HomeMy WebLinkAbout01-1050
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of I?() Y P. N'tJ.5S
also known as
Register of Wills for the
Deceased. County of C u. m 13€/ttJ1./<JI> in the
Social Security No. 7/7- ", - 7.5 8'1 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executriX named
in the last will of the above decedent, dated .T u If S- ,19~
and codicil(s) dated
No.
To:
21-01-1050
(state relevant circumstances. e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in C tun be.r' Ca.n ,.J
h is last family or principal residence at "" Beu:.l1c./;ff
7W.tJ.J. fJen~sv/y/Ut,tA /7///3
.
(list street, number and muncipality)
Decendent, th~n R If years of age, died
at H,,/v Splrd H"s;u'fa/ JEasf /~~uuJ,l)n' 7UJfi.
Except as follows. de(;edent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
OCh>b~' 2fo ,y{. d;Obl ,
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania ~ $
situated as follows: ~t- BeeeJJ(!/,'I'1" ]Jr,'ve. &J-ks/~ /..f/!rt:r C[Pr'l1
~
/OJ 000. DO
~j~~'VO
7:.~. )
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters fesTaAlljJTa,.v
"
(testamentary; administration c.La.; administration d.b.n.c.t.a.)
theron.
'"
1_ )(-()a~ /~ ~
'6 ~ PA rJl!/CIA- K. Iff,( TN
Cl!:Q.I
-g.g rz- kl!.//v ~r;~
cIS.:;: (Ju'/'JIe,~;f /"7~/J
~~ .
li"..... ~. 717-~'17-87Z0
:; 0 s:.!~ /9/- ~z -tf//7
';j
c::
t:lll
iZi
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA }
ss
COUNTY OF Cuml!JcJeLA-pD
The petitioner(s} above-llamed swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
x: --iJa~ tV /.{ ~
affirmed and
14th
en
()Q'
~
I:::l
-
:;:::
~
~
I'). r::J /. 7
No. 21-01-1050
Estate of
ROY E NOSS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NOVEMBER 16 , 21~ 2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JULY 5, 1996
described therein be admitted to probate and filed of record as the last will of
ROY E NOSS
TESTAMENTARY
PATRICIA K RUTH
and Letters
are hereby granted to
~~;V~:ht:h!.4t' )4.,7'
egtster of Ills
FEES
Probate, Letters, Etc. .........
Short Certificates( )..........
x-page.s .
RenunCiation ................
JCP
$ 115.00
$ 9.00
.3.00
$
$ 5.00
TOTAL _ $ 132.00
. . . . . . N.Q'lEMB.ER.l!+.,. . 20.Q1. .. .. . . .
~t!:~:m-
ATTORNEY (Sup. Ct. LD. No.) .3iS/3
~ C/~.r&' 1<'d.~/1feehIV1Jt!tln-t/"9. ~"/7oSS
[)
ADDRESS
Filed
7/7- 7&,~ -~Z~?
~~~~
T n~.~n.:: ~~'/ 0/?(~
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 mmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
. ?-'~"/1d fJLVl. fbn01
Local egisrrar ~
Fee for this certificate, $2.00
p
7691742
(Je i;;}LtA; A ~ 1. t:J() /
Date
21-01-1050
H105 i4J A.v 2.187
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
ryPEJPA'NT
'01
PERMA"ENT
Bl..ACKINK
NAME Of DECEDENT (f"51 M_e. laSl'
1.
E.
SEll
a. Male
SlATE FILE NUMBER
SOClAl seCURITY NUMBER
AGE (la5l_V)
Roy
UHDER 1 YEAR
Morwha O.ya
3. 717 - 09
5. 88 VIS
COUNTY Of OEAlH
UNDER I OM
- llolinu'"
1IlRTHI'I..ACE ,CoIy 0Ild
5... c. fCfftql Caunary)
=-".,10
RACE .__. _. WIlll.. elC
t~l
....
CUmberland
.;East pennsboro ....
KINO Of BUSINESS/lNOUSTRY
II.
White
la.
13.
Pennsylvania
MARITAl. SWUS._
......._.. w_.
0N0rc:ecl~
,..Widowed IS.
17e.IJ[......__in Silver Sprinq Twp
SURVIVING SPOuSE
," _. !l'\/8--1
DECEDENT'S USUAl OCCUp,q'1ON
t~-=_:"~':::zt:f
n.. SIMe
171>.
Did
-
.... in .
CUmberland -.eIlip? 17..0 :"'*:::".':::01
IoIOTHER'S _ ,F.... _. _Sur.......,
-
I..
_R.SNAJolEIF.... _la5l)
II. W. Scott Noss
_ORMANT'S NAJolE (TypowPtlf'll)
Patti Ruth
CJIy-
~
~
u
...
o
o
w
~
2
IS. Farmie Basehore
INfORMANT'S IoIAlUHO AOORESS \SIr.. CCy/boI!. _. 1'lllCoclet
.12 Kelly Drive, carlisle, PA. 17013
PlACE Of 0lSfI0SlTI0H. ....... 01 ee-y. c,........, LOCRION . CilyI1Own. Stal.. 1'op Code
Qf ou... P1ace
2001
ale. stone Church Cemet
17025
17055
....0
E:~..j ;;Z::,J { t\ r ( 1'., O!...t?o----
m A CONSEQUENCE Of):
as.
l =::-...:....
:-....-
I
: J';-v)
PART .: ou... sognilIcenI_ CDrlll'GWng 10 _.W
_.-;ngin....~__inMRTI
I :
DUE mlOA AS A CONSEOUENCE Of):
DUE m (OR AS A CONSEQUENCE Of)'
WERE AUTOPSY FINDINGS MAHNER ~ DEATH
AlMULABLE PRIOR m
COUPLETION ~ CAUSE Hal",.. D 0
~ OEAlH? Hornoclde
Accodenl D P.ndong 1n_~II(," 0
'fwD No 0 Suoclde 0 Could noI be de..rm,ned 0
DATE ~ INJURY
(toAonlll Dav. 'INrI
TIME ~ INJURY
Il\UURY AT \NORK? DESCRI8E HOW INJURY OCCURRED.
Yea 0 NoD
__ 2110.
cunlFlUl IClledl onr, onel
.COITWVIlllG PHYSICIAN (Pt\yseoan Cet~c.ause 011 ~aan wtlBfl oiOOUlttl pI'l\lSIC1all has fJfClOOlJnced dealh ana compt~e<J Ilem lJ)
To__o,...,......Ieclge........__IO...C.....(.'....m0M8r..'......... ................
3Oll. M.
PlACE ~ INJURV - AI ""-. tarm. "'_. lec1ory. office
buikIng, "c. ISpecllvl
3Oll.
6l1\1~ I,;)!
lOCATION (SIr.. C~. SlaJet
S1GNATUflE AND TIT
d,D.
~..ROtIOUNCIMG AND CERTIFYING PHYSICIAN (Phy.i'Cliln 00It! jJlOOOUllClOCJ ae..lo and cerolYlng 10 cause of oealh)
To" be.a 0' 1ft" knowtedg., de.'" occwr'" ...... lime. cM'., .nd place, .nd due to the c.....(a) and mann... .. ....ed
'MEDlCAL ElIAIIINEAlCOftOHER
On tM ba..ot ..amination and/or investigAtion, in my upeoion, d..th occurred.t the Ume. date. and pia.:., .nd due to the c.uH(a} and
Il\al\R8f" ".'ed . . . . . . . . . . . . . . . . . . . . . . . .
)1..
fAj/~:j.-]
.~ ...
~. ~
21-01-1050
LAST WIT .T . AND TESTAMENT OF ROY E. NOSS
I, ROY E. NOSS, of Silver Spring Township, Cumberland County, Pennsylvania, being
of sound and disposing mind, memory and understanding, do make, publish and declare this my
Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any
time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my beloved niece, PATRICIA K. RUTH,
currently of 12 Kelly Drive, Carlisle, Cumberland County, Pennsylvania, for her own use and
benefit absolutely.
3.
In the event, however, that my said niece, PATRICIA K. RUTH, should predecease me, I
give, devise and bequeath my said estate in equal shares unto her two (2) children, HEIDI
MCCARVER and TORRE RUTH, ~ sili:pes.
4.
I nominate, constitute and appoint my niece, PATRICIA K. RUTH, to be the Executrix of
this my Last Will and Testament. In the event that PATRICIA K. RUTH should predecease me or
for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint
my niece, SHARON N. JORDAN, to be Executrix in her place and stead. In the event that
SHARON N. JORDAN should predecease me or for any reason be unwilling or unable to act as
.. '..
'\,-
Executrix, I nominate, constitute and appoint my niece, MARJORIE L. JOHNSON to be Executrix
in her place and stead. I further direct that they shall not be required to file bond or other security
in the Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5111 day of
~r ' A.D. 1996.
R~g 711U4
ROYE. N SS
(SEAL)
Signed, sealed, published and declared by the above-named ROY E. NOSS as and for his
Last Will and Testament~ in the presence of us, who at his request and in his presence, and in the
presence of each other, have hereunto subscribed our names as witnesses.
~~~7a
_M~ (]!k#~
June 21,1996
21-01-1050
REGISTER OF WILLS OF C UM13~IJD COUNTY
OATH OF SUBSCRIBING WITNESS
eha,./es E. S",'e/c/S .:or
Lvd.dl
(saeh) a subscribing witness to the will presented herewith, ~ being duly qualified according to
law, depose(s) and say(s) that he was present and saw
~v E. /1/0$$
I
the testator- , sign the same and that h~ signed as a witness at the
request of testat~ in h ;.5 presence and~R the flr8SeRee 5f fll.:J. other} (in the presence of the
other subscribing witness(es)).
~f:~
Ch4r1es E. (Name)Sh,'elcl.r :ur
{;, C/ouser R~ /J!echan/Gsbu'1' /1/1 /7()SS-
(Address)
Sworn to or affirmed and subscribed before
me this 14th day of
>9 NO~ ~2001
/' ~;+~~I/~'lr
Reglst
(Name)
(Address)
REGISTER OF WILLS OF COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
testat_ of (one of the subscribing witnesses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
21-01-1050
REGISTER OF WILLS OF C u/l1 f3E12.JAf-AJj) COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose{s) and say(s) that present and saw
the testat , sign the same and that signed as a witness at the
request of testat_ in h presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19_
(Name)
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF CUM8E12-LA-AJD COUNTY
OATH OF NON-SUBSCRIBING WITNESS
Parr'.C/R K. Rufh
~ a subscriber hereto, ~ being duly qualified according to law, depose(s) and say(s) that
s),(!- /s familiar with the signature of Rov E. A/CS$
",€Qdidl_
testat~ of (QRe gf tAe ~l.lb~criBiRg nitn(33eB to) the will presented herewith and
eodidl
that she believes the signature on the will is in the handwriting of
Rt/y E" /1/t>s.s
to the best of h-er
knowledge and belief.
)( -jJa>>u-, -("~.) /<- .~
fbh.,'e;.,'1f k: iE?u~ (Name)
I ~ KeJly :p,.,'ve~ C'tt~/,'J/e;, J?A 17D 13
(Address)
Sworn to or affirmed and subscribed before
me this 14th day of
~NOVEMBER }4:Z001
_~n~7 eJk~p~h/.,(h ~'4/
Register tt
(Name)
(Address)
~
v
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ROY E. NOSS
Date of Death: October 26, 2001
Will No. Admin. No. 21-01-01050
TO THE REGISTER:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
December 12, 2001:
Name
Helen Waggoner
Jay Noss
Oren Noss
Patricia K. Ruth
Ray Noss
Harry N oss
Howard Noss
Larry Noss
Mae Noss
Miriam Waugaman
Ruth Trimmer
Address
31 Millers Gap Road, Enola, Pennsylvania 17025
11 Amity Lane, Mechanicsburg, Pennsylvania 17055
103 Millers Gap Road, Enola, Pennsylvania 17025
12 Kelly Drive, Carlisle, Pennsylvania 17013
4215 Valley Road, Enola, Pennsylvania 17025
74 Beachcliff Drive, Carlisle, Pennsylvania 17013
146 Green Ridge Road, Carlisle, Pennsylvania 17013
1628 Forrest Crossing Boulevard, Franklin, Noss 37064
103 South Market Street, Mechanicsburg, Pennsylvania 17055
Thomwald Home, 442 Walnut Bottom Road, Carlisle, Pennsylvania 17013
88 Greenwood Circle, Wormleysburg, Pennsylvania 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
'f.J . . _: 8quUl~
Date: J..alIuary 16, 2002_}\lel~
1:"" . ~.c,)l o~eH
~}1~~~':f58CJ
~E~~r
CHARLES E. SHIELDS, III
6 Clouser Road
Mechanicsburg, P A 17055
Telephone: (717) 766-0209
Counsel for Personal Representative
Zs: l d ZZ N\1r 20.
~ I?- /2/- '7
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT QF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 11128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT1 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RecOroeCJ <?!fiC~ iATE
Register Oi VVdl~STATE OF
DATE OF DEATH
1)3 MAY - 2 Al13~T~UMBER
CHARLES E SHIELDS III ACN
6 CLOUSER RD Clerk-(}:_: Court
MECHANICSBURG PA 17055 Curnberland Co., PA
04-28-2003
NOSS
10-26-2001
21 01-1050
CUMBERLAND
101
*
REV-1547 EX AFP (01-03)
ROY
E
Allount Rellitted
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 ~
REY=istrj-i3f-AFP--loi-:03i--NOY-iCi--OF--fNHiifiTAirci-TAi-APPRA-isiMENT~--Ai:.i-owAirci-irR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF NOSS ROY E FILE NO. 21 01-1050 ACN 101 DATE 04-28-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
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)
115,000.00
.00
.00
.00
25,461.75
2,831.10
.00
(8)
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)
14. Net Value of Estate Subject to Tax
(9)
(10)
24/346.14
29.524.34
(11)
(12)
(13)
(14)
NOTE:
.00 X 00 =
.00 X 045=
.00 X 12 =
89/422.37 X 15 =
+
INTEREST/PEN PAID (-)
450.00-
AHOUNT PAID
13/863.35
DATE
03-13-2003
NUHBER
CD002287
BALANCE OF UNPAID INTEREST/PENALTY AS OF 03-14-2003 TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AfTER DATE INDICATED 1 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
NOTE: To insure proper
credit to your account 1
subllit the upper portion
of this forll with your
tax paYllent.
143/292.85
53.870 48
89/422.37
.00
89/422.37
(19)=
.00
.00
.00
13/413.35
13/413.35
13/413.35
.00
29.88
29.88
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) 1 YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III ESQUIRE
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 717-09-7584
FILE NUMBER: 2101-1050
DECEDENT NAME: NOSS ROY E
DA TE OF PAYMENT: 03/14/2003
POSTMARK DATE: 03/13/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 10/26/2001
NO. CD 002287
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $13,863.35
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: PATRICIA A RUTH
C/O CHARLES E SHIELDS III ESQ
CHECK#1050
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$13,863.35
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1 162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III ESQUIRE
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 717-09-7584
FILE NUMBER: 2101-1050
DECEDENT NAME: NOSS ROY E
DA TE OF PAYMENT: 05/15/2003
POSTMARK DATE: 05/13/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 10/26/2001
NO. CD 002566
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $29.88
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: PATRICIA K RUTH
C/O CHARLES E SHIELDS III ESQ
CHECK# 1335
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
$29.88
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
//) -,_:J / - -)
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-I6D7 EX AFP [01-05)
CHARLES E SHIELDS III
6 CLOUSER RD
MECHANICSBURG
.03
of DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
All :4 ~OUNTY
ACN
05-27-2003
NOSS
10-26-2001
21 01-1050
CUMBERLAND
101
ROY
E
ReCOrOf;>i;
Reci~t:.
JUN -6
Allount Rellitted
PA 17~rh-
Cumbel j,;>
~' '.
.: i '~-i.
; ...
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=1 6ifj-!'if-AFP--fo1-.:oi.Y------...--iNifERI,.-ANCE--yA'if-STA-fEME-tiy-ifF-Accouiff--...---------------- -----
ESTATE OF NOSS ROY E FILE NO.21 01-1050 ACN 101 DATE 05-27-2003
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 BALANCE I ANDI IF APPLICABLE I
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-28-2003
P R I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
131413.35
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-13-2003 CD002287 450.00- 131863.35
05-13-2003 CD002566 29.88- 29.88
TOTAL TAX CREDIT 131413.35
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 $11
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRll
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
Clv
STATUS REPORT UNDER RULE 6.12
Date of Death:
~./ E. I\~
u
10 - c1 ~- ~ool
Name of Decedent:
Will No.
Ad' N o? t- 0(- jO S-o
m.l.n. o.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: 41// ~ /ne)$.
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
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 No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~~~
Signature
Date:
, -/ '1... 0 '-----
.d"(j
"'.,
Charles E. Shields, III
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
C)~:
J l i\F-tf'\
!~ ~. q
ZOo
(717) 766-0209
Tel. No.
ersonal Representative
Capacity:
Counsel for persona
epresentative
(MAH:rmf/AM3)
Q;tl
o~
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Rolj, C" NOS5
Date of Death: /IO-~cQ/
Will No.
Admin. No.
~/- 6/05D
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 representati~:~ an
account informally to the parties in interest? ~~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
~&/tJ 3
Charles E. Shields, III
Name (Please type or print)
6 Clouser Road, Mechanicsburg, PA 17055
Address
i (
(717 ) 766-0209
Tel. No.
Capacity:
Personal Representative
~unsel for personal
representative
(MAH:rmf/AM3)
~
RE'/-15CO EX 16-0C
. / 7 - :.::< /- C>'~">
""}
REV-1500
(11)
. (12)
(13)
o
FILE NUMBER
~L-.fJ-L
COUNTY CODE YEAR
1050
- NUMBER - X-
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SOCIAL SECURITY NUMBER
7/7 - O,? - 7Sg1-j
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
I-
Z
W
C
Z
o
l1.
(Il
w
0::
0::
o
U
THIS SECTION MUST BE: CPMPLETED.ALLC;ORRESPONJ)E:NCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME CII/l-RLE5 E. SH/ElbS 7!r COMPLETE MAILING ADDRESS
beL 1/ tiS E}? k'.1:>.
/J1Et3h1/1A1/cSBu;ecr/ ;O~ / 70S~
1
I
OFFICIAL USE ONLY
I-
Z
W
C
W
U
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
#0&'5 E.
(8)
;'/43. ,J1~. ~s-
DATE OF DEATH (MM-DD-YEAR)
10 - ~ ~ - .;l.CJc:;; /
DATE OF BIRTH (MM-DD-YEAR)
7/7//9/3
(14)
"f SJ. 8]J}.'ff
'J 8", if 1.Z. .37
o
f
89, 42Z. 37
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
W
I-
ll::~(Il
uO::ll::
wl1.U
J:oo
uO::..J
l1.lD
l1.
<
C8J1. Original Return
D 4. Limited Estate
~ 6. Decedent Died 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 ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o
o
o
.,. / 3, 'f I 3. 35
, / 3, '7 f 3. 3,5'
z
o
<
~
::)
a..
:E
o
u
><
~
CHECK HERE IF YOU ARE RE
> > BE SURE TO ANSWERALL QUE:STI()NS ON REVERSE SIDE AND RECHECK MATH < <
FIRM NAME (If Applicable)
TELEPHONE NUMBER
7/7 - 7~ 6 - 0201
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
~ / IS: 000. DO
D-
o-
0-
~.- ---.-
, .:zs. II' I. 7~
"! 2., f 3 I./D
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
(1)
(2)
(3)
(4)
(5)
z
o
~
...J
::)
!::
a..
<(
u
W
D::
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D 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)
(9)
(10)
J'
;;l't. ~ If&.. 1;'1
1- ,;}~ S.:J cf. 3~
(6)
(7)
N~( ZGA.o
13. Charitable and Governmental Bequests/See 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
15. Amount of Line 14 taxable at the spousal tax ()
rate, or transfers under Sec. 9116 (a)(1.2) x.oL (15)
0 x .0 Lf'5 (16)
16. Amount of Line 14 taxable at lineal rate
() x .12 (17)
17. Amount of Line 14 taxable at sibling rate
f ?~ q12. 37
18, Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20. D
REV-1502EX + (1-97:
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
,vDSS.!
I<.j') fj
E..
FILE NUMBER
81-01- /OS-O
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 oj
survivorshio must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
;1 T~.4-CT5 of L ~ut:> S,\"Tu.A-TG" IN To-tE? IOW/IJ.sHIP OF SILVf'R
5?I<INo(;,.J C{)U\\lTy of C\)..h\eE)2LA-ND, "PENNA., oNIF" oF= tvl-llcH
15 \ n-IPr<OVe=D vJl'1l1 JT DwI:LLlrJr;,. HOllSfi BEING- mORE:-
I
Pit IZ 'rJ C ULJH< 1.- Y -;p E:;; Sc..~ I 8E"C IN iHR-r CEF It m /Iv ]:; E7E:D
F~DM Roy E. No'7.5;. /JAIl) I11IfN'y ..Jff/Vc /IIt:>~~, N/S .{(.,I/,c-c:::
10 7;(~ S/f/P R'tWE A1tJ.5SJ 'DArlf!?t) /fLlG-. 2~ /999 4/l1p
I<Et!RIJ8) //'1 ]J!::;?:t) .Bt:J{)~ 2o{P, ;tJ/f6E 7'~~, //1/ TN€'
;<EetJltlJ~ t)r lJEED.s Orr/~ /111 /f#'.LJ;::&.If Cum Ib~-
LAIYj) tffit(~ ,P'Eh"#~. (SG"E (bPY of jJFE/J /I 7T/f CHCZJ )
5H/J> P/2oPE72Tl/ wfts /t1'f3/2/1-/ St=D ~y t<..rJ;U..rAM A.
73 /iSSEi IT of f.J,JOl. FE:? Sfle:~E7l. !<.E79LTlM!.S (se:
,
~py 01= IfP~R/f/.sA-L /I rrA-t!.HS )
~
J I 5", 0DtJ. t>D
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
J J 5, 000. 00
. ,
7:2-00'( ~
..
E'-l- r -.'IF;~LER
ROB (.. :. ...'-' r-
fll'" r-..1 1".;: i)'Et:.OS
R" CO J .. ..). ,
t. ,\;..' ,,-,\."'0....
GUM e E. R l" Ii 0 CO J~: I I \!'\
'99 RUG 25 Pr\ 12 50
Tax Parcel No. 35-05-0435-064
THIS DEED
Made the __..21..:iliL_day of _~_________ in the year one thousand nine
hundred and ninety-nine (1999). --(f---
Between ROY E. NOSS and MARY JANE NOSS, his wife, by and
through her attorney-in-fact, PATRICIA K. RUTH, the said NOSSES
being currendy of Silver Spring Township, Cumberland County,
Pennsylvania, Grantors
and
the said ROY E. NOSS, Grantee.
WITNESSETH, that in consideration of the swn of ONE and No/lOO ($1.00) DOLLAR in
hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant and
convey to the said Grantee, his heirs and assigns:
ALL THOSE CERTAIN pieces or parcels of land situate in the Township of
Silver Spring, County of Cumberland and State of Pennsylvania, bounded
and described as follows, to wit:
TRACf #1
BEGINNING at a Railroad spike in the public road, being Route T-593,
and commonly called Green Ridge Road, at the comer of other lands now
of Roy E. Noss, et ux; thence by said road, North fifty-four (54) degrees
East thirty-nine and three one-hundredths (39.03) feet to a spike; thence
continuing along and through the same North sixty-seven (67) degrees East
one hundred eight and fifteen one-hundredths (108.15) feet to a spike;
thence by lands now or formerly ofW. Scott Noss, North forty-one (41)
degrees forty-five (45) minutes West two hundred thirty-nine and twenty-
five one-hundredths (239.25) feet to a pin; thence continuing along the same
North thirty-four (34) degrees twenty-one (21) minutes West ninety-three
and ten one-hundredths (93.10) feet to a pin at lands of Mae Noss; thence
South forty-seven (47) degrees fourteen (14) minutes thirty (30) seconds
West two hundred ninety-seven and ninety-one (297.91) feet to a point in or
about the center line of a 16 foot wide macadam drive; thence through said
macadam drive North thirty-seven (37) degrees West thirty-eight and thirty-
nine one-hundredths (38.39) feet to a point at line of lands of Mae Noss;
thence along same South fifty-four (54) degrees thirty~eight (38) minutes ~ one, hlAnd1!#iH"
thirty (30) seconds West seventy-three and thirty-five/(73.35) feet to a pin;
thence South thirty-five (35) degrees East one hundred three and ninety one-
hundredths (103.90) feet to a pin at other lands now of Roy E. Noss, et ux,
thence by said other lands of the said Roy E. Noss, et ux, North s~ty- j., I /J
seven (67) degrees East two hundred fifty-seven and seventy-nine (257.79) ~ol1t- ~nO,.,d'I1S
feet to a point; thence by the same South thirty-five (35) degrees East one
hundred fony-nine (149) feet to a railroad spike in the public road aforesaid,
the place of BEGINNING.
TIllS DESCRIPTION is drawn partially from a survey made by George W.
Walker, Registered Surveyor, dated September 24, 1960 and from the
FINAL SUBDMSION PLAN, Tract No.2, for Roy E. Noss, et ux, dated
June 12, 1982, drawing no. 27, also by the said George Walker, recorded
in the Recorder of Deeds Office in and for Cumberland County in Plan
Book 42, page 102* (*Nota Bene: Microfilm copy is largely illegible, an
original copy exists in the files in the basement of the Recorder's Office.)
800K 206 PAGE 466
.
BEING that portion of the premises which W. Scott Noss, widower, by
Deed dated December 28, 1960 and recorded. in the Recorder's Office in
Deed Book "Z," volume 23, page 718, conveyed to Roy E. Noss, et ux,
remaining after the said Roy E; Noss, et ux, granted and conveyed a
triangular piece of ground to Mae A. Noss, by their deed dated April 20,
1983, recorded in the Recorder's Office in Deed Book "D," volume 30,
page 512.
TRACT #2
BEGINNING at a railroad spike in the public road, being Route T-593, and
commonly called Green Ridge Road, at the corner of other lands now of
Roy E. Noss, et ux; thence South fifty-four (54) degrees West one hundred
thirty-two and fifty-seven one-hundredths (132.57) feet to an iron pin;
thence South thirty (30) degrees West one hundred thirty-two (132) feet to a
stake; thence North thirty-five (35) degrees West two hundred sixty and
sixty-eight one-hundredths (260.68) feet to a pin; thence North sixty-seven
(67) degrees East two hundred fifty-seven and seventy-nine one-hundredths
(257.79) feet to a pipe; thence South thirty-five (35) degrees East one
hundred forty-nine (149) feet to a railroad spike in the public road aforesaid,
the place of BEGINNING.
BEING the same premises which W. Scott Noss, widower, by Deed dated
August 18, 1954 and recorded in the Recorder's Office in Deed Book "Y,"
volume 15, page 128, conveyed to Roy E. Noss, et ux, the Grantors
herein.
THIS DESCRIPTION is taken from the said deed and from the said FINAL
SUBDMSION PLAN at Plan Book 42, page 102 as is more fully set forth
above.
TIIESE TWO TRACfS, although listed under one tax assessment number,
are still, as of the date of this deed, shown as separately bounded lots on the
said FINAL SUBDMSION PLAN and have accordingly been described as
such herein.
AND the said Grantors will warrant specially the property hereby conveyed.
THE SAID MARY JANE NOSS, by a Power of Attorney dated July 5, 1996, appointed the said
P A TRlCIA K. RUlli as her true and lawful attorney to act for her and in her place and stead as is
more fully set forth in said Power of Attorney which is being recorded in the Recorder of Deeds
Office aforesaid simultaneously herewith, in Miscellaneous Book {P :2- ?> , Page .:z- 7.;L .
THE SAID MARY JANE NOSS hereby conveys her interest in and to the said premises to her said
husband, ROY E. NOSS.
THIS IS A TRANSFER BE1WEEN SPOUSES AND IS TIIEREFORE TRANSFER TAX
EXEMPT.
IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seals the
day and year first above written.
Signed, sealed and delivered
in the presence of:
I r? ~ t 11 ()<l4
'd) // "I/ R E. NOSS
&tA.du.-J cfx?J'ue4fi~
'-'J -Ii ~.u>14 J- ~r ~
MARY JA SS,
by her Power of Attorney, PATRICIA K. Rum
(SEAL)
(SEAL)
-2-
MOl( 206 PAGE 467
,
. 4
fk~leu 1it-:tlt4Y
~~~ A--/duL
PATRICIA K. RUTH,
Attorney-in-fact for MARY JANE NOSS
(SEAL)
COMMONWEALTH OF PENNSYLVANIA :
: SS.
COUNTY OF CUMBERLAND
On this, the r:;;7LJJi day of ~ ' A.D. 1999, before me
the undersigned officer, personally appeared RO . NOSS, 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.
Notarial Seal .
Charles E Shields III. Notary Public
MechaniCSburg Bora, ~umbJ arlan~o c~gg~
My commission Expires una.
.' ..~ .',,"ni~ As~r.d"'ii)n of Notaries
~~~~JV
Notary Public
.,...~,.._:;.".,.tP ;",'_.....~~I"Ml...~,',':"..: ",
~. ......;""Ll' ""'~~'lo;~ ~~:"f"*
\ Q1 ~ ..In.:"' ~;~~~~:,'..~:~\.~,;..,t';..'.~;J~'::~
COMMONWEALlH OF PENNSYLVANIA :
: SS.
,." :!f~-:"
COUNTY OF CUMBERLAND
On this, the C)q~ day of .Alt~.t<z.t , A.D. 1999, before me
the undersigned officer, personally appeared PA CIA K. RUTH, ATTORNEY-IN-FACf FOR
MARY JANE NOSS, 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.
t~/:~
Notary Public
':'~1iil'\;~\!'''''''''
...,::~~1,:.==~~.,
":~.:~.:i.,;~~
',~!,:~I'I~."-~;.,,
''''~''s. '~~~~'''.,'
- No.tarial seN'ota Public
Charles E. ShB~~~s ~~mberl~d County
Mechanics~urQ Ex'pires June 20. 2000
My Com\1USSlOn .
. r"~",:;,I"3'da II.SSOCiJtion of Notanes
CERTIFICATE OF RESIDENCE
State of pennSYlVania} 86
County of Cumberland .
Recorded in the offic... for the recordmg of Deeds
q~ in~nd for ~rpberland County. PA1 I
irl ~ Book ~_ Vol. _ Page .J.1.ili
wItness my ha.nd and ~otfic~ ,[Act
Carlisle. PA thIS _ d27~7
~u,? IRecor r
I HEREBY CERTIFY that the precise residence of the Grantee(s) is
6(:, Suchc./,'f{ 1>1"., Ca./",),',sJe I Pit 17013
~~~-F-
Attorney for Grantee(s)
.,~.......; / A f or S )
.".:'titi!<~1:'t~;'''L: ,,-,...., ( , V, I .
.,,~;. ,;:\,::"";,~:,,,~,~:~:,-,~*_~,~t,;,:~~:,:;":>~::::~~,::":?~~., ::':~!'~~ - . , ~
"
BOOK 206 PAGE 468
INVOICE
F..om:
Wolfe & Shearer Realtors
33 South Pitt Street FILE NUMBER
Carlisle, PA 17013
02-002
To: I
N
Attention: V
Charles E. Shields, III, Attorney At Law 0
6 Clouser Road I
Mechanicsburg, P A 17055 C
E
Invoice Appraisal Appraiser Client Case Number Appraisal Office Tax ID Number Appraisal Office
Date Date Phone Number
3/72/93 3/72/63 WAC 23-2385405 717-243-1551
Purchaser/Borrower /Client: Roy E. Noss
z Property Address 66 Beachcliff Drive Unit -
>-0 City Carlisle Subdivision
f--
a:f- County Cumberland State PA Zip 17013
w<(
0...:2: Legal Description Deed Book 206, Paqe 466
oa:
a:0
o...u..
~
Man Reference 05-0435
Appraisal Fee Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 250.00
Mail or Handling Fee. . . . . . . $
z Additional Charges 1 . . . . . . $
0
oi= Additional Charges 2 . .. . . . $
-<( Additional Charges 3 . . . $
0:2: .. .
>a: Sales Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Zo
-u..
~ Thank you for your business !
T olal Amount of Invoice $ 250.00
Please detach and include the bottom portion with your payment . . . Thank you !
~
--------------------------------------------------
Invoice Appraisal Appraiser Hie Number Client Case Number Client's
Date Date Phone Number
3/72/93 3/68/98 WAC 02-002
From:
Charles E. Shields, III, Attorney At Law AMOUNT
6 Clouser Road DUE
Mechanicsburg, PA 17055
$ 250.00
To:
Attention: William A. Bassett
Wolfe & Shearer Realtors AMOUNT
ENCLOSED
33 South Pitt Street
Carlisle, PA 17013 $
TERMS - Balance due upon receipt of invoice
Please return this portion with your payment. Thank you !
Wol1e & Shearer Realtors
Ray "Suz" Wolfe, CRS
Broker/Partner
WOLFE G.
SHEARER
REALTORS
William L. Shearer, Jr., CRS
Broker/Partner
....
)
33 South Pitt Street
Carlisle, PA 17013
717.243.1551
800.377.3027
fax 717.243.0472
www.wolfeshearer.com
-
R=SIDENTIA~
COMMERCIAL
APPRAISALS
INDUSTRIAL
CONSULTING
IN\!=STfJl=[r;~
February 5, 2002
Charles E. Shields, III
Attorney-At-Law
6 Clouser Road
Mechanicsburg, P A 17055
RE: Estate of Roy E. Noss
66 BeachcliffDrive
Carlisle, PA 17013
Dear Attorney Shields:
In compliance with your request, I have personally inspected the above captioned property on
January 7, 2002 to estimate its market value.
The value shown has been arrived at after careful study of the location, type of improvements and physical
condition. Therefore, I believe it to reflect a true measure of the subject's market value as of
October 26,2001 (Date of Death) of:
Value Reported: $115,000
I hereby certify that I have no fmancial interest, present or contemplated, in this property, and that neither the
employment to make the appraisal nor the compensation therefrom is contingent upon the value reported.
Sincerely,
,'-"~~~~
William A. Bassett
Certified General Real Estate Appraiser
GA-OOl618-L
rF
File No 02-002
SUMMARY APPRAISAL REPORT
of
66 Beachcliff Drive
Carlisle, PA 17013
PREPARED FOR:
Charles E. Shields, III, Attorney At Law
6 Clouser Road
Machanicsburq, PA 17055
AS OF:
April 4, 2001
PREPARED BY:
Wolfe & Shearer Realtors
33 South Pitt street
Carlisle, PA 17013
717-243-1551
MCS, . Division of ACI Development (800) 697-7783
Wolfe & Shearer Realtors
Property Description
UNIFORM RESIDENTIAL APPRAISAL REPORT
File No. 02-002
Prooertv Address 66 Beachcliff Drive Citv Carlisle State P A ZiD Code 17013
leoal DesCrlntion Deed Book 206 Paae 466 Countv Cumberland
Assessor's Parcel No. 38-05-0435-066 Tax Year 2001 R.E. Taxes $ $1 397 Snecial Assessments $ 0
I- Borrower Estate of Rov E. Noss Rov E. Noss r lowner 1 Tenant rx 1 Vacant
U Current Owner Occunant
W Pronertv riahts ann raised Ix Fee simole r 1 leasehold I Pro"ect Tvne r PUD r 1 Condominium (HUON A onlvl
., HOA $ IMo.
CQ Neiahborhood or Pro;ect Nam.Bilver Sorina Townshin Man Reference 05-0435 Census Tract 0118
::J
(/) Sales Price $ Date of Sale OescriDtion and $ amount of loan charoeslconcessions to be naid bv seller
lender/Client Charles E. Shields III Address 6 Clouser Road Mechanicsbura. PA 17055
Aooraiser William A. Bassett Address 33 South Pitt Street Carlisle PA 17013
Location DUrban U Suburban -0-RuraJ Predominant Single family houoing Pr__use"" land use change
Built up Dover 75% GJ 25-75% o Under 25% OCCIlpilDCY PRICE $ 1000) AGE Iyrs) One family ~ o Not likely GJ likely
Growth rate o Rapid GJ Stable o Slow DOwner 80 70K low 15 2-4 family - o In process
Property values GJ Increasing o Stable o Declining o Tenant 15 150K Hioh 50 Multi-family _ To: Res.
Demand/supply o Shortage GJ In balance R Over supply GJ Vacant 10-5%1 I Predominant I Commercial
Marketinn time n Under 3 mos. rx; 3~6 mas. Over 6 mos. n Vacant lover 5%1 120K 45 Vac 40
Note: Race and the racial co_sition of the neighborhood are not _aisaI factors_
Neighborhood bound.rles and characteristics: On the west Beachcliff Drive on the north Rich Vallev Road to the east
0 Kellv Drive and to the south Green Ridne Road.
0 Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, emplovment stability, appeal to market, etc.):
0
J: The subiect Prooertv is in Silver Sorina Townshin within 15 minutes of the Borouahs of Mechanicsburn
a: and Carlisle.
0
CQ
J:
C)
jjj
Z
Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing time. . . such as data
on
competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.lhe neiahborhood of the subiect
Pronertv is arowina. The subiect's oroximitv to route 114 is within 1 mile as is interstate route 81.
Project bdonnalion for pUD. lit applicable)--ls the developer/builder in control at the Home Owners' Association IHOA)? U Yes UNo
0 Approximate total number of units in the subject project Approximate total number of units for sale in the subject project
;> Describe common elements and recreational facilities:
Dimensions Irreaular Topography level to slonina
Site Area 2.65 Acres Corner Lot I2Ll Yes D No Size Tvnical for the neiah.
Specific zoning classification and de5criptiorRura( Residentia' Shape I rreaular
Zoning compliance GJ Legal o Legal nonconforming IGrandfathered use I D Illegal D No zoning Drainage Addeauite
Highest & best use as improved GJ Present use o Other use (explain) View Averaae
Off-site landscaping Averaae
Utilities Public Other Type Public Private Driveway Surface Macadom
Improvements
W Electricity I2Ll Street Macadom GJ 0 Apparent Easements None visable
I- Gas 0 Curb/Gutter None 0 0
en
Water 0 well Sidewalk None D D FEMA Special Flood Hazard Area DYes GJNo
Sanitary Sewer R sentic Street lights None R R FEMA Zone C Map Date 05-02-93
Storm Sewer N/A AIIev None FEMA MaD No. 420370000-5B
Comments{apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning, use, e~(}ne visible or known.
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION
No. of Units 1 Foundation Con Blk Slab No Area Sq. Ft. 1 120 Roof Fiberqlass GJ
No. of Stories 1 Exterior Walls Brick Crawl Space No % Finished 0 Ceiling Fiberqlass GJ
Type(Det./ A tt.) Detached Roof Surface Shinnle Basement Yes Ceiling OJ Walls Unknown D
Design (Style) Ranch Gutters & Dwnspts Aluminum Sump Pump Yes Walls Con Blk Floor Unknown 0
(/) Existing/Proposed Existina Window Type Double Dampness Yes Floor Concrete None 0
I-
Z Age (Yrs.) 46 Storm/Screens Yes Settlement No Outside Entry Nnne Unknown 0
W
:2: Effective Aoe IYrs.) 25-30 Manufactured HousJ\JO Infestation Unknown
W ROOMS Fover livina Dinin" k'itr-hen Den F"'mil" Rm. Ree. Rm. Bedrooms # Raths laundrv Other Area Sn.Ft.
>
0 Ba~ement 1 120
ex: level 1 1 1 1 1 2 1 1 560
a..
~ level ?
u..
0 Finished area above made contains: 5 Rooms' 2 Bedroom(sl~ 1 Bath sl~ 1,560 Snuare Feet of Gross Livina Area
Z INTERIOR Materials/Condition HEATING KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE
0
i= Floors Car/Hard wd Type Forced Air Refrigerator 0 None 0 Fireplace(s) # [i] None 0
a.. Walls Plaster Fuel Oil Range/Oven ~ Stairs 0 Patio covered [i] Garage # of Cars
0: Trim/Finish Wood Ava Disposal 0 Drop Stair 0 Deck 0
U Condition Attached
(/) Bath Floor Ceramic COOLING Dishwasher 0 Scuttle GJ Porch 0 Detached 2
W
0 Bath Wainscot Ceram/Plast Central Ves Fan/Hood GJ Floor 0 Fence 0 Built-In -
Doors Wood Other Microwave 0 Heated R Pool R Carport
Condition Ava Washer/Drver n Finished Drivewav Mac
Additional features (special energy efficient items, etc.\;
Condition of the improvements, depreciation (physical, functional. and external), repairs needed, quality of construction, remodeling/additions, eteAll electrical
(/) insoection as well as a foundation insDection should be comnleted Drior to sale of the nronertv.
I- There are two sheds on the nronertv in verv noor condition and are not niven a value in this
Z anDraisal.
W
:2: Adverse environmental conditions (such as, but not limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on the site, or in the immediate vicinity of
the subject
:2: property: None visible or known.
0
U
Freddie Mac Form 70 6-93
MCS. a D,VIS,on of ACI Development 1800) 697-7783
Page 1 of 2
Fannie Mae Form 1004 6-93
Wolfe & Shearer Realtors
UNIFORM RESIDENTIAL APPRAISAL REPORT
File No. 02-002
ESTIMATED SITE VALUE. . . . . . . . . . . . . . . . . . . . . . .. = $
ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS:
Dwelling 1 ,560 Sq. Ft. @ $ $56.70 = $
Basement ~ Sq. Ft. @ $ $10.85 =
88.452
16,926
60 000 Comments on Cost Approach (such as source of cost
estimate, site value, square foot calculation and for HUD,
V A, and FmHA, the estimated remaining economic life of
the property): The subject was valued usina
the Marshall valuation service. Estimated
remaininG economic 15 vears.
Garagea:arport ~ Sq. Ft. @ $
Total Estimated Cost New. . . . . . . . . . . . . . .
Physical
Less 40 %
Depreciation 46 130
Depreciated Value of Improvements. . . . .
. . As-is" Value of Site Improvements. . . .
INDICATED VALUE BY COST APPROACH
ITEM I SUBJECT
66 Beachcliff Drive
::I:
()
<(
o
a:
a..
a..
<(
~
en
o
()
AddressCarlisle
Proximitv to Subject
Sales Price
Pcice/Gross Liv. Area
Data and/or
Verification Sources
V ALUE ADJUSTMENTS
Sales or Financing
Concessions
Date of Sale/Time
Location
Leasehold/Fee Simnle
Site
View
Oesian and Anneal
Gualitv of Construction
Aqe
Condition
Above Grade
en
en
>-
...I
<(
Z
<(
Z
o
en
a:
<(
a..
::
o
()
en
UJ
...I
<(
en
Room Count
Gross Livinn Area
Basement & finished
Rooms Below Grade
Functional Utilitv
Heatino/Coolina
Enerav Efficient Items
Garaae/Carnort
Porch, Patio, Deck,
Firenlacelsl etc.
Fence Pool etc.
Net Ad' total'
ITEM
Date, Price and Data
Source for prior sales
within year of appraisal
I Functional I
Insnection
DESCRIPTION
Averane
Fee simole
2.65 acres
Averaae
Ranch
Averane
48 Vrs.
Averane
Total I Bdrms I Baths
17 11
5
1560
fulllO%
$17.27 =
9,948
115,326
. . = $
External
= $ 46,130
............= $
...........= $
........... - $
COMPARABLE NO.1
12 White Birch Ln.
Mechanicsbura
4 Miles
69 196
2000
131,196
COMPARABLE NO.2
106 Maple Drive
MechanicsburG
4 Miles
COMPARABLE NO.3
3 Sunset Drive
Mechanicsburq
4 miles
fn $94.64
1$106000
rill
1$ 88 000
fill
1$122000
I1I1
$ 46.10
$ 108.93
Courthouse Records
Courthouse Records
Courthouse Records
DESCRIPTION
Conventional
None
7/16101
+ /-1$ Ad"ustment DESCRIPTION
Conventional
None
616101
+ 1-1$ Ad'ustment
+ 1-1$ Ad'ustment DESCRIPTION
Conventional
Sellers Assist
-$3 637
$3000
$3000
9120101
Averane
Fee simole
1 .33 Acres
Averane
AveraGe
Averane
28 vrs.
AveraGe
Total T Bdrms I Baths
h 12
-$2,000
$4400
-$3,000
Averaae
Fee simole
.48 Acres
AveraGe
AveraGe
Averaae
37 vrs.
AveraGe
T etal I Bdrms I Baths
12 r 1
AveraGe
Fee Simole
.31 Acres
AveraGe
Averaoe
Averaae
48 vrs
Averaqe
Total I Bdrms I Baths
>> 12
6
1120
full/1 00%
3
-$2,000
-$3 490
$2,000
7
$4 400 1 909
Sa Ft.
5
1 120
full/O%
None
AveraGe
2000 Forced Air
None
2000 None
None
None
-1000
1 0 400 fxl + r 1- $
Net 6.8%
11 6 400 Gross 19.3% $
114763
Sa. Ft.
Sa. Ft.
Sa. Ft.
AveraGe AveraGe
HP/CA BB
None None
2 Car Det. 2Car Carnort
Covered patio Stoop
1 Fo Wood Stove IFI
Fence
Ixl + f1- $
Net 9_8%
Gross 11.7% $
Averaae
$ 2 000 HP/CA
None
$3 500 2 Car Attached
Encl.& Patio
$ 1 000 1 Fn
6010 rl+ Ixl- $
Net 5.9%
94010 Gross 13.1% $
SUBJECT
None
-$2 000
-$1,000
-7237
COMPARABLE NO.1
COMPARABLE NO.2
COMPARABLE NO.3
Adjusted Sales Price
of Comparable
Comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc.)AII sales are in the same townshin as the
subiect within a 5 mile radius.
Analysis of any current agreement of sale, option, or listing of the subject property and analysis of any prior sales of subject and comparables within one year of the date of appraisal:
No sales within 1 yr.
Courthouse records
No sales within 1 yr.
Courthouse records
No sales within 1 yr.
Courthouse records
INDICATED VALUE BY SALES COMPAmSON APPROACH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . .. $ $ 11 5,000
INDICATED VALUE BY INCOME APPROACH tll Applicable' Estimated Market Rent $ IMo. x Gross Rent Multiolier - $
The appraisal is made U"as is" U subject to the repairs, alterations, inspections or conditions listed below U subject to completion per plans and specifications.
Coad'lIons 01 Appraisal The market aooroach is the most reliable with the cost aooroach sunnortinG it. The
income annroach was considered but found to be not annlicable.
Final Reconciliation The market annroach has been determined to be most reliable in this case. Aooraisal AS Of
Date /Date of Death\ October 26 2001.
z
o
t=
<(
::i
C3
Z
o
()
UJ
a:
The purpose of this appraisal is to estimate the market value of the real property that is the subject of this report, based on the above conditions and the certification, contingent
and limiting
conditions, and market value definition that are stated in the attached Freddie Mac Form 439/Fannie Mae Form 10048 (RevisEii/93 ).
IIWE) ESTIMATE THE MARKET VALUE. AS DEFINED. OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT. AS OF
10-26-01 '. . (WHICH IS THEJ>A.TE OF INSPECTION AND THE EFFECTIVE DATE OF THIS REPORT) TO BE $ 115,000
~\\ \" . . Q\(j. (\ \. " , SUPERVISORY APPRAISER(ONLY IF REQUIRED)
Signature ~-' ~~~~ . <-: ~~ Signature 0 Did 0 Did Not
Name William A. Bassett \ 1 Name Inspect Property
Date Report Signed :~ \ '~, \ c ':L-- Date Report Signed
State Certification #GA-OO 1618-L \ State P A State Certilicatian #
Or State License # AB-049762-L SlatePA Or State License #
Freddie Mac Form 70 6~93
State
State
MCS. a D,V,SIon 01 ACI Development (800) 697-7783
Page 2 01 2
Fannie Mae Form 1004 6-93
WOLFE & SHEARER APPRAISAL SERVICES
Borrower/Client: Roy Noss
Property/Address: 66 Beachcliff Drive
City:
Carlisle
County: Cumberland
State: P A
Zip Code: 17013
Lender:
Charles E. Shields, III, Attomey At Law
APPRAISAL ADDENDUM SPECIAL CONDITIONS
The following checked items arc speeitic special conditions that were identified by this appraiser during the inspection of the subject property, the comparable sales and
there neighborhoods and locations. Unless otherwise noted, the conditions that apply to the subject property or the comparables used DO NOT affect the market value
or the future marketability of the subject property being appraised. This is not a home inspection service. This is an appraisal t 0 estimate market value.
_ I.) The subject is located in a rural area and is less than 25% built-up. This condition is typical and common for the area
and DOES NOT affect the market value or future marketability of the subject.
_ 2.) Commercial/Industrial uses are located within the subject's neighborhood. These uses are typical of similar
neighborhoods and DO NOT affect the market value or future marketability of the subject property.
_L3.) Vacant and undeveloped land uses are located within the subject's neighborhood. These uses are typical for the area
and DO NOT affect the market value or future marketability of the subject property.
_ 4.) The predominant value in the neighborhood is less than that of the market value of the subject property. This is due
to the very wide range of value of properties in the area and superior quality of the subject property. This condition
DOES NOT affect the market value of the subject or its future marketability.
_ 5.) The subject property is located in a F.E.M.A Identified Flood Zone. This condition DOES NOT affect market value
or future marketability of the subject when flood insurance coverage is required. Flood Insurance is suggested.
_ 6.) Dampness is noted in the basement of the subject. This condition is considered typical in dwellings of the style and
DOES NOT affect market value or the future marketability of the subject. Standing or running water was not present on
basement floor.
_ 7.) The subject property is serviced by private well_ and septic _ systems which is common for the area.
This does not affect market value or future marketability.
_ 8.) The subject is older than five (5) years old. All mechanical systems including the heating, electric and plumbing
systems appear upon a visual exterior inspection to be in working order. No warranties are implied in this statement.
9.) Repair items were noted on the cornnlent section of the report. These comments on repair items are for descriptive
purposes only and are not required repairs. The repair items listed are cosmetic in nature and DO NOT affect the
market value or future marketability of the subject property.
_ 10.) The basement floor is a dirt floor. This condition is common and typical for the area and DOES NOT affect the
market value or future marketability of the subject. The presence of a dirt floor DOES NOT pose a health or
or safety hazard.
_ 11.) The subject property does contain functional obsolescence as noted in the report. This condition is considered
typical and cornn10n for the area and this style dwelling and DOES NOT affect the market value or future
marketability of the subject property.
_ 12.) The land value exceeds 30% of total value due to the high demand for vacant land in this neighborhood. This
condition is considered conmlon and typical for the neighborhood and DOES NOT affect the market value or
future marketability of the subject.
~ 13.) The land value exceeds 30% of total value. This is due to the large size of the site. This condition is considered to
be typical and cornn10n and DOES NOT affect the market value or true marketability of the subject property.
_ 14.) Individual adjustments were required that exceed 15%. These adjustments were required due to lack of more
similar comparables on that individual rating. All three comparables are the BEST A V AILABLE.
_ 15.) Total adjustments exceed 25%. This is due to the lack of comparable sales that were more similar in the subject's
market area. All three comparables are the BEST A V AILABLE.
_ 16.) One or more comparable sales are older than six (6) months old. Although there are comparable properties in the
subject's area, none have sold recently, therefore, sales in excess of six (6) months old have to be used. All
three comparables used were the BEST A V AILABLE.
L 17.) One or more comparables used were in excess of one (I) mile from subject property. Although there are
comparable properties in the immediate area, none have sold recently. Therefore, it was necessary to use
comparable sales outside of the immediate area. All comparables used are located in similar neighborhoods and
within the same marketing area. All three comparables used were the BEST AVAILABLE.
_ 18.) The electrical system was not connected during inspection.
_ 19.) The water service was not connected during inspection.
_ 20.) The heating system was shut down during inspection.
_ 21.) Roofing_ Plumbing_ Electrical_ Heating_ certification is suggested.
_ 22.) Inground swimming pool_, out buildings _ included _, not included_ according to lender guidelines.
_ 23.) According to lenders guidelines a maximum of _ acres were considered for this valuation.
Remaining acreage was given no value.
_ 24.) The subject property is located on a private road.
_ 25.) Wood Infestation inspection is suggested.
_ 26.) Last recorded deed transfer: Date . Consideration $
_ 27.) Proposed construction/renovation accordance to plans/specifications to be completed in a workman-like manner.
_ 28.) Seller is paying part or all of closing costs. This DOES NOT affect the market value or future marketability of the subject.
.....129.) All comparable sales are verified closed sales.
_ 30.) There are no special conditions or other requirements that would affect market value or future marketability
in this Appraisal Report. _ Exterior inspection only.
31.) Other PERSONAL PROPERTY HAS NO AFFECT ON MARKET VALUE OF PROPERTY.
- \_..>~. ~;\--\s:\~~ t \<~~~~~ d- \ 4 \ G '.-:L_ DATE
APPRAISER REVIEW APPRAISER '
William A. Bassett
Wolfe & Shearer Realtors
File No. 02-002
DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market
under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not
affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from
seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised,
and each acting in what he considers his own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) pay-
ment is made in terms of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents
the normal consideration for the property sold unaffected by special or creative financing or sales concessions * granted by anyone as-
sociated with the sale.
* Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary
for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable
since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the
comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the
property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession,
but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the app-
raiser's judgment.
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to
the following conditions:
1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it. The
appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title. The property is app-
raised on the basis of it being under responsible ownership.
2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements, and the sketch is
included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its size.
3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data
sources) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because
the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination.
4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless
specific arrangements to do so have been made beforehand.
5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at their con-
tributory value. These separate valuations of the land and improvements must not be used in conjunction with any other appraisal and
are invalid if they are so used.
6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the presence of hazar-
dous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware of during
the normal research involved in performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no know-
ledge of any hidden or unapparent conditions of the property or adverse environmental conditions (including the presence of hazardous
wastes, toxic substances, etc.) that would make the property more or less valuable, and has assumed that there are no such conditions
and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be respon-
sible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions
exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be considered as an
environmental assessment of the property.
7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or
she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of
such items that were furnished by other parties.
8. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional
Appraisal Practice.
9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory comp-
letion, repairs, or alterations on the assumption that completion of the improvements will be performed in a workmanlike manner.
10. The appraiser must provide his or her prior written consent before the lender/client specified in the appraisal report can distribute
the appraisal report (including conclusions about the property value, the appraiser's identity and professional designations, and
references to any professional appraisal organizations or the firm with which the appraiser is associated) to anyone other than the
borrower; the mortgagee or its successors and assigns; the mortgage insurer; consultants; professional appraisal organizations; any
state or federally approved financial institution; or any department, agency, or instrumentality of the United States or any state or the
District of Columbia; except that the lender/client may distribute the property description section of the report only to data collection or
reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must
also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, or
other media.
Freddie Mac Form 439 6-93
MCS, . Division 01 ACI Development (8001 697-7783
MCS Form LCS
Page 1 of 2
Fannie Mae Form 10048 6-93
Wolfe & Shearer Realtors
APPRAISER' S CERTIFICATION: The Appraiser certifies and agrees that:
1. I have researched the subject market area and have selected a minimum of three recent sales of properties most similar and
proximate to the subject property for consideration in the sales comparison analysis and have made a dollar adjustment when
appropriate to reflect the market reaction to those items of significant variation. If a significant item in a comparable property is super-
ior to, or more favorable than, the subject property, I have made a negative adjustment to reduce the adjusted sales price of the comp-
arable, and if a significant item in a comparable property is inferior to, or less favorable than the subject property, I have made a pos-
itive adjustment to increase the adjusted sales price of the comparable.
2. I have taken into consideration the factors that have an impact on value in my development of the estimate of market value in the
appraisal report. I have not knowingly withheld any significant information from the appraisal report, and I believe, to the best of my
knowledge, that all statements and information in the appraisal report are true and correct.
3. I stated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and conclusions, which are sub-
ject only to the contingent and limiting conditions specified in this form.
4. I have no present or prospective interest in the property that is the subject to this report, and I have no present or prospective per-
sonal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis
and/or the estimate of market value in the appraisal report on the race, color, religion, sex, handicap, familial status, or national origin
of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties in the
vicinity of the subject property.
5. I have no present or contemplated future interest in the subject property, and neither my current or future employment nor my
compensation for performing this appraisal is contingent on the appraised value of the property.
6. I was not required to report a predetermined value or direction in value that favors the cause of the client or any related party,
the amount of the value estimate, the attainment of a specific result, or the occurrence of a subsequent event in order to receive my
compensation and/or employment for performing the appraisal. I did not base the appraisal report on a requested minimum valuation, a
specific valuation, or the need to approve a specific mortgage loan.
7. I performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were adopted and pro-
mulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place as of the effective date of this appraisal,
with the exception of the departure provision of those Standards, which does not apply. I acknowledge that an estimate of a reason-
able time for exposure in the open market is a condition in the definition of market value and the estimate I developed is consistent
with the marketing time noted in the neighborhood section of this report, unless I have otherwise stated in the reconciliation section.
8. I have personally inspected the interior and exterior areas of the subject property and the exterior of all properties listed as compar-
abies in the appraisal report. I further certify that I have noted any apparent or known adverse conditions in the subject improvements,
on the subject site,or on any site within the immediate vicinity of the subject property of which I am aware and have made adjustments
for these adverse conditions in my analysis of the property value to the extent that I had market evidence to support them. I have also
commented about the effect of the adverse conditions on the marketability of the subject property.
9. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report. If I relied on sig-
nificant professional assistance from any individual or individuals in the performance of the appraisal or the preparation of the appraisal
report, I have named such individuallsl and disclosed the specific tasks performed by them in the reconciliation section of this appraisal
report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any
item in the report; therefore, if an unauthorized change is made to the appraisal report, I will take no responsibility for it.
ENVIRONMENT Al DISCLAIMER: The value estimated is based on the assumption that the property is not
negatively affected by the existence of hazardous substances or detrimental environmental conditions
unless otherwise stated in this report. The appraiser is not an expert in the identification of
hazardous substances or detrimental environmental conditions. The appraisers routine inspection of
and inquires about the subject property did not develop any information that indicated any apparent
significant hazardous substances or detrimental environmental conditions which would affect the
property negatively unless otherwise stated in this report. It is possible that tests and
inspections made by a qualified hazardous substances and environmental expert would reveal the
existence of hazardous substances or detrimental environmental conditions on or around the property
that would negatively affect its value.
SUPERVISORY APPRAISER' S CERTIFICATION: If a supervisory appraiser signed the appraiser report, he or she certifies
and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree with
the statements and conclusions of the appraiser, agree to be bound by the Appraiser's Certifications numbered 4 through 7 above, and
am taking full responsibility for the appraisal and the appraisal report.
ADDRESS OF PROPERTY APPRAISED:
APPRAISER, -\ ,_ \t
Signature: '\ .) ,)--1~-3~~J5 \... . ~.s~:.o-.J~j
Name: William A. Bassett,
Date Signed: .J-. \ \-\ \u .~
State Certification No.: GA-01618-l
or State license No.:
State: Pennsylvania
Expiration Date of Certification or License: June 30, 2003
SUPERVISORY APPRAISER (only if required);
Signature:
Name:
Date Signed:
State Certification No.:
or State License No.:
State:
E~iration Date of Certification or License:
U Did D Did Not Inspect the Property
Freddie Mac Form 439 6-93
MCS, a Division of ACI Development (800) 697-7783
MCS Form LC5
Page 2 of 2
Fannie Mae Form 10048 6-93
_J3.QILQw~r/Client _ ~_~~
Property Address..
.. City_~_______ ________
lender
file o. 02-002
County
State
Zi Code
FRONT
REAR
STREET SCENE
Form PP 1
Wolfe & Shearer Realtors
MCS, a Division of ACI Davelopment 18001 697-7783
Jllurower/Client IClient: Rov E. Noss
ProDertV,Address 66 Beachcliff Drive
-'-idlY Carlisle
lender Charles E. Shields, III, Attorne
o. 02-002
Countv Cumberland
At law
State P A
ZiD Code 17013
\~';; .~
.,;. -. ---..-, , oi/_i...,
..,!~:' "J /l~k<~
I
.,..
.........
(
........."
~. .11..'
", "
Form PPC
Wolfe & Shearer Realtors
MCS, a Division of ACI Development (SOO) 97~7783
.
.
,
Wolfe & Shearer Realtors
~: ---- -
. File No. 02-002
Borrower/Client /Client: Rov E. Noss
Pronertv Address 66 Beachcliff Drive
Citv Carlisle Countv Cumberland State PA Zin Code 17013
Lender Charles E. Shields, III, Attorney At Law
BUILDING SKETCH
.... --.".... ..,..- ._._~ "_u', ." .._~. _.' ___. -. -....._~ -,~-,~",_""",,,'.'......_-,.............._.,..~--- . - . ._~'-'--'-'--_.'
.....i.
N
<>(\
1
!
....
-"
.c
"
\')
c
~\- ~~ ,",co
l;: .~
t..l-"\ '" '" ~"
~ .;..:. \ Ul r
;Q X> 0 ~ "\ ~
i:. (' 1':>
b ~ ..J:. ......\ ~
b \;) \ -t.
... ~ ('>. .t:.
r- ~ ~ C
('
l
'I') (i) ~..
't)
"CI
~
t I
~, I
"I'"
,
_ J
-- ~-.-
~ '(
, ~
s.. t....
l' l'l
..
,
I 1:.. ~ ~
1"- ~ "t c
- .. ;:.
1) 'I: '\ '>
" <'-.; ;,-
...I.
T .r<:,.
4'
1111 III ..
~
'"
'\)
1 ~
l::> ~. ~
" :;. 1
~ ~
'\ (\
~
')
Form MPB
MCS, . Division of ACI Development (800) 697.7783
E:BLL-L69 (OOBl jUGwdojG^oO IJ\I 10 UO!S1^'O . 'SJVII
ldVII WJO~
... E::J
VINV^'ASNN3d '^.lNnOO ONV'~38wno
BE .LOIl:USIO
dIHSNMO.L ~NIHdS H3^ 11S
:10
dVW X30NI
\ J d,",l
101] 1001>"
;~c;-U.
I
\
,I
\
1
4
,
.,
I
1
I
.j
Q
$
I-
8 LOL L apo::>
'r/ d ate!s
Mell'r/ AauJou'r/ 'III 'sPla!4S '3 sapelj::> Japual
puepaqwn::> luno::> a)s!pe::> ll::>
aAJJO H'IJljJeas 99 SS8JpPV jJa Old
ssoN '3 ol::l :!U8!1::>1 lua!l::> JaMOl 08
-.-
:
/'
/'
~T[(',cg t'
lP'11y"...,~.:---.
'd
~
'a.
l
'1. --
~~\
'~
0-
3:
I-
x
W
lI)
ld
...1
o
o
2
\ 69t=-t;.
--.-------- 1
\ (j) ,,,-v ! ___ -1-- - v
\ ~-' ~
________m~~ ~ ~=~Nno~~B3d~__::;~~:1L~.~i
dVII\I NOLL V::> 01
lOO-lO 'ON al!::!
SJOlleaH JaJeaqs ~ aJloM
REV.1508l!x + (1-97:'
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
.;2../-01- /05"0
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
/v'DSS,
FILE NUMBER
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.
RoY E.
ITEM
NUMBER
1.
~.
3
DESCRIPTION
CI T/ZENS 13A-NK ~
11.) T"m~ /)lfpo.sif # /40-002..049 -C- to
13.) Itecr, :into fp eli,v.d. DVI I~ A.
C.) 77me lJtf1p.sd #- /'10- OS1.6A!;"-~ '*
D.) .4ur. I:.J1r. tz, c/.o, d. D"1 ~ C_
R.) 7/~ tJ~s/f J.:I= OOS""7 '1 / 8't..f
F.) .4cc.r, kf. ~ do.e(. eM / -kM E
(. /.JJ... /' C/ TI ZE7/lS .B'+/lJ K Q tfa dt.ecl \ .
See Ie-lIef ';'Phf )
1f In/,;;. PlPte: I11tlr)' k,fJ{! Alp>> U/R.J tv/;k 01' Roy c_ /lJLJ.s~ .
~ /?rul~(!eq>2/ h/M / JUlJ//,,! d,'~d' en ~r;. 2//2000
J-IO{JS~flO/../) /N(EN1i;IlV (~ee -&~ecl j,jh'cJ allockcl)
PEIYNIf:. CElV1Jl.If-L. Feu. D;::" IIHRIt/SSuRG- (/.fure IS esf,M.
#IJI /JI~Athly r:5liif~HIt'~ts)
VALUE AT DATE
OF DEATH
~
e:< I ,S'?/,t). PO
V IS". 90
~
:z.." Soo. t:JD
" ., . ifo
,c
/9 tf'"~s: /1
,
~ I 3'-. 22.
% 3/~ ZS'"
~ /SO, F7
TOTAL (Also enter on line 5, Recapitulation) $ :(.s, tI' I. 7 S-
(If more space is needed, insert additional sheets of the same size)
+: CITIZENS BANK
Account
Number A ccount Title
100-019-1625 Roy E Noss Or
Patricia K Ruth
140-002049-C Roy E Noss Or
Mary Jane Noss
140-052825-C Roy E Noss Or
Mary Jane Noss
00579184 Roy E Noss
Tuesday, March 05,2002
Date Opened: 04/19/2001 Account Type: 00
Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$5,661.37 $0.84 $5,662.21 $10.59
Date Opened: 08/28/1990 Account Type: TO
Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$2,500.00 $15.90 $2,515.90 $99.02
Date Opened: 07/31/1997 Account Type: TO
Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$2,500.00 $9.40 $2,509.40 $71.17
Date Opened: 09/04/1997 Account Type: TO
Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$19,835.11 $136.22 $19,971.33 $422.05
Page 2 of 2
HOUSEHOLD INVENTORY of ROY E. NOSS
KITCHEN:
Kitchen Stove (old-style 1960's kitchen stove, broken glass in oven door, may
not be repairable).
Table with chairs sold to Keith Davis
Refrigerator (broke during summer before death, has been junked)
Misc. kitchen utensils & hand held appliances
Small toaster oven (old & doesn't work very well)
Old radar-range microwave (does not appear to work)
Plastic waste can
DINING ROOM- House does not contain a standard or separate dining room
LIVING ROOM:
Three upholstered chairs and sofa (deteriorated condition and given to shelter
for abused women)
Recliner chair (decedent had been vomiting blood before ambulance came, all over
chair, therefore chair was junked)
Small color TV(at least 5 yrs old) (on metal cart stand)
2 little end tables with 2 metal lamps, somewhat pitted (soiled shades)
Fireplace tools (not solid brass---economy type)
BEDROOM #1:
Double bed (no head board) (metal frame)
Chest of drawers and dresser (painted gray)
2 small table lamps
Suitcase (old)
Old books, mostly bibles or commentaries (donated to church)
BEDROOM #2
Dresser, chest of drawers, bed with headboard, night stand set (beat up from
wear and tear)
BATHROOM:
Waste can
$10.00
$60.00
$0.00
$6.00
$1.00
$0.00
$0.25
NONE
$15.00
$0.00
$25.00
$5.00
$7.50
$5.00
$15.00
$1. 00
$0.50
$1.50
$100.00
$0.25
.P~bE' :z
t-Iou SEHOLb \NVEN,ote\.f of Roy E. /JoSS
MISCELLANEOUS:
Washer and Dryer (very old---bad shape)
Hope chest (fake wood)
Metal hamper
Old stereo cabinet sold for
GARAGE:
Miscellaneous hand&garden tools (bad shape)
Lawn Mower (does not work properly)
CASH IN WALLET
TOTAL
$5.00
$1.00
$0.25
$1. 00
$6.00
$10.00
$38.00
$314.25
.
REV-1509 EX + 11-9/i
'*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EST ATE OF
/lJc S~;' Jeoy E
FILE NUMBER
.;2..,/ -01- /OS-D
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
ADDRESS
RELATIONSHIP TO DECEDENT
A. P fJ,. Tie/CIA- k. Rtt.-rH
I;;). JcElt.y :J>/i?IVE ;' e""-eL/SLE,, Jl?A- /7tJ/3
NIEC.E'
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank oo:ount number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Jf .Iq." I e /7'1 Z ENS -a,1.AI/< , DEmAN/> "De-rbS./T .A- a r: :{.5,"'2.21 d ~ .2./g3/. ItJ
-#- (~O-Ol" -n.z~ ~
P/&wf.1PAl- s: f;>ft! I. 37
INr- . 3'1
~ 5, ',z.21
(See Ie I;ir IrP/11 e//lZEAlS ~K &i llackcl
-k Scitecl ~)
fI> 10
TOTAL (Also enter on line 6, Recapitulation) $ .:2,831.
-
(If more space is needed, insert additional sheets of the same size)
REV.15~~ EX + (1-97;
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ,:;J E
/V05S/ II..OY .
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
2/-01 -/DSV
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE OATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST IF APPLICABLE)
1. ONG -N/fir /A/rEltES/ IN JplAlT S-'M/k Aee7: ~ 100To ~
;;J..,f3/./1 3, ~. t>O N€T~
A- T efT! Zt?7VS ,J!3"1/J1K /9-5 ~E/ltJ/Z.TE[) /)N SCWEl>.
F,/ /11 ,f. tJE ,tJ-s Or ~'/9.pll tv/MIN f)/f/E
Yt9-1f /)/= lJ, P..p-
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-991
. t>, ~,O
.~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
.:21 - 01- IDSt)
Nos 5, ROY
FILE NUMBER
E.
Debts ot decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
1
FUNERAL EXPENSES:
m It-l fJ E Z Z I Ftt N E I( /fl H~Hf~ t/F /J1 ~ CH AN / C S ,t3lt IlG
5ror1e Chu..r"c.h - Cemef-e..rt L-or
C;Ant ~ods - ~I>P( -kr funeral mPal
tearl B4rr;c.K - orr ten; sf
10"'1'5 un/fed I1'I,JI,pr/'-s! Church - ~r uSL ~/' /lul/, e~.
.Ta.mes If. G'~r/d1 Memor;cr-/s
.;.
3.
1.
s.
,.
1
B. ADMINISTRATIVE COSTS:
2.
Personal Representative's Commissions
Name of Personal Representative(s) P 1'r-rR./ C I ~ +<. 1< IA -r 1-\
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address \ :l 1<. t: L L Y J) IZ.I V E
City C A-R.. 1-1 S L FE
State~Zip 110\3
Year(s) Commission Paid:
Attorney Fees CHPrR.L.e:S f:. '5HI ~Ll:>.s '1il
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
4.
5.
6.
7.
Y.
7.
I".
/I.
Claimant
AI~/lI~
AMOUNT
rf
5-; f to 'f.PO
'I
S~s: 00
?6 9, '13
~
7 o. /JO
JZ/3o.00
~ Cf;? y.t1P
,.
c.,. 7LfS_ St.
~
S; 5tJIJ, 00
NtJIIE
" I 3 :2. . DO
,. ;;loo.I!JO
~ 70,00
~
;276.00
,.
3stf. co
I'c-
01. bS
~
/ (" /. '0
~/O'.8'3
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees OJ\,I.d Or-~'Ir'\o..\ "15"=>u.e. of S'rort c.e..rt;~'cQ.t-~S
Accountant's Fees :Slut wn Jd/;S I ;J I'tfJ. of /P/f/, /A 'f/ I dc. ~ sh M. )
TaxReturnPreparer'sFees Sh{.LW'\ EIt;.s..~. o-f dose-o...t /0,\0, PA-'fO, 1Z-7c.
Ont~j,a: Flop&! Insurance
Don'7!a/ f.!r;/JU!()Jf)lIerS J:nSural1ce.
/JPfL
fJ fJrL.
Aj>IUL)'
~
TOTAL (Also enter on line 9, Recapitulation) $ -,c,711L .<1/, J"'~.I'I
(If more space is needed, insert additional sheets of the same size)
nl,u'c//r/j 7Je,Pf. d"1i.6/,'c /tk/kre
~sh~.)
Sc'HeD. fl.. I UJnt0'
( :7.
13'.
/'1.
IS.
Ib_
17
j(~5S ~y F.
I
fJ jJf L
Wt//fe ~' J/!t:nrer /tat! Ksf ~flnl'J-al
[)p/17jal lJ1uflta! :JP'S&lr. - fI()m~Mlner; J#ftfP:
/It1Y~rh'.r/7 I'" Cuhtkr/aJtd LILu) ::JburnQ /
.1dJlerhJ/{f /n . 11;}./~/-MwI" /lteh-h~Gt
A/~'I/~H~/ jJrt' JaJt: he
51ave ~!!I ESJ' ~r ddPlce
;5SU€$" / efc,.
/)jisc. ~S!S. t2~ra~ecl/ /~~~/e.s, /1112//7/ e?t.
(k,f! pf ;;/'7 1/7j,er. ht..x relurn
e,~f pi .I~7'1t /i/s! a;<</ hAIl/ a~un Iwti
mIVU/ ~~ -b hX ad .l'e/dll" .5j1t?t(f/1f5, ~.
P P f-L
fJe6ra &sekft /vIes/: /~ ~1I~r
.I
~t7f-L
i:br .1sur.
I!.
1'1.
~.
~.
;;J
;&
df.
.(~
;2f,.
CJ./-OI- (Osv
~7Z.7.)
'i'
;;; S-o, 0'0
JT;:.
36 'I. C/o
~
7 S,. "0
~ 80. 5'Z
~I -<&. dO
~:yJ#t. )
fl'
l~tJ. ~o
)l / 7. 2a
~ IS: bO
~/;{3 00
l/?'fJ. .-
tr
/03.7'-
fL /, 2~/f. ~F
~ ..:? 15. 3"
jl' '70. em
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET - SUITE 101
CARLISLE, PENNSYLVANIA 17013
TELEPHONE
(717) 245-2698
July 22, 2002
Charles E. Shields, 111, Esquire
6 Clouser Road
Mechanicsburg, PA 17055
BILL FOR SERVICES RENDERED
Review of Materials:
Telephone calls:
Appointment:
Fee: $150.00
FAX
(717) 245-0629
.2
.2
.3
~-
~h~:~.~
IN.~' .
->';;~~
COMMO"WEALTH OF PE"nSYLVA"li.,
I,'JHER,TANCE TAX RETUR~i
RESIDENT DECEDEW
~ RE\i.iS12 EX + (1_97
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF #e:?SS, /(I7Y E.
FILE NUMBER
2/-0/- IOSO
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
:;1.
3.
1.
5'.
"
1.
8".
,/,
/ D.
1(.
I ::2.
13.
C \ Q.1'"emont Nu.rs i0 tl.Md
cle..hb due re. : mdt''! Ia.ne
)<.DY b:. Noss (sa b ;11;(1
S: I veJ" Sp r; d It-M bl,<.!tt l'Ice
b~te detl-th.
DESCRIPTION
R e ha.b;' j to.h'o VI
NO$~ I i-r> be
a tf-a.ch ed )
Ce..nte.r !or Wlt>nthly
paid fr-f>Wt CLl'1e1 by
AMOUNT
~
~ 1 ~ "3. SV
%45: 00
,.:
~ g:z . 8fD
g
57. I 6'
"
B~9.31
F3/. "$3
~
b!; lIf'
~ 3~. 7iP
'jt
';9.3Lf
~93.S-S;
~
STJ .I b
~
J.s9.00
,
1./,577,87
_ overdfAt:.. meMbership ke fn~u.rrecl
k,'r~ICLnclG - b'dl"nj -br ClAl"fA;ll roc/oS in~,^rncl
de...o..~ .
JO- A/Jn :$ft>re - cover/eo r::. 0 rd ered be-lore de.a. rJ,
tvaI-lJtqrf - ill,1 fo,.. ;JhllrlJ1/1ceuf,cals
(l,hf(!/:151
,PpIL
4;tway - Fuel ()/I
Y,rk UJA.sft. 7J/sj7oSI'L /
beJ.,.re
kohls
[/erize>'1
'Ba.!:,;"eAM. Oft,'c;""I1S ..fz,r e.YWtl.$ses
CICl....etnortt NI.lt"6;(J 0Md r<d1D..b;/:t"".io.... Ce.t1ter- fr>r dek'ls
dlAG 1 ~ ClortVlee:h" Dill w~ ~ It-pp/; CO\: t:cm ~r M It/ NHC 6..1.ttI by
uoreement w,'J-t. 7krt. pF Pli.b/,'c welfm.re
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$:J.Cf S.:2t/.3<f
,
.
,
~
ant ~Ur8 .
:\Q;~ l~
0~ ~
?--
375 Claremont Drive
Carlisle, PA 17013-8805
main (717) 243.2031
fax (717) 240-1952
cf(ehabilitation Center
June 14,2002
Ms. Patti Ruth
12 Kelly Drive
Carlisle, Pa. 17013
RE: MARY JAJ.'ffi NOSS - OUR RESIDENT #3737
Dear Ms. Ruth:
As you are aware, Mrs. Noss was a resident at the Claremont Nursing. and Rehabilitation Center
in Carlisle, Pennsylvania.
An application for Medical A1isistance has been submitted to the Cumberland County Assistance
office and benefits have been approved. As part of the Medical Assistance process, the resident
was required to pay a portion of her income from Social Security, etc. to Claremont. Medical
Assistance pays for the balance of the billed charges for care. We have enclosed a copy of our
signed Admission Agreement for your review.
At this time, we are owed the following amounts from Mrs. Noss' income:
December 1998 $511.70 July 1999 $512.65
January 1999 $512.65 August 1999 $512.65
February 1999 $512.65 September 1999 $512.65
March 1999 $512.65 October 1999 $512.65
April 1999 $512.65 November 1999 $512.65
May 1999 $512.65 December 1999 $512.65
June 1999 $512.65 TOTAL $6663.50
Pleilse direct prompt payment to our BusLT1ess Office at the address noted above.
Should you have any questions, please feel free to contact Denise Lehman in our Business Office
at (717) 240-1908. Thank you for your cooperation and assistance in this matter.
______V;r<~l~~ur~
k'trIf~~-
Fiscal Director
cc: Charles Shields III, Esq.
fi service agency of Cumberland County
.
~ "'--;--;_1-"-1...-
::;: - ~ / i.-/ ~
..
CHARLES E. SHIELDS, III
ATTORNEY-AT-LA W
~; ,r,-
/,' .;..--
/
6 CWUSER ROAD
Comer ofTrindle and Clouser Roads
MECHANICSBURG. PA 17055
GEORGE M. HOUCK
(1912-1991)
:27 m.rt rCI1 c? 00 ~
TELEPHONE (717) 766-0209
FAX (717) 795-7473
e./ aruY/ont J//t/rs/171 f Rchltj, Cmkr
(/
375 ~/4~IJf'n11 :J)r/ve
&r//sle/ ,tJ/I 17~/3 - 8'805"
/16: IHr. ~fllfJll/krJ'
6: a)' Alos.5 ?/lryJCmp AIo..ss
Mar Jeff-
A> ,/r#r my {!p/J f'IJ-rsq l/cJ/1J /{//$ (!hda ~4r /HIt! /Jd; {!t:l1J1/l);e II.. :I RAJ
eMIasl# n oAaR //1 ~ n""uAt' o~ :$ '::1I, 577. tf2 drawn 0'1 tk aftt~
f!htK/;J Aut of I&,Y ~6S aI /Jfel/6'7 (C,hzens) Bunk, #edt4n/cSbu{J-
.11 /.5 my tt/Jd~r.S-f4/14'/d ii'at 14,'s h"jun' R/~5 -& resu/; o/' a SlU'ies
tJl e"l('tt/~h'p/lf fl?/'~r~n' by .0. /! /41. ~l'Id7 ~ a.ri?/%'b/~7 ~/
!;//Jd.5 t?f /JU'l Jii& /tM ~/ /t/~.t.5 aile! ~ e1j/'j,:iJ1y deler/n;/JR~on
-;br ~55isfttl1ce. I unclerf/llI1t1l#at.t1 Nr/llen J,rt'Hk~lI/n c;l' ;7fesG /r
bt/1l1 se/Jf ~ /J1e iy IJeJ tt?/H/~ea
If /s my Itt~tler UJ1~e~sJk/JclJ/ ~/l~.1IR ~~e01 t3T #It's /J11J/Jey
6" {!1tt~m~111 /tI11/ /t'.5u/f 1/7 //# e1!/j/!J~ d /Ioltlal1~e sla&nf Mu/
tl te/ell.58 IJI tJ$er ~./? If/. 4/1&73 dhe//y *' ChlOllIJI1T A#t/ $p,1
11/5 jJmeess ~/// ff'.5tf/f I'" /It> hir~r (!/P///75 /fI/h5f e/$er~/
~ ~75(!S /tI;~ I'fJnnl ~ j)..f!Jt/. CJr Cl5S;S!&ha' ~1//'J/~(r-
I dP ttlldt'rsht/!Ct: j;pff/(lt/~r; /tat #ete /J- q hrr/Mr ;/?Qe/~Hf/ent
c/e.6f ~lf/etl ~ Clare/11tJ/lf -#r .:::ernees /J/?)f//'cIe/ ~q' ;({;vL ~ J/7:4:MWYt
aJ1.tl 1y5/5 IS k/l.! fl/tfJtrJr/ ad ~/II ~ die ill {h/t//etY>on tp//Jf lie
/nclt'j/el/chl1f clelJf. :r lil/denfand dal O/1u it?1f 6J! ~se ~b/;
Ote pelld #tlf ~ /VIII ~e 110 hrtkr .C~/m5 /'?t1jY ,I';/;/ ~~//;:;-I'
(M A/~55e5. ~~ /tflt/ ;u. pf/r ,,!:,/!4'" 4#e;th'o/1 ~ & s-
.
'-
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Comer ofTrindle and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991 )
/Ja.-tU ~ ~"eftl.s h Clare.mo/l! ./ /lltlr,27" O.z. TELEPHONE (717) 766-0209
/-. I FAX (717) 795-7473
/J1a fie/"".
~7 huly j/t!PNrs/"
~/! ~dv-2lL
et!: au ~k#
{It: ~ IJ /h' /&1/.
~: t!4d +r.. CS'J.
Ce! .5fer~ h'~J' ~.s;.
'~i
f s 11tlE /)F !foy /lPSS
99
I
,I
60-82414
313
DAT-;1lla../'icL d ~1'-~O()d-
PAY .1 - ~
' b~6~~OF ( i! {]!./L::J}~'7t1.' A A1~"L. U7[( "Au _l~rl. .ft-, l..."u( ~(f.-A I $...."'/4-7'7 c..-,
-J.-. '--"" A 7 J ;i - ...,. ,/.-" ' /" ;) oL-
I ~.1 ~ -rJX--'-~ tP~:~~..J-< . '- ..,I{ 1.: "'''ti>!.LJ,( .KLM 1.)~ 1J - ~~( ~OllARS m~~'"'.:'
~: - b ' ^-!-1
I @ Mellon Bank
Mellon Dank. N .A.
Commonwealth Region
lIarril'lburR. PA
FOR
---/2Gt~ , '/tLJ /~~ M'
__k_.__~____________________
II- 0 000 q q II- .: 0 :l . :l 00 B 2 .': 000 III B 2 ? III ? ? 5 a II-
REV-1513'X + fl.;-
, '
SCHEDULE J
BENEFICIARIES
--
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NeSS,. !2tJY E.
FILE NUMBER
2/- 01- IOSO
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
1, PII71(/C/1t k. 7<UiH
/:< Kelly .Dr/ve
Car/,'s!e, /1/1- /1t?/3
A,.! /ece.
/ [) 0 io
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
"
'"
.
LAST WILL AND TESTAMENT OF ROY E. NOSS
I, ROY E. NOSS, of Silver Spring Township, Cumberland County, Pennsylvania, being
of sound and disposing mind, memory and understanding, do make, publish and declare this my
Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any
time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my beloved niece, PATRICIA K. RUTH,
currently of 12 Kelly Drive, Carlisle, Cumberland County, Pennsylvania, for her own use and
benefit absolutely.
3.
In the event, however, that my said niece, PATRICIA K. RUTH, should predecease me, I
give, devise and bequeath my said estate in equal shares unto her two (2) children, HEIDI
MCCARVER and TORRE RUTH, 1K'! stit:pes.
4.
I nominate, constitute and appoint my niece, PATRICIA K. RUTH, to be the Executrix of
this my Last Will and Testament. In the event that PATRICIA K. RUTH should predecease me or
for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint
my niece, SHARON N. JORDAN, to be Executrix in her place and stead. In the event that
SHARON N. JORDAN should predecease me or for any reason be unwilling or unable to act as
...
'"
Executrix, I nominate, constitute and appoint my niece, MARJORIE L. JOHNSON to be Executrix
in her place and stead. I further direct that they shall not be required to file bond or other security
in the Office of the Register of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5111 day of
!)Jr ' A.D. 1996.
R ~ J::. 11 ,J.-i4
ROYE. N SS
(SEAL)
Signed, sealed, published and declared by the above-named ROY E. NOSS as and for his
Last Will and Testament, in the presence of us, who at his request and in his presence, and in the
presence of each other, have hereunto subscribed our names as witnesses.
C!Iu/uJ i? ~ 7lL
M~ 09xwd-
,