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Home My WebLink About02-0691 PETITION FOR PROBATE and GRANT OF LETTERS named , 19~ (state relevant circumstances, e.g. renunciation, death of executor; etc.) . 'Decendent was domiciled at death in C.\A'('0.bex-l(AY'od County, Pennsylvania, with h e.r last family or principal residence at FOre.s"\- 1"c:wIL \-Ie'''' Ith Ceo:l:g: IOC':> Wn.\'\\v..\; ~"" '\<d. , Cil,<;;,\\S\e_ \>,1'.., 1,013 (list street. number and muncipality) Decendent, then 'is '3 years ofage, died -.\ U,\,\ e.. ':>' 200 7. " ~ at G-lv\\S\e, ?f.>... , Except as follows, decedent did not marry, was noldivorced 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: 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: $ 2'?,(., ODD $ $ $ WHEREFORE, petitioner(s) respectfully reque,st(s) the ~{.obate of the last will and codicil(s) presented herewith and the grant of letters ic::sTo.m.:::.."" C\~ (testamentary; admims ration c.t.a.; administration d.b.n.c.t.a.) theron. '"' 1l' ...!L '5-r '~8 -g.g "'il ~a.. ;'0 :a Iii, in ...- ~ Gowlt: ,*,,"^<:'Kav~,.~) lJJ;,~~ ~~Y;~~:~:Q.8n 0 OATH OF PERSONAL REPRESENTATIVE' COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF C.unlBJ:1=\UtN /) \.- The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and corr~ct to tbe "~st of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above deceuent 'petitioner(s) will well and truly administer the estate according to law. affiy~; and ~.. r~. r9""'~ '7<.~~ ~ '" i: ~ ~ \ /l-\\;- I No. Estate of Jl:::1\'N ( i1t.. (,Q1 -rrll.' I (I{ nCiL l-tUC7HF~ '-J 1::r\N -' . Deceased l~l~Cll'1I:2; lrKit DECREE OF PROBATE AND GRANT OF LETTERS ,:;;UO~ AND NOW j, Itt~ ' )11'_, in consideration of the petition on the reverse side hereof, satisfactory proof having been 'p~esen:;d, before me, I, ell (In IT IS DECREED that the instrument(s) dated IY\!t'J-\( ~ I! r: . ~ described therein be admitted to probate and filed of record as the last will of ..:rc: AI'., ~ l-'t~~,:~~':~ ,t~~ ,-n>A~ CLU..,! I E ILU [; 11 f:-) and Letters -' -.:> ___ _ 1-:1>. , [,-1 _ are hereby granted to _LAw n.....1 (If lC I E!J;-{(Eli t,.[ (J r7;:/A(~ i" , .. , llvi!) LVL! ,Lid! Ii; /1 ~:,,~/L!',;)),', . I ' ! Register of Wills .. J ,"r ~I?' r( Probate, Letters, Etc, .'.'."" $ L ,~'v " r: I h, (,r" Short Certificates( 1J. . , . . . , $' -' ' -'~) Rani~h..~..cton ;\;". r'l1.,2;:,. ....... $ r~~ J{,; ~$ \.h_f)f: At TOTAL_ $dUj.{,{'; Filed,.. .1.11. J.,. .Q,DJ..,.............. FEES ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE (}jhL J\ Iii ! ~+j - '7-1 Y7 PETITION FOR PROBATE and GRANT OF LETTERS No. To: named , 19_ Register of Wills for the Deceased. County of Sod Security No. Commonwealth of Pennsylvani tition of the undersigned respectfully represents that: Your p itioner(s), who islare 18 years of age or older an the execut in the last 'Il of the above decedent, dated and codicil( dated (state relevant circumstances. e.g. renunciation, death of executor, tc.) Decendent was dom iled at death in h last family 0 rincipal residence at County, Pennsylvania, with (list street, number and muncipality) Decendent, then , 19 at Except as follows, decedent did ot marry, was not divorced nd did not have a child born or adopted after execution of the will offered f probate; was not the vie m of a killing and was never adjudicated incompetent: Decendent at death owned property Wl (If domiciled in Pa.) All perso al property (If not domiciled in Pa.) Personal p perty in B nnsylvania (If not domiciled in Pa.) Personal pro erty in ounty Value of real estate in Pennsylvania situated as follows: . ~ u d v :g3 "~ "'d ",,0 S:::";= ~'';:: 3d:: "~ BO ~ d '" Vi $ $ $ $ WHEREFORE, petitioner(s) respect full presented herewith and the grant of lelters the probate of the last will and codicil(s) theron. ~TH OF PERSONAL REPRESENTATIV LTH OF PENNSYLVANIA l ss 1 The petition (s) above-named swear(s) or affirm(s) that the statements in the foregoing pe 'lion are true and corr t to the best of the knowledge and belief of petitioner(s) and that as personal re esen- tative(s) of t e above decedent petitioner(s) will well and truly administer the estate according to aw. Sworn before affirmed and subscribed { day of 19_ Register '" 00' " '" - " ~ ~ I(h_SIl~ Rn' 'i-'W, T'~lis is to certify r:1at the in!{)rmarion hert: given is lOrrtTtly Local Registrar The originJ.! ct'rtitlcatc \vill b~ forwarded to copied from :01 original certiFicate of death du~y flied with tht' S[~lre Vital Records Of-lice fl.)!" permanent filing. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. P 83199Sl' No. /,ii{~r"otp;;,~ i',#/ ~~Jj;'~. ,1'~/ .. \,~\ lf~( '~ \',~~ . <:::;II ~.v ~ ~ '-", '1 " . ~.b. ~ \'*~~*i ~a-" '< - /~l %~~~~(..~-- -- /~~ "'. :?r"'Hi, ~\ ~ ,,!' """'""""//lIIP"j,I!!I, ~~.~~"l'~~ LOCJ.IRegistrar Fee for rhi~ ccrri/leare, S2.00 JUN 1 4 21102 Dare H'05_143R~_2!S7 COMMONWEALTH OF PENNSYLVANIA e DEPARTMENT OF HEALTH a VITAL RECORDS CERTIFICATE OF DEATH "' "' " l'I...ME Of OEGEOe-NT(F"",_ M_e. LoWl I. Jean C. Hughes AOf(LaIllSW1I>dIvl UNOE!'I:1'1'E'J', _. D'~ \JHOE!'I:1D,>I;1 ~lMlnuI" '" 2. Female st,oJ"~ "LE-NUMBfR SOCI...\. SEC\JI\IT'1 NUI,l{lEIl ,. 145 - 40 - 5324 D"'TEOFOEATIi;~OfIIl\_Oa"'''''''1 .. June 13, 2002 5. 88 COUNTY OF CleAn! '" SlRTI-IPLACl:(Cilyaod Stote~FO/OOQeCOI./nl'Vl Richwood,W.VA F'LACI1:OF oe...,-H(CMck...-<yn<'& _.n,rrvcl.,....""__l HOSPITAl; Inll"......' 0 ~!\J~i&1I\ [J g:dyjO h. Cumberland Carlisle Forest Park Health Center ~~I oeCEOfNT'SU$UAlOCCUPAJION I(INOOFBUSINESSilNOU$HIY (c;r~:n.,~~iJ,:1 ". Homemaker 1'~, OWn Horne oe~g:;;~t~~~~e-ff~'ffhCe~~rC<xR\ ~~~ctWS RESIDl'.:NCE 700 Walnut Bottom Rd. 1s.."'lln.cliOfll ,.. carlisle, PA 17013 ",,,,,,,,src.l FA1HEl'I'SNAME("~.,"'"""",,la") 1'. Charles S. Cowie INFOAw.NT'SNAME(t1flelPtintl Lawton Rov no Me'tHOO ~ SPOSITIO'i 9uI\aI!2Qc_"",O -""'" lSEFlVlCE WAS DfCEOWTE1(1;.l\m U.S.,rJIMED'OfICES? ..".0 Mol?fl (,c::r..14 n. "'''RffAlSTnUS,,,,,rrie<l N......M'.....,.~, -"""" Widowed SUFlVlIlINOSPOUSE \~_,Il"*"'-nwt1.) k. ". "O.SIItO FA "' -- ~.. Cumberland -...Np1 11d.~ ~"":"~cl MOTIiEo'l'S N...Mf{F;,"" M~. ~'i<ltnSulname) 1.. Margaret Garrett INmR~"""'T'S """lUNG ADORESS (Stnoel. C,!y/lOwn.Sl.IIO. U> C<xIe\ l1e,O_,~~... "". 17b.Coun Carlisle "'- 2'. ;. oA M 27.PAl'(f': fn,.."'-dl..._,injunHO/eompj",,"lio""..~IC~eoUl"'I"'''aln_O<:>nol'''I''I'''ITIO<l. Uot."".,,,,.._on__ 1 WCIJlQtl.Crr,rITOwn.Sl.le,n>CO<Io 2002 1d. Perryman! MD o man- e a St., Carlisle, Pa 17013 13 ;;0"'- ,.1lV" , WA.SC!l.SfRfFER EDroMEDlC..o.lE)('o'~iNERIC ",0 !J ( ~.;) 6"0 cJ ino;z.ou<:II"<:a<<li""",tQp\lItQ1)l'''''l,_'''IIo.rl'''.~'e H. 'AppIO...".,IO :1n1__n lo"""'anddo..... , i "41'11",0I1101aiG"ilk:onteon<lllionltolltrlbo,rtingflldoolll,bu1 ,"-~ln_~_~InPAATI. Myocardia1 Infarction DUETO~AS"'CONSEOUENCEOF). L DUETOIOAASACONS,EOUENCEOF)' DUETO(Ol't~A~OUENCEOf')' WERE...lJ1Of>$YfIIoIOlNOS ~LA81.EPFllORlO COMP\.E"tlOHOFC"USI! ~"""' ~ANNEIlOFO~ATH O...TEOFINJURY (~O/l"',OIy.""'"') T\lI.EOF~JlJI'l'1 IN.JUFlY!ifWOfU(7 OESCFlIBfHOWINJUf!YOCC1JRREO. ",0 ,.0 - - o o P'ndl~I_~.clon CauklnalbOldol"""lnll<l o o O~EOfI~UFlY.Ml>Ome,to,,".II.....1a<:l"'Y.0"""''''. buildlng,o<<:.($pocoM ,~. N'l..... HomICOdo REGrSTRAR'S SiON,oJ"URE "NO ~.~~ 10.,\ ,G.,\,OI .,... 0 "",0 2M. 2". CVlTIFIEI'I!Che<:ttcwWy"""l 'CUlTIP(INQ /'t1Y51CI..." {""\'lIor;.an CII'~ au.. of dlNl~ ""... ~""'~'" O/l\"SC'a~ ~.. p"'''''''''''e<l deo'~ and c<rn",..O<l il"", Zll 10""_"'''''1<1>0'<0-.0, d.a<\loce~tro<ld""IQ_""'~"I_mo-TI1'O"",'I'Ia<l., ". - '~IlONOOHt;lfolQ """0. CEFlTI"""KO PI1Y'!.\CI-"H lPI>".,,,an tx>II> ;><onouoc'''O a..'" .nd "MilyonO 10 eo"", of 0&""'1 to ,... _ "''''''_''''_91, ,,",,If>oc.~,_.1 '~ell"", dale..nd plaee, .no d~'lo l~ec'~"('l.nd """'- e..".IK.. "MEDICAL OAMINEFlICOFlONER o..ltl.."..lo oloumln.'I"n andlo,lnvUl!goUon,ln "'y opinion, doslh oceurred II 'ho'Imo. d,lo"nd pla"o"nd due '0 I~e ~,u,,(ol *"d "'."n.'..IUlod......... ." ......,....................,..............................,......................... 3,.. ". '0 '-i ~, ".~ ~ J .J ,C~ "\ ~ ,j ~ , \. J\- SAlOIS, GUIDO & MASLAND 26 W. High Street Carlisle, P A [I " LAST WILL AND TESTAMENT OF JEAN COWIE HUGHES I, JEAN COWIE HUGHES, of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last jllness and funeral from my estate as soon after my death as conveniently may be done. SECOND I give, devise and bequeath my estate as follows: A. The sum of Five Thousand ($5,000.00) Dollars unto the MARYLAND SCHOOL FOR THE BLIND in the name of Patricia Denise Messman. B. My grandfather clock to RICHARD L. ROVEGNO. C. ~ll the rest, residue and remainder of my estate to my nephew, LAWTON COWIE ROVEGNO, absolutely and in fee simple if he survives me by thirty (30) days. THIRD In the event that my nephew, LAWTON COWIE ROVEGNO, fails to survive me by thirty (30) days, then I give, devise and bequeath all the rest, residue and remainder of my estate to EVELYN ROVEGNO. II SAIDlS, GUIDO & MASLAND 26 W. High Street Carlisle, P A FOURTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in his absolute discretion: A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe for stocks, bonds, or other investments. C. To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such terms as my personal representative in his sole - 2 - SAIDIS. GUIDO & MASLAND 26 W. High Street Carlisle, P A discretion may deem wise without the necessity of obtaining any court approval thereof; F. To make distribution hereunder either in cash or kind, as my personal representative in his discretion may deem wise. SIXTH I do hereby nominate, constitute and appoint my nephew, LAWTON COWIE ROVEGNO, to act as Executor, of this my Last Will and Testament. Provided, however, that if he is unwilling or unable to act as Executor, I direct the duties of Alternate Executor, be performed by RICHARD L. ROVEGNO. SEVENTH I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, JEAN COWIE HUGHES, have hereunto set my hand and seal to this my Last will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for identification, this jiPl51. day of /'1..rcl. , 199~. (~~l ~,/7d~/;~) J)an Cowie Hughes / Signed, sealed, published and declared by the above-named Testatrix, JEAN COWIE HUGHES, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our SAIDlS, GUIDO & MASLAND 26 W. High SI reet Carlisle, PA r i said Testatrix and of each other. names at her request as witnesses thereto, in the presence of t'l~.~ I C- IJ.' , -I r:!'i-cz-.- L . v t-lk ADDRESS ADDRESS d~ tv. H:JI, Jt- w.-Io Ie /-'4 17M3 7 ~ tU Li-;:;l g/-' , C(l/~ ,/4,70/3 I SAIDIS, GUIDO & MASLAND 26 W. High Street Carlisle, P A I I I COMMONWEALTH OF PENNSYLVANIA: \ COUNTY OF CUMBERLAND I We, JEAN COWIE HUGHES, ALBERT H. MASLAND and JOAN E. WILK, SS the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last will and Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Y'/J (~~CVW tP . . ,7~lU. Jean:Cowie Hughes / 4<J~~ Alb H. Masland, Witness / (: tf) J!/ J Wilk, Witness Subscribed, sworn to and acknowledged before me by JEAN COWIE HUGHESA, the Testatrix, and subscribed to and sworn or ffirmed to before me by ALBERT and JOAN E. WILK, H. MASLAND Nb Y( ~\ , 1992. itnesses, this ll" +~I day of NOTARIAL SEAL M!C~E!H l. LANDIS, No'ary Poblic Carlisle 8.:;(0, Cun-;:';:;r]<lnu County, Pi). My Comm;ssion Expires April 25, ] 994 ~()1 ~d\J.tll <j(iincL~) Notary Public ZZZ9-EvZ (LIL) 3NOHd EIOLI 'VNN3d '3,SrnIV:) .L3mnS HDIH . M. n 09, XOH '0 'd ONV'lSVW W omnn 'SImvs S3:) Idd 0 M. V, S3H:xJH :;IIMXl N'iIlli' dO .LN:;IW\fJ,S:;I.L CIN'if 'I'IIM JB,1'1 CLAIM J/-!Jcl- (PC)J No........................................................ .............. ESTATE OF Deceased ...... ...'f!)<:r:?:?t...-.... .~....................................... .......... Notice of claim by..r!.~..~...4............................ ........................................................................................... In the amount of $... R?.f t. ??:?............. ............... ............ ......, filed pursuant to Section 3384, Probate, Estates and Fiduciaries Code Laws of1972, Act No. 164 effective July 1, 1972, as amended. Name and address of Attorney: CLAIM ESTATE OF ...fl.~""'~"''''''''''''''''''''''''} c:1/~(J;)- 1.,9/ No.......................................... Notice of claim by.~...~...~K.............. in the amount of$ .:Y..f.f.:.~:f.:...................:::::JF6ed pursuant to section 3384, Probate, Estates and Fiduciaries Code Laws of1972, Act. No. 164, effective July 1, 1972, as amended: Date..~..!~,..':"!:.~11. d- TO THE CLERK OF THE COURT DIVISION: ~....I"r~ '" ~lJ ~ /CjC Enter the claim of ...Y.f(f.0:!-:.~.~V....... ... ......... ............................................................ ............ ..... .c!..f...~....~...-K.:..........:~I~.~~~~....?4!!!~....../:1..../.1.(!.?y..:............ intheamountof$.~..~.q...~..~~.~..~.~.r~ against the above entitled Estate. The decedent. who resided at .Jt!Zk.4i:..!!?~........... ................ ..7~t!...?!/~..~.~.)...l!.~..!?4......l?di~3......................... died on .~.../.i{;..ol..l?c:.~............. Written notic<:~isaid claim was given to~..~~.~...................... ............ ........ at.N'!.~..~.~~..Q~;t~~.~~:.I~....~...~~...~.t!.d-- The basis of aforesaid claim is as follows: (Itemize fully to enable personal representative to make proper investigation). ' aLL ~~ ~~ -d ~ ~iduLv ~./UV--cUd ~ ~ ~ ~&z ~~~ Claimant's counsel ~&...n..~:............... /7. '-- "" .I'd ~Sti>w '7lL .UW:w:1t;I!d<<.,(im . ..(f..... ./?:~~~~;........J........~jJm.).I?A..!7!!.7.i ..c:M...~..~~...~ /J!-- (address) / 7,1 7 t/ "j t_.: i-n [ n '" '" n '" it< o i:1 " ~ ~ o o -j o );! r (fJ 1 ~. S? ~ ~ ~ \ ~ 0"-. -.D ~ ~ o o ::: 'I; I-' ',,, en ~. --- 'ii!!: ~ filil: 211m! t"l '" = ... 5. = 5" rJQ t"l ., ;1 ~~ --... '""= ~'" .... => => ... ?:~ g~ z: '"""" 4: U1 )>r QCI lJlP6i.. . ,tn: o t11', o ;q, t"l ~ s:: tXl t"l ~ Z ~ t"l o t"l t"' t"l ~ o "'l t"l o ~ ::l [Jl ,.f ~, ~rF~ ~ T~~ \ ~ ~ ~ r t t ~~ "- ::;:(fJ ~.J ~~~~ --0 ~ ~ :1>_ .:'II ~ro ~s -J<Il ~- ~ ~ i '2 ~ ~ 6j - ne()l)n~t L.Efi . )';i~'" .~! :' f" 4>..0; ....;'~.\Z.. ',:.1"'-' \.. '''1' I' \ .,,-~) .1'1'\" I ' 1 .W':I: y .::,. '" " t ~!",-:,,-: I 1';<'" """ .',.tA" ".1 ... .'Y(' \ \ .... ~ , 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 NAYLOR TRICIA 0 104 S HANOVER STREET CARLISLE, PA 17013 nnuu fold ESTATE INFORMATION: SSN: 145-40-5324 FILE NUMBER: 2102-0691 DECEDENT NAME: HUGHES JEAN C DATE OF PAYMENT: 09/12/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/13/2002 NO. CD 001612 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $38,600.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: TRICIA 0 NAYLOR CHECK# 5 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $38,600.00 MARY C. LEWIS REGISTER OF WILLS ~DNTINVING "'AtJ' 28 South Second Street Newport, PA 17074 717-567-2147 717-567-6008 Fax C/ ~ RELEASE OF CLAIM :)/-u,~ -Gq / KNOWN ALL MEN BY THESE PRESENTS, that we, CONTINUING CARE RX, have received from the Estate of Jean Hughes, payment in the amount of $ 248.65 representing payment in full of the claim f1!ed against said estate, and I do therefore, hereby remise, release, quitclaim and forever discharge the Estate of Jean Hughes, her heirs, executors and administrators of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or of any other act, mater, cause of thing whatsoever. CONTINUING CARE RX. fuJU Qx By: WITNESS: Date: f-2j-(Jd. Specialist in Institutional Pharmacy Services J CERTIFICATION OF NOTICE UNDER RULE 5.6Ia) Name of Decedent: Jean Cowie Huqhes Date of Death: June 13, 2002 Will No. 2002-00691 Admin. No. 21-02-0691 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on September 16. 2002 Name Address Lawton C. Rovegno 514 Biddle Dr. Carlisle. PA 17013 Richard L.Rovegno 112 Srping Farm Circle, Carlisle, PA 17013 The Maryland School for the Blind 3501 Taylor Ave. Baltimore, MD 21236 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: September 16, 2002 ",.~ Name Tricia Naylor Address 104 S. Hanover st. Carlisle, PA 17013 Telephond71 7) 243 - 7 4 37 Capacity: _ Personal Representative ~Counsel for personal representative /,/--, , / , /- ,/ \/ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG I PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR OISALLOWANCE OF OEOUCTIONS AND ASSESSHENT OF TAX TRICIA NAYLOR J OSZUSTOWICZ 104 S HANOVER CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-31-2003 HUGHES 06-13-2002 21 02-0691 CUMBERLAND 101 LAW OFC ST '* REV-1547 E~ AFP !Ol-OS> JEAN C Amount Remitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... RE-li=is4i-EX--Aiip--[oFo:3rNOYicE--O,,-i-NHEifii'ANC"irTAic-APjiRA-isEiiENT~--ALUjWAN-CE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HUGHES JEAN C FILE NO. 21 02-0691 ACN 101 DATE 03-31-2003 TAX RETURN WAS: (X I ACCEPTED AS FILED I CHANGED NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS' .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 263,168.31 X 15 = 39,475.25 1191= 39,475.25 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule BJ 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule FJ 7. Transfers (Schedule GJ 8. Total Assets (II (21 (31 (41 (51 (61 (71 .00 17.360.26 .00 .00 264,621.18 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule HJ 10. Debts/Mortgage Liabilities/Liens (Schedule IJ 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (91 llOI 12,787.64 1.025.49 (Ill 1121 1131 1141 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax paYlllent. 281,981.44 1:\.813 13 268,168.31 5,000.00 263,168.31 . rAYM.N' l+' AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-I 09-12-2002 CDOO1612 1,973.76 38,600.00 TOTAL TAX CREDIT 40,573.76 BALANCE OF TAX DUE 1,098.51CR INTEREST AND PEN. .00 TOTAL DUE 1,098.51CR * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL OUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I ~/.- OJ . (PCj{ AGREEMENT TO INDEMNliif, ~EjPr,ANb1lliLEASE THIS AGREEMENT, by and among L\iWton Cowie Rovegno, Executor of the Estate of Jean Cowie Hughes Deceased and Lawton Cowie Rbvegno. WHEREAS, Jean Cowie Hughes died June 13, 2002, testate, a resident of Cumberland County, Pennsylvania; and WHEREAS, the Last Will and Testament of Jean Cowie Hughes dated March 16,1992, was duly probated in the Office of the Register of Wills of Cumberland County, Pennsylvania as appears of record at Number 21-02-0691 (a copy of the Will is attached hereto and marked Exhibit A); and WHEREAS, Letters Testamentary were issued to Lawton Cowie Rovegno on August 2, 2002; and WHEREAS, said Executors have du1y administered the estate according to the laws of the Commonwealth of Pennsylvania; and WHEREAS, in SECOND of her Will, decedent directed Executor to give, devise and bequeath her estate as follows: C. All the rest, residue and remainder of her estate to her nephew, LAWTON COWIE ROVEGNO, absolutely and in fee simple ifhe survives her by thirty (30) days. WHEREAS, Lawton Cowie Rovegno has been furnished with a complete listing of the estate assets, receipts and disbursements; and WHEREAS, it is the desire of the parties to this Agreement that final distribution ofthis estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting. NOW, THEREFORE, in consideration of the mutual promises, covenants and agreements recited herein, the parties do agree as follows: 1. Lawton Cowie Rovegno does hereby release and forever discharge Lawton Cowie Rovegno, Executor, from any and all liability which he had or may have or which may from time to time arise in connection with his service as Executor ofthe Estate of Jean Cowie Hughes, Deceased, and hereby authorize and request the Orphans' Court Division to charge the same against their shares of said estate, and in consideration for said distribution, hereby agree to refund any amounts so distributed which may be required to fully discharge any tax liability of the estate, debts of the decedent, or administration expenses. 2. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, executors, administrators and assigns. This Agreement shall be governed by the laws ofthe Commonwealth of Pennsylvania. DATED this 5"'" da f ^ , .....l... _ yo '"'v~ U:OI ,2003. 1Il..-e. Witness L~ Ie ..~-J-CM/~a~&\lr Lawton owie Rovegno Exe tor ~ txt~ ~\...- ~ ~ Witness c;f."q ~- C~_ K&v~.r.-<() Lawton Cowie Rovegno, Beneficiary COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-0691 .-------.--------------------------------------------------------------------- ESTATE OF JEAN COWIE HUGHES, DECEASED Late of Carlisle Borough, P A --------------------------------------.--------------------------------------- FAMILY SETTLEMENT AGREEMENT AND RELEASE OF LAWTON COWIE ROVEGNO, EXECUTOR Date of Death: June 13,2002 Letters Granted: August 2, 2002 First Complete Advertisement of Grant of Letters: August 29, 2002 Account stated to July 25, 2003 John C. Oszustowicz, Esq. 104 South Hanover Street Carlisle, PA 17013 (717) 243-7437 ..-:~,~~-- LAST WILL AND TESTAMENT OF JEAN COWIE HUGHES ii I, JEAN COWIE HUGHES, of South Middleton Township, 'i 1\ Cumberland County , Pennsylvania, being of sound and disposing !i ~mind, memory and understanding, do hereby make, publish and 'i ~declare this as and for my Last Will and Testament, hereby " "~l \~ ~~ " , \ ,\ , '\ .' " ~) SAIDIS. GUIDO & MASLAND 2fl W. High Street Carlisle, PA ;; revoking all other Wills and Codicils heretofore made by me. !I I, I, Ii I II Ii ,i Ii last illness II . tl '; conven~en y FIRST I direct the payment of my just debts and expenses of my and funeral from my estate as soon after my death as may be done. ~ '.j I: , SECOND .~ \. 0'\, 1: I' Ii ,I :i i' ii, I give, devise and bequeath my estate as follows: A. The sum of Five Thousand ($5,000.00) Dollars unto the MARYLAND SCHaar, FOR TilE BLIND in the name of Patricia Denise Messman. B. My grandfather clock to RICHARD L. ROVEGNO. C. All the rest, residue and remainder of my estate tc my nephew, LAWTON C01~n: ROVEGNO, absolutely and in fee \1 I Ii II ii In the event that my nephew, LAWTON COWIE ROVEGNO, fails to ~survive me by thirty (30) days, then I give, devise and bequeath :la11. the rest, residue and remainder of my estate to EVELYN II ;iROVEGNO. :1 simple if he survives me by thirty (30) days. THIRD 'I\II'~' ana all inheritance, estate, and transfer I II taxes imposed upon my estate passing under this Will or otherwise , ~shall be paid out of the principal of my residuary estate. , ,) ~ ~~ \,j ',' J':"<" FIFTH In addition to the powers conferred by law, I authorize any II personal representative acting under this instrument, in his II 'i 'I absolute discretion: :1 \~ I '.. I ~ , ,J \1 \'. II ": II ~ 'I >.~j...il. \ ) I "" I \ ' , , " . ',\ J! \', , \1 II I: II Ii I' I' ,I " " Ii SAmIS. Gumo II i! ,," MASLAND _'f, w. High Streel Carlisle, PA A. To retain in the form received, or to sell either at public or private sale any real or personal property; B. To exercise any options to subscribe for stocks, bonds, or other investments. C. To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms , i I, II I ,I [i ,\ " as my personal representative, in his sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; E. To make settlements and compromises on such terms as my personal representative in his sole - 2 - \ jt:, ,,,,f.:,'j,.. ,: ;~:y~\t.+::f;~}', make distribution hereunder either in cash or kind, as my personal representative in his discretion I I I may deem wise. SIXTH Ii q " I do hereby nominate, constitute and appoint my nephew, I: :1 LAWTON COWIE ROVEGNO, t.o act as Executor, of this my Last Will Iland Testament. Provided, however, that if he is unwilling or \i ~unable to act as Executor, I direct the duties of Alternate ii Executor, be performed by RICHARD L. ROVEGNO. SEVENTH , i; ~ I direct that no personal representative, guardian, trustee II ,or other fiduciary appointed under this instrument shall be ~AlDIS, GUmO "" MASLAND ~6 W. High Street Carlisle, PA ~required to give bond for the faithful performance of their ~duties in any jurisdiction. " II IN WI'l'NESS WHEREOF, I, JEAN COWIE HUGHES, have hereunto set II hmy hand and seal to this my Last Will and T~stament, consisting ~Of three (3) typewritten pages, the first two (2) of which bear Imy signature in the margin for identification, this /IP~ day of Ii /'1A-rcf. , 199:;J.. \1 II ii !I ilTestatrix, JEAN COWIE HUGHES, as and for her I,ast will and ~Testament in the presence of us, who have hereunto subscribed our ..---/' F" -0' /c / ,:...v.lA 7 . ,'7/JJiZ ..<J/ Jean Cowie Hughes I // Signed, sealed. published and declared by the above-named ??~~U' . ;tfc>- f: !Jd \ 1I11S, GUIDO , MASLAND \\' I-li!!h SUCCI CHlisle, PA ADDRESS ~(, lv, lIy" Jt. CtJ",/o I~ /Jd- 17M3 7C, 0 Ii:J;l ~- (lr~ ,/4r70/3 - I ADDRESS ,\mIS. GUIDO & MASLAND .'(, w. High Street rarlislc, PA ..,,"." COMMONWEALTH OF PENNSYLVANIA: SS We, JEAN COWIE HUGHES, ALBERT H. MASLAND and JOAN E. WILK, I; " I' ,I Ii ii , i' il I' " i! J I I, I' 'i Subscribed, sworn to and acknowledged before me by JEAN ICOWIE HUGHESA, the Testatrix, and subscribed to and sworn or laffirmed to before me by ALBERT H. MASLAND and JOAN E. WILK, I~"itnesses, this )L, +~I day of M(",~c~\ , 1992. 'I I, iI il !i II "-0' "~1 ( ,( , Ildluc~ ~crA, tI(A,n(L~) Notary Public NOTARIAL SEAL MICHEUE L LANDIS, Notary Public Carlisle Boro, Cum!nrlilnd County, Pa. My Commission Expires April 25. 1994 .. FAMILY SETTLEMENT AND FINAL RELEASE ESTATE OF LESTER A. SHEAFFER KNOW ALL MEN BY THESE PRESENTS, that Lester A. Sheaffer, late of Mount Holly Springs Borough, Cumberland County, Pennsylvania, deceased, died testate on August 11, 2003, having first made his Last Will and Testament, which was duly executed on October 30, 2001 and probated in the Office of the Register of Wills of Cumberland County, August 21, 2003. WHEREAS, the said Lester A. Sheaffer, by the aforesaid Last Will and Testament, named James M. Sheaffer as Executor 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, Pennsylvania, to the said Executor, hereinafter called personal representative; WHEREAS, the personal representative has gathered the assets of the Estate of the said decedent and the assets consist of personal and real property with the total value of $5,820.00 as set forth in Exhibit "A", which is a copy of the Pennsylvania Inheritance Tax Return filed and approved by said personal representative, and which is attached hereto and made a part hereof, and marked Exhibit "A"', ~, WHEREAS, the debts and deductions, including the payment of-inheritance tax L. -l in the said Estate, which have now been paid, leave a balance fOf0distribution of ITi $1,759.11, also as set forth in the statement of said personal representative, which is attached hereto and marked Exhibit "B"; ---I WHEREAS, the balance for distribution as shown in the said statement marked Exhibit "B" has been reduced to cash and has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the said Decedent; NOW, THEREFORE, James M. Sheaffer, Virginia Russell, Margaret Simon, Connie Bierman, Norma Jean Simpson and Richard Sheaffer being all of the heirs under the Last Will and Testament of the said decedent, and being those persons entitled to inherit under said Last Will and Testament, do hereby each of us acknowledge that we have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sums of money, legacies, v- J bequests, and devises as are given, devised and bequeathed to each of us respectively by the said Last Will and Testament, the amounts due us under said Last Will and Testament, which amounts we have received this day or prior to this day; and, each of us do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we 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 they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge the said personal representative, James M. Sheaffer, his heirs, executors, administrators and assigned, of and from the said estate and from all actions, suits, payments, accounts, reckonings, 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 each of us 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, we and each of us do hereby covenant and agree with each other and the aforesaid personal representative, that we will contribute pro-rata our share of the Estate to 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, we have hereunto set our hands and seal the day and year noted below. 9-'lJ3'O~ Date Lj,i~D~[h Witne lkfi C.c/t1W l2.. At... . 1\ ./ (Ja~es Sheaffer . Date Witness Virginia Russell Margaret Simon Date Witness Connie Biermann Date Witness Date Witness Norma Jean Sampson Date Witness Richard Sheaffer ~cj bi~ ~ \-OeM) r~~ O'YL 9-';' 3- O'l elur:!..~~ NOTARIAl SEAL CHERYL 0 SMITH. Notary I'1Jbllc Mt Hotly Springs Boro~Oh, Cumberland Co. My Commission ExpIres Feb. 1 a, 2(){)6 , IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date q/21/01l ~ Witness Jlima itness K-ajJ ff ~ ,D IWT ARIAL SEAL . R'R~~IA A BREWBAKER, NOTAiWAJ8t!il!> Carlisle Boro, Cumberland County My Commission Expires Aprit 4, 2005 Date Date Date Witness Witness Witness James Sheaffer ;<:V..,lr Rw.v.J5? QQ Virgini ussell Margaret Simon Connie Biermann Norma Jean Sampson Richard Sheaffer IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Date /0- 20 .O'{ Date Date Date Date Witness ~tness 'i / " };~I/;(d~r~ Witness Witness Witness Witness James Sheaffer Virginia Russell /!1 /l~~ J/~ Marga t Simon Connie Biermann Norma Jean Sampson Richard Sheaffer IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. James Sheaffer Date Witness Virginia Russell Date Witness /~b')Ju<( Date Witness Margaret Simon ~~L<([iW11~~~. . .. v '#..6 Date Date Witness Norma Jean Sampson Richard Sheaffer Date Witness IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer Date Witness Virginia Russell Date Witness Margaret Simon Date Witness imw~ Witness Connie Biermann )() -/'1- oc) Date )7f7fl1C1go~ ~ IlIiorma Je n Sampson Date Richard Sheaffer Witness IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer Date Witness Virginia Russell Date Witness Margaret Simon Date Witness Connie Biermann Date Witness Norma Jean Sampson lo/--;/oL/ Date /~ JJ~ Witness COHHONWEAL~H OF PENNSYLVANIA DEPARrHENT OF REVENU~ BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE' AND TAXPAYER RESPONSE FILE' NO. 21 03-0691 ACN 03143951 DATE 11-27-2003 REV-IHJ E~ AFP 109-00) EST. OF LESTER A SHEAFFER 5.5. NO. 204-03-9406 DATE OF DEATH 08-11-2003 COUNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF . JAMES M SHEAFFER 18 FAIRFIELD ST MT HOLLY SPRING PA 17065 } a EXHIBIT A REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth ~f P...m.syr-,;;::;;:d.i:._ Quc:;:~!ens ::::1:" !:l~ SnSW3f"2::i b~ co!.lir:g (717) ?!!?'-S327. COMPLETE PART 1 BELOW Account No. 5140191008 l( l( l( SEE Date Established REVERSE SIDE FOR 03-21-2002 FILING AND PAYMENT INSTRUCTIONS PART [!] 20,331. 65 50.000 10,165.83 .045 457.46 TAXPAYER RESPONSE iii!i!!R~:~~~II!fi~~::!!l~~~~~fi:f~f~~~:,:!:l~~,~~~f!f!!~~ii::~fm~~~,~~:~~~:ii!,~~J!!:!,~~~~~~~~~:!:!~~~~l'!1:if:~I!!ffm~~i!'fj~~~:~~~f!!:'!' Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x To insure proper credit to your account, two (2) copies of this notice must accompany your paynent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax [CHECK ] ONE BLOCK ONLY A. D The above inforlJlation and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or YOU may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. c=J The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ~ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 0 and/or PART 0 below. If you indicate a different tax rate} please state your relationship to decedent: PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART @] TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation] , $ Under penalties of perjury) I declare that the facts I have reported above are true} correct and complete to the best of my knowledge and belief. HOME ( WORK ( TELEPHONE ) ) NUMBER DATE TAXPAYER SIGNATURE Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Sheaffer, Lester A. , Deceased No. 21 - 03 - 00691 Date of Death 8/11/2003 Social Security No. 204-03-9406 also known as James M. Sheaffer The Personal Representative(s) olthe above Estate, deceased, verify thatthe nems appearing in the following Inventory include all of the personal assets wherever snuate and all of the real estate located in the Commonweallh 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 Decedenfs death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penallies of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Personal Representative . 011 ~ Signature: ~./ Th-. -4V'ISO J es M. Sheaffer Signature: Attorney: Ga1en R. Waltz I.D. No.: 39789 Signature: Address: 28 S. Pitt SI. Carlisle, P A 170 \3 Address: 18 Fairfield Street MI. Holly Springs, Pa 17065 Telephone: 717/245-9688 Telephone: 717 486-8053 Dated: {/JID/O~ , , ~ Personal PrODertv Cash 5,320.00 1991 Ford, VINNo. IFAPP36X7MK123696, 500.00 Total Personal Property $5,820.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate $5,820.00 .' Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Sheaffer, Lester A. , Deceased No. 21 - 03 - 00691 Date of Death 8/11/2003 Social Security No. 204-03-9406 also known as James M. Sheaffer The 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 located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposne each nem of said Inventory represents its fair value as of the date of the Decedenfs death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unswom falsification to authornies. Personal Representative on ~ Signature: ~/ ~. .-4V'\.Q; J es M. Sheaffer Signature: Attomey: Galen R. Waltz I.D. No.: 39789 Signature: Address: 28 S. Pitt St. Carlisle, P A 17013 Address: 18 Fairfield Street Mt. Holly Springs, Pa 17065 Telephone: 717/245-9688 Telephone: 717486-8053 Dated: ff/ID/O'-? , , - Personal ProDertv Cash 5,320.00 1991 Ford, VINNo. IFAPP36X7MK123696, 500.00 Total Personal Property $5,820.00 (Attach addnional sheets if necessary) Total Personal Property and Real Estate $5,820.00 REV-'.OOEX+(UDl *' G REV-1500 OFF!CIAL USE ONLY COMMONWEALTH OF PENNsYLVANIA INHERITANCE TAX RETURN FILE NUMBER DEPARTMENT OF REVENUE RESIDENT DECEDENT 21 03 00691 DEPT 280601 - HARRISBURG, PA 17128-0601 COUNTY CODE YEA" NUMBER -- .. DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Sheaffer, Lester A. 204-03-9406 ~ z DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATEWlTH THE w c w 081lI/2003 08/201l922 REGISTER OF WILLS u w C (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ,. Original Return 0 2. Supplemental Return 0 3 Remainder Return (date of death prior to 12-13-82) w ~ 0 4. limited Estate 0 4.. Futuro Interest Compromise (dale of death after 0 5. Federal Estate Tax Return Required ~S'U) u~~ 12-12-82) W~U 0 0 zOO 6. Decedent Died Testate (Attach copy 7. Decedent Maintained a living Trust (Attach 8. Total Number of Safe Deposit Boxes u~~ ~m of 'Mill) copy of Trust) - ~ ~ 0 9. litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A) (Attach 8ch 0) 12-31-91 and 1+95) lliISSECi10lltNlUST,BECONlPLETED;ALLCORRESPONDENCE:AND:CONFIDENTIAL TAXJNFORMATIONSH.OU~[),BE DIRECTED TO: AME COMPLETE MAILING ADDRESS ~ Galen R. Waltz z w IRM NAME (If applicable) 0 28 S. Pitt St. z Turo Law Offices 0 ~ Carlisle, PA 17013 ELEPHONE NUMBER 717/245-9688 I ,. Real Estate (Schedule A) (1) None OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) None 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None - 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 5,820.00 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 10,165.83 o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None (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) (8) 15,985.83 (9) (10) 13,922.57 1,612.52 11. Total Deductions (total Lines 9 & 10) (11) 15,535.09 450.74 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 450.74 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 450.74 .045 (16) 0 16,Amount of Line 14 taxable at lineal rate x ~ ~ ~ " ~ 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) ~ 19. Tax Due (19) 20.28 20.28 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. :":;>*"6'E:;S,QIl"g:;f9<~..s~::'~lij~Q~$tlq~~,:Q'N}'R~~~SE!srD~-::ANjjJiE~HECK.MArH<< Copyright 2000 fonn software only The Lackner Group, Inc. Fonn REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 18 Fairfield Street ~-- CITY I STATE Pa I ZIP.-17065 Mt Holly Springs Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 20.28 1.01 Total Credits (A + B + C) (2) 1.0 I 3. Interest/Penalty jf applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 19.27 (SA) (5B) 19.27 Make Check Payable to: REGISTER OF WILLS, AGENT 3. Did decedent own an Kin trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..u..................hh...............h...........................h...................... ..................... 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;.. ...............................................h..... ~ I~ b. retain the right to designate who shall use the property transferred or its income;.......... ................... c. retain a reversionary interest; oru.......................................... ............................... ..................................... d. receive the promise for life of either payments, benefits or care?.........................................m ................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................ ............ .............u.......................................... 0 o o ~ ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penanies of petjwy, I declare that I have examined this return, including accompanying schedules and statements, and to tha best of my knowledge and balIef, it is true, correct and complete. Declaration of pmparer other than tha per$(lflal representativa is based on all infonnatlon of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FO FlUNG RETURN ADDRESS James M. Sheaffer DATE 18 Fairfield Street Mt. Holly Springs, Pa 17065 ADDRESS (J o , OATE ADDRESS 28 S. Pitt St. Carlisle, P A 17013 I ~ ! I II! ~1Ii1 _____ - - -lIlI!"'''''I! 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) (ill. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements fordiscJosure of assets and filing a tax return are still applicable even if the surviving spouse is the onty 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 ofthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.s. ~9116 1.2) [72 P.S. ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. *' I Ie SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COWMONWEAL TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sheaffer, Lester A. I FILE NUMBER 21 - 03 - 00691 Include the proceeds of Imgation and the date the proceeds were received by the estate. All property jolntiy-owned with the right of survivorshIp must be disclosed on schedule F. . ITEM NUMBER I Cash DESCRIPTION VALUE AT DATE OF DEATH 5,320.00 2 1991 Ford, VINNo. IFAPP36X7MK123696, 500.00 TOTAL (Also enter on Line 5, Recapitulation) 5,820.00 *' .~ .~~~ 1 SCHID.JLE H FUNERAL EXPENSES & All\IIINIS1RATlVE COSTS COIJMONWEALTH OF PENNSYLVANIA INHERrrANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sheaffer, Lester A. I FILE NUMBER 21 - 03 - 00691 , . Debts of decedent must be reported on Schedule I. - ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: I Hollinger Funeral Home and Crematory, Mount Holly Springs, Pa. 7,149.64 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State - Zip Year(s) Commission paid 2. Attorney's Fees Turo Law Office 3,000.00 3. Famity Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant James M. Sheaffer Street Address 18 Fairfield Street City Mount Holly Springs State Pa Zip 17065 Relationship of Claimant to Decedent Son 4. Probate Fees Register of Wills 84.50 Family Agreement 25.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs I The Sentinel, Executors Notice 88.43 2 Curoberland County Legal Journal, Legal Notice 75.00 TOTAL (Also enter on line 9, Recapitulation) 13,922.57 '. I ~ SCHEDULE F JOINTLY -OWNED PROPERTY ESTATE OF J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sheaffer, Lester A. I FILE NUMBER .. 21 - 03 - 0069] 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 James M. Sheaffer 18 Fairfield Street Son Mt l-lnl1v ."nnnO"<;: p~ 170h-'\ JOINTLY OWNED PROPERTY: ITEM LETTER DATE I" DESCRIPTION OF PROPERTY DATE OF DEATH %OF DATE OF DEATH FOR JOINT MADE Include name of financial institution and bank account number DECD'S VALUE OF NUMBER TENANT JOINT or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENTS INTEREST estate. 1 03/21/2002 PNC Bank checking accourrtNo. 5]40]9]008 20,331.65 500/, 10,165.83 TOTAL (Also enter on line 6, Recapitulation) 10,165.83 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COI\lMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RElURN RESIDENT DECEDENT I FILE NUMBER 21 - 03 - 00691 ESTATE OF Sheaffer, Lester A. Include unreimbursed medical expenses. ITEM NUMBER I Met-ed electric bill DESCRIPTION AMOUNT 67.14 2 Central Penn Medical Group Emergency 18.22 3 West Shore EMS 1,527.16 TOTAL (Also enter on Line 10, Recapitulation) 1,612.52 REV.15" E"" ":'0) ',w d COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1" SCHEDULE J BENEFICIARIES Sheaffer, Lester A. I FILE NUMBER 21 - 03 - 0069] . RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 James M. Sheaffer, ] 8 Fairfield Street, Mount Holly Springs, Pennsylvania, Son Enitre estate! 17065 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet TI. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TOTA)( IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA DEP,',\,RTMENT'OF REVENUE BUREA'u 0" IND'IV'IDU~L TAXES DEPT. 280601 HARRISBURG, PA 17128-050, REV-'1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GALEN WALTER R ESQUIRE 28 S PITT STREET CARLISLE, PA 17013 - fold ESTATE INFORMATION: SSN: 204-03-9406 FILE NUMBER: 2103-0691 DECEDENT NAME: SHEAFFER LESTER A DATE OF PAYMENT: 11/10/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/11/2003 NO. CD 003214 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $19.27 I I I I I I I I TOTAL AMOUNT PAID: $19.27 REMARKS: GALEN R WALTZ ESQUIRE CHECK# 1154 SEAL INITIALS: JA RECEIVED BY: TAXPAYER DONNA M. OTTO DEPUTY REGISTER OF WILLS " Exhibit "B" Grave Lot 3 and 4 at Mount Holly Springs Cemetery Life Insurance for G. Sheaffer (beneficiary = Lester A. Sheaffer) Inheritance Tax Paid From Residue of Estate '. = $ 500.00 = $1,278.38 $ 1, 778.28 $ 19.27 $ 1,759.11 Paragraph 3 of Lester A. Sheaffer's Last Will and Testament provides that the "rest[.] residue and remainder ... in equal sheares to Margaret S. Simon, Vonnie Bierman, Norman J. Simpson, Richard D, Sheaffer, Virginia A. Russell and James M. Sheaffer." Distribution Margart S. Simon $293.19 $293.19 $293.19 Vonnie A. Bierman Norman J. Simpson Richard D. Sheaffer $293.19 Virginia A. Russell $293.19 $293.19 James M. Sheaffer EXHIBIT l~ STATUS REPORT UNDER RULE 6.12 n J v.\.r j~ -, Name of Decedent: Jpnn C f-lu9-he S -ZOO 2.. Date of Death: ,J\l nf' J~ I Will No.: 2.002... - GOinG) I Admin. No.: 2/ -07 -O(oq I Pursuant to Rule 6.12 ofthe 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 D?J No 0 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 l( No 0 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 G No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this repon. Date: ~ )03 si~~~;1 ,John C Oc,7UStoW iCZ. Name InL\ S HnnO\lE'f st I r'nrl.15Je Address 2L\3.,L\3, Telephone No. Capacity: L 1 Personal Representative !Xl Counsel for personal representative . RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Orphans Court Hanover and High Street Carlisle, PA 17013 Receipt Date Receipt Time Receipt No. 8/05/2003 11:05:10 1022353 HUGHES JEAN COWIE File Number 2002-00691 Remarks JOHN C OSZUSTOWICZ, ESQ. JA ------------------------ Distribution Of Receipt ------------------------ Transaction Description Payment Amount Payee Name RELEASE 25.00 CUMBERLAND COUNTY GENERAL FUN Check# 16 Total Received......... $25.00 $25.00 oJ::i2~...:-t