer and Seller, If the same Licensee Is designated for Seller and Buyer, the Licensee Is a Dual Agent.
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1. r~i6 lIgreement/ dated ~ / Z I 01..00 .:L
SELLER(S): JJ.J ~ b Jt. t.( p. ~~,..
LoU t\:s 0",
, Is between
BUYER(S): ~/} ~
. called "Seller," and
,called "Buyer."
2, PROPERTY (1-98) Seller hereby agrees to sell and convey to Buyer, who hereby agrees to purchase:
ALL THAT CERTAIN lot or piece of ground with buildings and Improvements thereon erected, If any, known as:
7;tD ~ ~
Inthe ~ of~~~
County of ~ /.o-...cI.... in the Commonwealth of Pennsylvania, Zip Code I '70 70
Identification (e.g., Tax ID #; Parcel #; Lot, Block; Deed Book, Page, Recording Date)
3. TERMS (1-02)
(A) PurchasePrice ~ ~ ~...."'--"'- ~~
U.s. DoUars
which will be paid to Seller by Buyer as follows:
I. Cash or check at signing this Agreement: $
2. Cash or check within --2.... days of the execution of this Agreement: $
3. $
4. Cash, cashier's or certified check at lime of settlement: $
TOTAL $
(B) Deposits paid on account of purchase price to be held by Broker for Seller, unless otherwise stated here:
, , 5"00.
,
'9'1000,
10-0. SOo.
.
(C) Seller's written approval to be on or before: ~ :LtJ, ;;;"/U, ~
(D) Settlement to be on Clt.,...:e. s', .;tCO ~ ,or before if Buyer and Seller agree.
(E) Conveyance from Seller wi be by fee sim;le deed of special warranty unless otherwise stated here:
(F) Payment of transfer taxes will be divided equally between Buyer and Seller unless otherwise stated here:
(0) At time of settlement. the following will be adjusted pro-rata on a daily basis between Buyer and Seller, reimbursing where applicable: taxes
(see Information Regarding Tax Proration); rents; interest on mortgage assumptions; condominium fees and homeowner association fees, if
any; water and/or sewer fees, if any, together with any other lienable municipal service. The charges are to be pro-rated for the period(s)
covered: Seller will pay up to and including the date of settlement; Buyer will pay for all days following settlement, unless otherwise stated
here:
4. FIXTURES & PERSONAL PROPERTY (1-00)
(A) INCLUDED in this sale and purchase price are all existing items permanently installed in the Property, free of liens. including plumbing;
heating; lighting fixtures (including chandeliers and ceiling fans); water treatment systems; pool and spa equipment; garage door openers
and transmitters; television antennas; shrubbery, plantings and unpotted trees; any remaining heating and cooking fuels stored on the
Property at the time of settlement; wall to wall carpeting; window covering hardware, shades and blinds; built-in air conditioners; built-in
appliances; and the range/oven unless otherwise stated. Also included~ ......' L" ~ J~ 1- , ~ r ~ -^-~; A - T"&L
~ ........;...~ ~ ~ -f-1o Lt', ,/..".( ----.:.. ~.
(8) LEASED .tems (no owned by Seller):
(C) EXCLUDED fixtures and items:
5. DATESmME IS OF THE ESSENCE (1-02)
(A) The said date for settlement and all other dates and times referred to for the performance of any of the obligations of this Agreement are
agreed to be of the essence of this Agreement and are binding.
(B) For the purposes of this Agreement, number of days will be counted from the date of execution, by excluding the day this Agreement was
executed and including the last day of the time period.
(C) The date of settlement is not extended by any other provision of this Agreement and may only be extended by mutual written agreement of
the parties.
(D) Certain time periods are pre-printed in this Agreement as a convenience to the Buyer and Seller. Any pre-printed time periods are negotiable
and may he changed by striking out the pre-printed text and inserting a different time period acceptable to all parties.
I
Seller Inltlals:~J
COPYRIGHT PENNSYLVANIA ASSOCIATION ~LTO~ 1OO2
Otlll2
I1-SS
AlS-2K Page I of 8
Buyer Initials:
m Pennsylvania Association of
REALTORS"
REAlI .. lM..................~~
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~~~~~~~nd~~:~~~~O~~ n~~~~~~ b~~~e~~rs of ilie Pennsylvailla Association of REALTORS~ (PAR).
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PROPERTY r7 () E\\.G ~ood Dr;u<L
SETTLEMENT DATE _ -AI.A.C6' St!:: I L<XJ,-
PURCHASE PRICE $
1. Broker's Fee r;; '$
2. Preparation of Deed
3. Transfer Tax
4. Seller's Assist to Buyer
5. Home Warranty
6. Municipal Certification
7. Settlement Fee
8. Notary Fees
9. Survey
10. Tax Certifications
11. Ovemight/Express Mail Charges
12. Domestic Lien Search
13. Other -'-'rt""A A_ ~ ~,<. t. ~~...... I F.-e.Q
14. Other
Estimated Costs
Adjustments (+/-) (e.g., real estate taxes, refund of escrow)
TOTAL ESTIMATED COSTS/ADJUSTMENTS $
Purchase Price
Total Costs/Adjustments
Estimated Proceeds
Seller's Estimate of Mortgages, Equity, and Other Loan balances, liens, assessments, etc. $
ESTIMATED NET PROCEEDS TO SELLER $
sEe
J 00,5 Do
Charges
$
$
$
$
$
$
$
$
$
$
$
$
$
$
~.o30
. 75"
~Oo~
-0 -
/50
/0
.
4
/60
$
7t~74
(756)
G..(PL <1
( 06. .5"cJu
( G, (;,"21 ')
9-s I r.,7~
$
$
$
$
The estimated proceeds do not take into account any other mortgages, liens, assessments or other obligations which may be
against the Property or the Seller.
The above figures are approximated closing costs and will be adjusted as of date of final settlement, if necessary.
I1We understand and have received a copy of these estimated closing costs before signing the agreement of sale.
SEILE~-llh1f ..ft. CjMM~f
SELL~R . J )
SELLER
<{~ t.t t,<-~
' l
DATE ~/;/01o ? --/
DATE . I
DATE
00"1-