HomeMy WebLinkAbout12-29-05
REV-' 500 EX (6-00)
REV-1500
OFl:IC1AL USE ONLY
FILE NUMBER
~L-~S- ~~~Z~
COUNTY CODE
YEAR
NUMBER
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SOCIAL SECURITY NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
COLLINS) :TAMeS L.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
03 -/, - ,200S 0:1. -Itf -/9iZ8
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
J'1l / A
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (dateofdeathpnorto 12-13-82)
o 5. Federal Estate Tax Retum Required
I 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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!Xl 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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NAME (J HAil t. ES IF". SIIIl:F ~ l:> S ff
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COMPLETE MAILING ADDRESS
~ C L 0 L( J€/{ leA
IJIE(!.HA-A/ICSSU/eG-.., P/I- /7osr
FIRM NAME (II Applicable)
TELEPHONE NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
~ 131,000. DO
., J.f,f'1.53
- 0
" J :1.,000. 00
f- 8'0. 2.09. Sf
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(1)
(2)
(3)
(4)
(5)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
(6)
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)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(9)
(10)
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14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax /)- X .0 .Q.....
rate, or transfers under Sec. 9116 (a)(1.2) (15)
16. Amount of Line 14 taxable at lineal rate f ~(}{q, 7~9.29 x.O~ (16)
17_ Amount of Line 14 taxable at sibling rate -0 x .12 (17)
18. Amount of Line 14 taxable at collateral rate -0 x .15 (18)
19. Tax Due (19)
20.0
CHECK ;iERE F 'SU ARE ~EQUEST'NG ;. KEF'JND JF ..N JVERPAY'V1ENT
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OFFICIAL USE ONLY
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(11)
(12)
(13)
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Decedent's Complete Address:
STREET ADDRESS I 3 Lv t:s L. .... b r~/ v c;
CITY
STATE
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mEeN/f-lf//e s $u'€~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
, J I :lfa7. S"'D
~ 38~.S'D
Total Credits ( A + B + C )
(2)
'17, 'SO.o"
3.
Interest/Penally if applicable
D. Interest
E. Penally
(3)
(4)
(5)
(5A)
(5B)
o
()
4.
Total Interest/Penally ( D + E)
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 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
I:
ZIP /7osr
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f'.&'S2.81
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........ ............................. ............................................................... ...... .............. D
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
SON RESPON
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ADDRESS YH 1-1(
b-07 N. LF: '1S8E/lJt.Y
SIGNA):pj\E O~ PREPARER JHE THAN R
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ADDRESS CHA-A.1.155 Ef. ::'HIE'LDS I
(. CLOU"ioElt ~D" N1r:e,",AtJIC~"BU.~[;.. PA- I/OS:~
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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. 39116 (a) (1.1) (i)].
11osS"
DATE
J 2./19 /o~-
DATE
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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. 39116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 39116(a)(1 .2)J.
T~ 18x rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 39116(1.2) [72 P.S. 39116(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. 39116(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.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
. .
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005414
COBLE MARY ELIZABETH
507 N LEWISBERRY RD
MECHANICSBURG, PA 17055
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
__nun fold
101
$7,267.50
ESTATE INFORMATION: SSN: 175-22-4796
FILE NUMBER: 2105-0270
DECEDENT NAME: COLLINS JAMES L
DATE OF PAYMENT: 06/09/2005
POSTMARK DATE: 06/09/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 03/16/2005
TOTAL AMOUNT PAID:
$7,267.50
REMARKS: M E COBLE
CHECK# 1011
SEAL
INITIALS: VZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
REV-1502EX' (1-97)
ESTATE OF
SCHEDULE A
REAL ESTATE
J./-05- J.7o
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a wiiling buyer and a wiiling seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of
survivorshio must be disclosed on Schedule F.
ITEM
NUMBER
1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COLLINS, J'~h1E.s L.
FILE NUMBER
VALUE AT DATE
OF DEATH
rf
13/,000.80
DESCRIPTION
Rea.l EsfD.' Callsisnna 6P 0. IDr irnprDVuJ h~ it ciwell.'~ h>u~
1M L.ower R/ltll "(;,wnsh; fJ J Cu..tw\.laullMVi &u.i) Pe-IfIhQ. 'lJaM'na
att a.d.&.rt$S J 13Lf wesley 'Drive" MechttJ1;csbllC'1" PA I7l)s~
1J.Jt. of deo.~ valLee of. 11, 31, DOl) . 00 pt-"( app ra; SD.I of !nark
1-/; ~t. (See evpy D(- IL(Jpra;s41 (J. 1hlc.hed here"!;).
f :Inf"nno.lifJ"a! nole: $ti.;J fJ"()r""~ WItS 5ubJe.ff w.ut.J~
Sold t; Wfl.ynt (3. Heet-nt.r 9Vl Sept. 30, 200S, f;,r
~1'30, 000. oj) _ (see et>Py of. ec",f"rl'tlla deeJ tJAtJ seltl~~
Shee-f aftacJv.J ht.t.t.:tD f.,,. a.dd: t.OI1a{ perh'lIel1.t dala).
TOTAL (Also enter on line 1, Recapitulation) $ l3 I I oat). 00
(If more space is needed, insert additional sheets of the same size)
Mark E. Hilbert & Associates
05-110M1
FileNo.05-110M1
I
APPRAISAL OF
Summery Appraisal
LOCATED AT:
134 Wesley Drive
Mechanicsburg, PA 17055
FOR:
Charles E. Shields III Esq.
6 Clouser Road
Mechanicsburg, PA. 17055
BORROWER:
James Collins ESTATE
AS OF:
March 16, 2005
BY:
Mark E. Hilbert
MARK E. HILBERT & ASSOCIATES
219 East Main Street, Mechanicsburg, PA 17055 717-7664988/717-795-9301 Fax
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Mark E. Hilbert & Associates
UNIFORM RESIDENTIAL APPRAISAL REPORT
05-110M1
051 M
ProDertv escrlDtion File No. - 10 1
PrtiPertv Address 134 Weslev Drive Citv Mechanicsbura State PA liD Code 17055
Legal Description Attached County Cumberland
Assessor's Parcel No. 13240793103 Tax Year 04-05 R.E. Taxes $ 1832 EST Soecial Assessments $ None Noted
Borrower James Collins ESTATE Current Owner ESTATE Occuoant: I J Owner I Tenant I X I Vacant
II Property richts aOPraised Ix I Fee Simple I Leasehold I Proiect Tvpe I I PUD I I Condominium (HUDNA onlvl HOA$ /Mo.
Neighborhood or Proiect Name Windsor Park MaD Reference Census Tract 111
Sale Price $ Estate Date of Sale' Descriotion and $ amount of loan charaes/concessions to be oaid bv seller NI A
Lender/Client Charles E. Shields III Esa. Address 6 Clouser Road Mechanicsbura. PA. 17055
Appraiser Mark E. Hilbert Address 219 East Main Street Mechanicsbura PA 17055
Location U Urban ~ Suburban U Rural Predominant Single family housing Present land use % Land use change
Built up (RJ Over 75% o 25-75% 0 Under 25% occupancy PRICE AGE One family 76% (RJ Not likely o Likely
$ (000) (yr5)
Growth rate 0 Rapid (RJ Stable o Slow (RJ Owner 100 Low New 2-4 family 15% o In process
Property values 0 Increasing (RJ Stable o Declining o Tenant 275 Hiah 65 Mult~family 4% To:
Demand/supply 0 Shortage (RJ In baIanoe o O/gsuPJiy (RJ Vacant(0-5%) ~ Predominant 111 Commercial 3%
Marketing time n Under 3 mos. fXj 3-6 mos. n Over 6 mos. n Vacanl(over5%l 155 I 40 V. Land ) 2%
Note: Race and the racial composition of the neighborhood are not appraisal factors.
Neighborhood boundaries and characteristics: Subiect Property is located alona Wesley Drive in the development of Windsor Park Lower Allen
. Township, Cumberland Countv, Pennsylvania.
· Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, etc.):
~ Property has Qood access to employment and services. Churches ,Schools and Recreational areas are within a reasonable distance.
.
II
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.):
With the improvina markets the seller are not reauired to offer sales or financina concessions.Financina is readly available from a
variety of sorces.
Project Information for PUDs (If applicable) - - Is the developer/builder in control of the Home Owners' Association (HOA)? UYES lxJ NO
. 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 See Attached Deed Topography Basically Level
Site area 0.21 Acres Corner Lot U Yes lxJ No Size 0.21 Acres
Specific zoning classification and description Residential Shape Rectanaular
Zoning compliance (RJ Legal 0 Legal nonconnng (Grandfathered use) U Illegal o No zoning Drainage Appears adeauate
Hiahest & best use as improved: rXT Present use Other use (explain) View AveraQe
Utilities Public Other Off.site Improvements Type Public Private Landscaping Typical
Electricity (RJ 200 AMP Street Macadam (RJ 0 Driveway Surface Macadam
Gas o None Curb/gutter None 0 0 Apparent easements None apoarent
Water (RJ Sidewalk None 0 0 FEMA Special Flood Hazard Area U Yes lxJ No
Sanitary sewer ~ Street lights Yes (RJ R FEMA Zone II C " Map Date 09-30-77
Storm sewer Alley None II FEMAMap No. 421016-B
Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning, use, etc.): None Apparent
Subiect however to reservations easements, conditions and riaht of wav of record.
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION
No. of Units One Foundation Block Slab Part Area Sq.Ft. 546 Roof 0
No. of Stories Two Exterior Walls Brick I Vinvl Qav.l Space NO N E % Finished 50 Ceiling (RJ
Type (Det./Att.) Detached Roof Surface Composition Basement Part Ceiling Drvwall Walls (RJ
Design (Style) Spl/Lev/Av Gutters & Dwnspts. Aluminium Sump Pump Floor Drain Walls Drywall Floor (RJ
Existing/Proposed Existina Window Type ObI. Hung Dampness None noted Floor V Tile None 0
Age (Yrs.) 45 Storm/Screens ThermolY es Settlement None noted Outside Entry Yes Unknown 0
Effective Aae Yrs. I 8-12 Manufactured House No Infestation None noted
. ROOMS Fover Living Dining Kitchen Den F amilv Rm. Rec. Rm. Bedrooms # Baths Laundry Other Area Sa.Ft.
. Basement 1 PI Rm. 1 Storaae 546
.
Levell 1 Area 1 520
. Level 2 3 1 609
. Finished area above grade contains: 5 Rooms; 3 Bedroom sl; 1 Bath(s); 1 129 Sauare Feet of Gross Livina Area
. INTERIOR Materials/Condition HEATING KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE:
Floors Carpet I AVQ Type H. Water Refrigerator (RJ None 0 Fireplace(s) # _ 0 None 0
. Walls Drvwalll Ava Fuel Oil Range/Oven (RJ Stairs 0 Patio 0 Garage # of cars
Trim/Finish Wood I AVQ ConditionAva. Disposal 0 Drop Stair 0 Deck 0 Attached
Bath Floor CeramicTilel1 Ava COOLING Dishwasher (RJ Scuttle (RJ Porch 0 Detached
Bath Wainscot Fiberalass I AVQ Central Yes Fan/Hood (RJ Floor 0 Fence 0 Built-In
Doors Wood I Ava Other None Microwave R Heated R Pool R Carport 1
ConditionAva. Washer/Dryer Finished Drivewav 4
Additional features (special energy efficient items, etc.): Newer Roof, New Boiler, & Cent. Air Complete new kitcheb includina Appliances.AII new
reolacement windows.
Condition of the improvements, depreciation (physical, functional, and external), repairs needed, quality of construction remodeling/additions, etc.:
.
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 property:
Freddie Mac FD"m 70 6-93
PAGE 1 OF 2
Produced using ACt software. 800.234.8721 WWN.aciweb.com
Fannie Mae FD"m 1004 6-93
Valuation Section
Mark E. Hilbert & Associates
UNIFORM RESIDENTIAL APPRAISAL REPORT
05-110M1
File No 05-110M1
E:HIMATED !ITE VALUE. . . . . . . . . . . . . . . . . . . . . . . . . . . = $
ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS:
Dwelling 1,129 Sq. Ft. @ $ = $
Bsmt. 546 Sq. Ft. @ $ =
o
o
Comments on Cost Approach (such as, source of cost estimate,
site value, square foot calculation and for HUD, VA and FmHA, the
estimated remaining economic life of the property):
In the reproduction cost of improvements Marshall & Swift
Residential Cost Handbook and local contractors are
referenced.
.
=
: GaageJCapat _ Sq. Ft. @ $ =
: Total Estimated Cost New .. .. .. . .. .. ../.. = $ 0
Less Physical I Functional " External Est. Remaining Econ. Life: 42
· Depreciation I = $ 0
Depreciated Value of Improvements . . . . . . . . . . . . . . . . . .. = $
"As-is" Value of Site Improvements. . . . . . . . . . . . . . . . . .. = $
INDICATED VALUE BY COST APPROACH. . . . . . . . . .. = $ 0 Estimated remainina economic life is 30-35 vears.
ITEM I SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3
134 Wesley Drive 127 Winston Drive 1002 Apple Drive 120 Winston Drive
Address Mechanicsbur PA MechanicsburQ, PA Mechanicsburo, PA Mechanicsburo, PA
Proximity to Subiect ~ 0.70 Miles 1 Block
Sales Price $ ESTATE ~ $ 1 ':1..1 ann
Price/Gross Liv. Area $ 0.00 (tJ $ 81 .22 (tJ II
Data and/or C.P.M.L. C.P.M.L. C.P.M.L.
Verification Sources Inspection Inspection Inspection Inspection
VALUEADJUSTh'CNTS DESCRIPTION DESCRIPTION I +(-)$Adjustment DESCRIPTION I +(-)$Ad'uslmenl DESCRIPTION I +(-) $ Adjuslmenl
Sales or Financing DOM 2 : DOM 3 : DOM 2 :
Concessions Conventional: Conventional: Conventional:
Date of SalelTime 11-30-04: 02-25-05: 03-01-05:
Location Suburban Suburban' Suburban' Suburban I
Leaseho(j,feeSirole Fee Simple Fee Simple: Fee Simple: Fee Simple :
Site 0.21 Acres 0.19 Acres: 0.23 Acres: 0.19 Acres :
View Residental Residental: Residental I Residental'
Design and Appeal Spl/Lev/Av Spl/Lev/Av: Spl/Lev/Av: Ranch I Ava. :
QJaitvofCalshJctm Brick I Vinvl Brick I Vinyl: Brick I Vinyl: Brick :
AQe 45 Years 45 Years' 45 Years I 46 Years '
Condition Averaoe Average : Above Averaae: -4 000 Above Average :
Above Grade Total' Bdrms I Baths Total' Bdrms' Baths : Total I Bdrms' Baths : Total' Bdrms I Baths :
. Room Count 5: 3: 1.00 6: 3: 1.00: 6: 3: 2.00' -3,000 6: 3: 1-1'
. Gross Living Area 1,129 Sq.Ft. 1,661 Sq.Ft.: -5300 1,649 SoH.: -5200 1189 SqH. :
. Basement & Finished Part Part : Full : -1,000 Full :
Rooms Below Grade Fam.Rm. I P/Rm Fam.Rm. / P/Rm : Family Rm ' +1,500 Unfinished :
: Functional Utility Average Average : Average : Averaoe :
Heating/Cooling H.Water I ClAir Hot Air I None: +4,000 H. Waterl 1 Wall: +1,000 Hot Air-ClAir :
· Energy Efficient Items Averaae Averaae ' Averaoe : Average I
Garage/Carport 1 Carport Car Garage : -1 000 Off St. Parkino: +2000 Car Garaae :
.. Porch, Patio, Deck, None Patio : -1,000 Sun Room : -4,500 Sun Room :
Fireolace(s), etc. None None I Fireplace I -3 000 None I
Fence, Pool, etc. None None : None : Porch/Patio:
None None : None : None :
Net Adi. (total) + X - : $ 3'300MX - ' $ 16200lllllX _ '$
Adjusted Sales Price
of Comparable $ 131,600 $ 133 700 $
Comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc.): See Attached Addendum.
o
-4 000
-1,500
-1,000
+4 500
-1,000
-4,500
-3 000
10 500
129 400
ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3
Date, Price and Data None None None None
Source for prier sales NI A NI A NI A NI A
within yea of appraisal Owners Deed C.P.M.L,/Court House C.P.M.L,/Court House C.P.M.L ICourt House
Analysis of any current agreement of sale, option, or listing of the subject property and analysis of any prier sales of subject and oompaables within one yea of the date of appraisal:
The sales comparison approach carries the most weioht in determino market value as it is based on historical information and is not
as
INDICATED VALUE BY SALES COMPARISON APPROACH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
INDICATED VALUE BY INCOME APPROACH (If ADolicable) Estimated Market Rent $ NI A /Mo. x Gross Rent Multiplier NI A = $
This appraisal is made [R] "as is" U subject to the repairs, alterations, inspections or oonditions listed below 0 subject to oompletion per plans and specifications.
Conditions of Appraisal: The appraiser assumes a maretable title and that equipment associated with the improvement is in workino order
.
131 000
o
Final Reconciliation: The market approach reindorced by the cost approach is a oood indicator of fair market value. The fact that the seller is
or is not payino any portion of the closino costs has no effect on this appraisal.
. DATE OF DEATH MARCH 16 2005
. 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, oontingent
and limiting conditions, and market value definition that are stated in the attached Freddie Mac Form 439/Fannie Mae Form 1004B (Revised 6/93 ).
I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT, AS OF March .16 2005
· (WHICH IS THE DATE OF INSrZECTIO AND THE EFFECTIVE DATE OF THIS REPORT) TO BE $ 131 ,000 .
. APPRAISE~ . /"'a I' A A? " SUPERVISORY APPRAISER (ONLY IF REQUIRED):
Signature '''~CJIY, ".P'/a.,7 Signature DDid DDidNot
Name Mark E. Hilbert /,. - ~ f Name Inspect Property
Date Report Signed May 18 , 2005 Date Report Signed
State Certification # RL-000388-L State PA State Certification # State
Or State License # RB029755A State PA Or State License # State
Freddie Mac Form 70 6-93
PAGE 2 OF 2
Produced using ACI software, 800.234.8727 www.aciweb.com
Faooie Mae Form 1004 6-93
Mark E. Hilbert and Assoc.
.
I
Tax Parcel Number:
THIS INDENTURE
MADE THE
thousand and five (2005).
~rh
day of
(~~
, in the year of our Lord two
BETWEEN
MARY ELIZABETH COBLE, as Executrix of the Estate of JAMES L. COLLINS,
deceased, late of Lower Allen Township, Cumberland County, Pennsylvania, Grantor,
and
WAYNE B. HEEFNER, Dillsburg, York County, Pennsylvania, Grantee.
WHEREAS, the said James 1. Collins, was vested in his lifetime with title to the premises
hereinafter described, in Lower Allen Township, County of Cumberland and Commonwealth of
Pennsylvania; and
WHEREAS, the said James 1. Collins, departed this earthly life, testate, on the 16th day of
March, 2005, and Letters Testamentary were duly issued to the said Mary Elizabeth Coble, by the
Register of Wills of said Cumberland County, docketed to No. 21-05-0270; and
WHEREAS, the lands herein-mentioned were not specifically devised:
NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Mary Elizabeth
Coble, Executrix, as aforesaid, for and in consideration of the sum of ONE HUNDRED THIRTY
THOUSAND and No/100 ($130,000.00) DOLLARS, and other good and valuable considerations, to her
in hand paid by the said Grantee, at and before the ensealing and delivery hereof, the receipt whereof is
hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by these
presents, by virtue of the power and authority in her vested by the Fiduciaries Act of the Commonwealth
of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said Grantee, his heirs and
assIgns:
ALL THAT CERTAIN lot in Plan No.2, Windsor Park, Lower Allen
Township, Cumberland County, Pennsylvania, as shown on the survey dated January 31,
1959, by D. P. Raffensperger, R. S., more fully described as follows:
LOT 39, BLOCK "C". BEGINNING at a point in the southerly side of Wesley
Drive, a distance of two hundred forty-four and three-hundredths (244.03) feet west of
the southwest intersection of Wesley Drive and Royal Drive; thence south forty-five (45)
degrees twenty-two (22) minutes west, along the division line between lots forty (40) and
thirty-nine (39), a distance of one hundred nineteen and eight-hundredths (119.08) feet to
a point; thence north forty-four (44) degrees thirty-eight (38) minutes west, along the
division line between lots four (4) and thirty-nine (39), a distance of seventy-five (75)
feet to a point; thence north fOlty-five (45) degrees twenty-two (22) minutes east, along
the division line between lots thirty-nine (39) and thirty-eight (38), a distance of one
hundred eighteen and twenty-three hundredths (118.23) feet to a point in the southerly
side of Wesley Drive; thence south forty-five (45) degrees seventeen (17) minutes east,
along the southerly side of Wesley Drive, a distance of seventy-five and five-thousandths
(75.005) feet to a point, the place of BEGINNING.
UNDER AND SUBJECT, to the covenants, conditions and restrictions
contained in the Declaration of Windsor Park, Inc. and King Associates, Inc., dated the
- day of March, 1959, and recorded in the Office of the Recorder of Deeds in and for
Cumberland County, Pennsylvania, in Miscellaneous Book Page
ALSO, to the utilities easements and to a setback line offive (5) feet in the rear of the
property line, all of which will appear more fully at large in instruments filed in the said
Recorder's Office. UNDER AND SUBJECT TO restrictions as filed with said plan.
I
BEING those same premises which Graymor, Inc. by its deed dated the 21 sl day
of April, 1960 and recorded in the Recorder's Office aforesaid in Deed Book "U",
Volume 19, Page 80, granted and conveyed to James L. Collins and Patricia W. Collins,
his wife. The said Patricia W. Collins departed this earthly life on November 12,1997,
whereupon full and absolute title to the said premises vested in the said James L. Collins
by the laws of the Commonwealth of Pennsylvania incident to tenancies by the entireties.
His said estate is the Grantor herein.
TOGETHER with all and singular the buildings, ways, waters, water-courses,
rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto
belonging, or in anywise appertaining and the reversions and remainders, rents, issues
and profits thereof; and all the estate, right title, interest, property, claim and demand
whatsoever, of the party of the first part in law, equity or otherwise however, of, in and to
the same and every part thereof.
TO HAVE AND TO HOLD the said buildings, hereditaments and premises hereby granted or
mentioned and intended so to be, with the appurtenances, unto the said -Grantee, their heirs and assigns, to
and for the only proper use and behoof of the said Grantee, his heirs and assigns, forever.
AND THE SAID GRANTOR, Executrix, as aforesaid, her successors and assigns does
covenant, promise and agree to and with the said Grantee, his heirs and assigns, by these presents, that the
Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby
granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or
otherwise howsoever.
IN WITNESS WHEREOF, the said Executrix of the Estate of James L. Collins, deceased,
Grantor herein, has hereunto set her hand and seal the day and year first above written.
Signed, Sealed and Delivered
in the Presence of:
t~ ~~~
i _. _ ~._( .; , (~. .
~~~~.~lIil~~~~' C~BL~,';~~~~~t';it~~~)
Esiate9f JAMES L. COLLINS, Deceased
I
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
SS:
)
On this, the :Joli day of 4~A., , A.D. 2005, before me a notary public, in
and for the Commonwealth of PennsylVania, personally appeared MARY ELIZABETH COBLE,
known to me (or satisfactorily proven) to be the person whose name is subscribed as Executrix of the Last
Will and Testament of James L. Collins, and acknowledged that she executed the same in such capacity.
IN WITNESS WHEREOF, I hereunto set my hand an official seal.
My commission expires:
IJ '
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"Y'f/'--A~~(___'i -y:::.::y.
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Notary Public
(SEAL)
COMMONWI!:AL TH 0" j\lol:NNmvANIA
NOTARIAL SEAL
JEANETTE L. PENNIN9TON, Notary Public
South Middleton T\\ll.. Cumberland County
Commission Ex ires Se lamber 10.2009
CERTIFICA TE OF RESIDENCE
l
I do hereby certify that the precise and exact post office address of!~e within Grantee is:
IJ. 'l' ':/"/"//('/'///'1', .<j, /)ll)'~'J:' I/Y) / /IL) <.;'
. t., 11.., ',.r _ " . t.. ,/
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Attorney for Grantee / -ito'
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A. B. TYPE OF LOAN:
. . 1.DFHA 2.DFmHA 3. [&JCONV. UNINS. 4.DvA 5. DcoNV. INS.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT 2005090219.PFD 826859824
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC)" were f),aid outside the closing; they are shown here for informational purposes and are not included in the totals.
, 1.0 3/98 (2005090219.PFD/2005090219.PFD/13)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Wayne B. Heefner Estate of James L. Collins Sovereign Bank
3335 Market Street 134 Wesley Drive 1022 E. Lancaster Ave.
Camp Hill, PA 17011 Mechanicsburg, PA 17055 Rosemont, PA 19010
SSN: 205-54-6223
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 20-1747090 I. SETTLEMENT DATE:
134 Wesley Drive Lakeside Abstract & Settlements, LLC
Mechanicsburg, PA 17055 September 30, 2005
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
13-24-0793-103 101 Front Street, PO Box 426
Boiling Springs, PA 17007
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 130,000.00 401. Contract Sales Price 130,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower (Line 1400) 5,161.89 403.
104. 404.
105. 405.
Adiustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance
106. CitylTown Taxes to 406. CitylTown Taxes to
107. County Taxes 09/30/05 to 01/01/06 109.49 407. Countv Taxes 09/30/05 to 01/01/06 109.49
108. School Taxes 09/30/05 to 07/01/06 718.25 408. School Taxes 09/30/05 to 07/01/06 718.25
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 135,989.63 420. GROSS AMOUNT DUE TO SELLER 130,827.74
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest monev 5,000.00 501. Excess Deposit (See Instructions)
202. Principal Amount of New Loan(s) 123,500.00 502. Settlement Charges to Seller (Line 1400) 1,310.00
203. Existing loan(s) taken subject to 503. Existino loan(s) taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Pavoff of second Mortoage
206. 506.
207. 507. (Deposit disb. as proceeds)
208. 508.
209. 509.
Adjustments For Items Uno aid Bv Seller Adiustments For Items Unoaid By Seller
210. CitvlTown Taxes to 510. CitylTown Taxes to
211. Countv Taxes to 511. Countv Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 128,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 1,310.00
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 135,989.63 601. Gross Amount Due To Seller (Line 420) 130,827.74
302. Less Amount Paid BylFor Borrower (Line 220) ( 128,500.00) 602. Less Reductions Due Seller (Line 520) ( 1,310.00
303. CASH ( X FROM) ( TO) BORROWER 7,489.63 603. CASH ( X TO) ( FROM) SELLER 129,517.74
OMB NO 2502 0265 ......
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
Bo=w" JI, ~ 12- ~J<i:
Wayne B Heefner
Seller
L. SETTLEMENT CHARGES
700. TOTAL,COMMISSION Based on Price $ @ % PAID FROM PAID FROM
Division of Commission (fine 700) as FolJows: BORROWER'S SELLER'S
701.$ to FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee 0/0' to
802. Loan Discount 1.0000 % to Cody Financial Mortgage Services, Inc 1,235.00
803. Appraisal Fee to Cody Financial Mortgage Services, Inc 275.00
804. Credit Report to Cody Financial Mortgage Services, Inc , 50.00
805. Processing Fee to Cody Financial Mortgage Services, Inc 200.00
806. Commitment Fee to Sovereion Bank 500.00
807. Mtg Broker Fee From Sovereign to Cody Financial Mortgage Services, Inc POC:B2778.75
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 09/30/05 to 10/01/05 @ $ 21.440972/day ( 1 days %) 21.44
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to State Farm Insurance POC $439.00
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months $ 36.58 per month 109.74
1002. Mortgage Insurance months $ per month
1003. CitylTown Taxes months $ per month
1004. County Taxes 8.000 months $ 35.81 per month 286.48
1005. School Taxes 4.000 months @ $ 79.73 per month 318.92
1006. months $ per month
1007. months $ oer month
1008. Aggregate Adjustment months $ per month -456.44
1100. TITLE CHARGES
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to
1106. Notary Fees to NO CHARGE
1107. Attorney's Fees to
(includes above item numbers: )
1108. Title Insurance to Lakeside Abstract & Settlements LLC 1 008.75
(includes above item numbers: )
1109. Lender's Coverage $ 123,500.00
1110. Owner's Coverage $ 130,000.00 1,008.75
1111. AL T A Endorsements to Lakeside Abstract & Settlements, LLC 100, 300, 8.1 150.00
1112. Closing Protection Letter to First American Title Insurance Company 35.00
1113.
1114. Wire Fee to Lakeside Abstract & Settlements, LLC 10.00
1115. Overnight Delivery to Lakeside Abstract & Settlements, LLC 15.00
1116.
1117.
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 64.50; Releases $ 103.00
1202. City/County Tax/Stamps: Deed 1,300.00' Mortgage 1,300.00
1203. State Tax/Stamps: Deed 1,300.00; Mortgage 1,300.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. Tax Cert to Bonnie K. Miller 10.00
1304.
1305.
1400, TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) _.'~'-""-"'., 5,161.89 1 ,31 0.00
"'.,",...." "'., ,...... ..."'._,,~~--,.. -'''~ -,.~.., ..;, (~..,~. '" 0 j ~J _
"II (1.A. I . ~///
I e Abstract & Setllem;n1s, LLC /'\,\\
. Settlement Agent . /
Page 2
Certified to be a true copy.
l.
(2005090219.PFO /2005090219.PFD /14)
REV-l503 Ex+(1-97J
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COLI. /II/.s, :TAmeS
L.
FILE NUMBER
~, -os- 270
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
S~/2.II=S Ee tI.S, SAVIN6S B()JJD~
(see CAleu.\o..\..: O~ shee.TS a.tt4.chtd)
TD 7A-1. V/l-t..ltE
~
~ f".S3
TOTAL(Alsoenteronline2,Recapitulalion) $ ~ ?fol. S.3
(If more space is needed, insert additional sheets of the same size)
t ol/Ins
03/2005
Value As Of
I'!;~Y".I
CALCU
I' Up'date!
Bond Info
EE Bonds
Series
Denomination
Serial Number
$ 75
# Bonds
38
Results
Total Price
$1,425.00
Total Value
$4,861.53
Serial Number
Total Interest
$3,436.53
Issue Interest
Issue Date Series Denom Price Interest Value Rate
03/1988 EE $75 $37.50 $55.44 $92.94 4.00%
01/1988 EE 75 37.50 55.44 92.94 4.00%
10/1987 EE 75 37.50 55.44 92.94 4.00%
08/1987 EE 75 37.50 57.30 94.80 4.00%
06/1987 EE 75 37.50 57.30 94.80 4.00%
03/1987 EE 75 37.50 59.19 96.69 4.00%
01/1987 EE 75 37.50 59.19 96.69 4.00%
11/1986 EE 75 37.50 59.19 96.69 4.00%
08/1986 EE 75 37.50 72.21 109.71 4.00%
06/1986 EE 75 37.50 72.21 109.71 4.00%
04/1986 EE 75 37.50 72.21 109.71 4.00%
02/1986 EE 75 37.50 74.40 111. 90 4.00%
11/1985 EE 75 37.50 74.40 111.90 4.00%
09/1985 EE 75 37.50 76.62 114.12 4.00%
07/1985 EE 75 37.50 76.62 114.12 4.00%
04/1985 EE 75 37.50 76.62 114.12 4.00%
02/1985 EE 75 37.50 78.90 116.40 4.00%
12/1984 EE 75 37.50 78.90 116.40 4.00%
09/1984 EE 75 37.50 81. 90 119.40 3.23%
07/1984 EE 75 37.50 81.90 119.40 3.23%
05/1984 EE 75 37.50 81.90 119.40 3.23%
03/1984 EE 75 37.50 87.60 125.10 3.26%
12/1983 EE 75 37.50 87.60 125.10 3.26%
10/1983 EE 75 37.50 91.23 128.73 2.97%
08/1983 EE 75 37.50 93.15 130.65 2.83%
05/1983 EE 75 37.50 93.15 130.65 2.83%
03/1983 EE 75 37.50 100.20 137.70 3.32%
01/1983 EE 75 37.50 115.65 153.15 4.00%
10/1982 EE 75 37.50 123.00 160.50 4.00%
Savinc
Issue Date
YTD Inl
$45.1
Next Final
Accrual Maturity
09/2005 03/2018
07/2005 01/2018
04/2005 10/2017
08/2005 08/2017
06/2005 06/2017
09/2005 03/2017
07/2005 01/2017
OS/2005 11/2016
08/2005 08/2016
06/2005 06/2016
04/2005 04/2016
08/2005 02/2016
OS/2005 11/2015
09/2005 09/2015
07/2005 07/2015
04/2005 04/2015
08/2005 02/2015
06/2005 12/2014
09/2005 09/2014
07/2005 07/2014
OS/2005 OS/2014
09/2005 03/2014
06/2005 12/2013
04/2005 10/2013
08/2005 08/2013
OS/2005 OS/2013
09/2005 03/2013
07/2005 01/2013
04/2005 10/2012
..... k80391209
...--k81339158
_ k80307988
~. k75858617
/k74125242
"..... k72792382
.....k72618985
...k67362738
> k66745460
..' k64254823
/ k56496346
k56488744
k56481727
k56470266
k56172640
;/ k53469787
"' k53445311
vk50312440
!/ k49923180
" k47872544
~'k45594262
... k44656213
vk42596508
.......k42337452
, k39872105
'-k39981791
J:~,k39979406 .
L /k34989000
;../k34980155
See atf-ac:Jw..J 4ct~i ~ B'K&I shed- ...,at., ~r"e~ a.r;a.I t1O. a. *~. Va.h4( ""4$. ~
~ OVtt',\\ -\atAl ',So ~ ~.
cs.
vk28989213 08/1982 EE 75 37.50 126.21 163.71 4.00% 08/2005 08/2012
'- k28980117 06/1982 EE 75 37.50 126.21 163.71 4.00% 06/2005 06/2012
....-.k23019892 04/1982 EE 75 37.50 126.21 163.71 4.00% 04/2005 04/2012
[/ k21400977 01/1982 EE 75 37.50 129.48 166.98 4.00% 07/2005 01/2012
v k21390040 11/1981 EE 75 37.50 129.48 166.98 4.00% OS/2005 11/2011
v k20747937 09/1981 EE 75 37.50 132.84 170.34 4.00% 09/2005 09/2011
/k20735835 06/1981 EE 75 37.50 132.84 170.34 4.00% 06/2005 06/2011
V'k20724549 04/1981 EE 75 37.50 140.43 177.93 4.00% 04/2005 04/2011
,/k19895802 02/1981 EE 75 37.50 143.97 181.47 4.00% 08/2005 02/2011
IView'lO'll Viewing Bonds 1-38
Le(end
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
MA Matured and Not Earning Interest
Please rate this service.
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Savings Bond Calculator
. ,
4/21/05 I :27 PM
Value As Of
IQ~~~29.s
I.Up"dafiil
1?'))'RJI_1
,1I1b",,,, ~, j
Bond Info
Series
Denomination
Serial Number
Issue Date
EE Bonds
~l
$1 75
i ~ I
I
Ijk1;:Aid~i'l
~7:"~"j" gi':'\c;j
Results
# Bonds
1
Total Price
$37.50
Total Interest
$100.20
Total Value
$137.70
YTD Interest
$1. 77
Serial Number Issue Date Series Denom
Issue
Price
Interest
Value
Interest
Rate
Next
Accrual
Final
Note
Maturity
k39973406
03/1983
EE
$75 $37.50
$100.20 $137.70 3.32% 09/2005 03/2013
10ell
le(end
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
MA Matured and Not Earning Interest
Please rate this service.
Service
(Please print and/or save this page before submitting your survey)
Excellent Good Fair
Poor
Savings Bond Calculator
o
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o
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h ltp://wwws.publicdebl.treas.gov/BC/SBCPr;ce
Page I of I
REV-lS07 EX + (1-97)
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COLLI1I/5, JItMES L.
FILE NUMBER
d-I- 0.5"- 270
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
'P((OmrssoR.y f1/{)T~ tJf A-pr;/ 29. 2.003 by wh/ch Sfac,'e L.
Russell is bOLlnd tv fCoA.f 10 J'a.mes L. CDII;n~ ~ SUM {)f
~ I :1., ()t)t). 00
(see eup~ t2f noTe a /fetch at J.
~ :2., ()OO, 6 ()
TOTAL (Also enter on line 4, Recapitulation) $ I 2, () 00 . C) 0
(If more space is needed, insert additional sheets of the same size)
~ ;
0~z>.-
""" \:~} it l""e
;:,'
PROMISSORY NOTE
f
; -~:
r .'-1 .".
$12,000.00
Date: April 29, 2003
For value received, the undersigned STACIE L. RUSSELL (the "Maker"), at 507 North
Lewisberry Road, Mechanicsburg, Pennsylvania 17055, promises to pay to the order of
JAMES L. COLLINS, (the "Payee"), at 134 Wesley Drive, Mechanicsburg, Pennsylvania
17055, (or at such other place as the Payee may designate in writing) the sum of
$12,000.00 with no interest.
Payment Terms
The unpaid principal shall be payable in full on any future date on which the Payee
demands repayment (the "Due Date"), or, in the event the Payee shall be deceased prior
to repayment of the unpaid principal, the unpaid principal shall be payable in full on any
future date on which the Payee's estate representative demands repayment. All payments
on this Note shall be paid in the legal currency of the United States.
The Maker reserves the right to prepay this Note (in whole or in part) prior to the Due
Date with no prepayment penalty.
Acceleration
If any of the following events of default occur, this Note and any other obligations of the
Maker to the Payee, shall become due immediately, without demand or notice:
1) the failure of the Maker to pay the principal in full on or before the Due Date;
2) the death of the Maker;
3) the filing of bankruptcy proceedings involving the Maker as a debtor;
4) the application for the appointment of a receiver for the Maker;
5) the making ofa general assignment for the benefit of the Maker's creditors;
6) the insolvency of the Maker;
Page 1 of 3
-
7) a misrepresentation by the Maker to the Payee for the purpose of obtaining or
extending credit.
Collection Costs
If any payment obligation under this Note is not paid when due, the Maker promises to
pay all costs of collection, including reasonable attorney fees, whether or not a lawsuit is
commenced as part ofthe collection process.
Extensions and Waivers
No renewal or extension of this Note, delay in enforcing any right of the Payee under this
Note, or assignment by Payee of this Note shall affect the liability or the obligations of
the Maker. All rights of the Payee under this Note are cumulative and may be exercised
concurrently or consecutively at the Payee's option.
Waiver of Presentment, Notice of Dishonor, and Protest
The Maker and all sureties, guarantors, and indorsers severally waive demand and
presentment for payment, notice of dishonor, notice of protest and protest of this Note.
Modifications
No waiver or modification of the terms of this Note shall be valid unless in writing,
signed by Maker and Payee. Any modification shall be valid only to the extent set forth
in writing.
Severability
If anyone or more of the provisions of this Note are determined to be unenforceable, in
whole or in part, for any reason, the remaining provisions shall remain fully operative.
Governing Law
This Note shall be construed in under the laws of the Commonwealth of Pennsylvania
including the Uniform Commercial Code, as enacted and in force in the Commonwealth
of Pennsylvania.
Page 2 of 3
Warrant of Attorney Confessing Judgment
The Maker hereby authorizes any attorney at law to appear before the prothonotary of
any court of record of the Commonwealth of Pennsylvania or in any state in the United
States at any time after this Note becomes due, whether by acceleration or otherwise, and
to waive the issuing and service of process and confess a judgment in favor of the Payee
or his estate against any Maker and indorser for the amount of principal and interest then
appearing due on this Note, together with costs of suit, and to release all errors and waive
all right of appeal.
WARNING-BY SIGNING THIS PAPER YOU GIVE UP YOUR RIGHT TO
NOTICE AND COURT TRIAL. IF YOU DO NOT PAY ON TIME, A COURT
JUDGMENT MAYBE TAKEN AGAINST YOU WITHOUT YOUR PRIOR
KNOWLEDGE AND THE POWERS OF A COURT CAN BE USED TO
COLLECT FROM YOU REGARDLESS OF ANY CLAIMS YOU MAY HAVE
AGAINST THE CREDITOR, WHETHER FOR RETURNED GOODS, FAULTY
GOODS, FAILURE TO COMPLY WITH THE AGREEMENT OR ANY OTHER
CAUSE.
Signed this ;/'-2 q- CJ;;; day of
,2003.
Maker:
" ,d;V
~~", h _~~J2~
S ACIE L. RUSSELL
507 N. Lewisberry Road
Mechanicsburg, PA 17055
By:
Page 3 of 3
Affirmation of Fact
I, Stacie 1. Russell, presently domiciled at 507 N. Lewisberry Road, Mechanicsburg PA
17055, County of York, Commonwealth of Pennsylvania, do hereby state and affirm that I have
an income in excess often thousand dollars ($10,000.00) per annum.
Date: ( ZC(~ O,-:q
BY:~MtAfi~~
STACIE 1. RUSSELL
507 N Lewisberry Road
Mechanicsburg, PA 17055-6019
REV-1508 EX. (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF C S""-A
OL.L{N , ,.J1TMC~ L.
FILE NUMBER .,
",J -OS- :17t)
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
~.
DESCRIPTION
Inm.s ~I pet:SDna.lf,. 1\01- Sold cd- 4.U.c..hOf'l a,Md I4pt lIWiH,;n
-fam:Jy a..s pa.rt rl.e..~h ch:[ds r~~pecJ.;.lIe inh~r,".J-cutceS
u.,nder ~ 14sf WIll Df -JAIIf\e$ L. CcJ11, YJ ~.' .::
(Gt!'- typed ;nvUlibry s"'e~t a.ttAc.htld Jt~~1;).
Re;....b\A.rselYlenTs D.h\J pro-ro.J.;ons ()U Sc1/e ~f r~tJ e.sto.'t.
t; WQ.Jj"e 13.. Hu.tner (~~ Sc. fH"W1en t cShef!Jr a..ttAckLcJ 1;
5 c..hu/ ,40,):
/t.) L.;IU 1/-07
8,J L.,' nt! l/ og
e"u.n7/
5c.hoo/
T CJ.Jt e.s
7O..t.eS
VALUE AT DATE
OF DEATH
'8
r2 o. 00
.,
/0,.'i9
11 -r I r. zS"
~f'2.()'3
" "t . 00
~ 70 .00
1
" 30.00
~
~ "1'01 71
.re1
! -
.<. ~"t:). I':>
"
f4~ al7. 72.
.,
39.ZI
.,.
9:Z1.9t
~
s, SZfj. ()D
~ IS. DD
3.
If.
s:
b.
Ve..rizon ('e,~nq ehe.ek.
Pe.~rkss I"'~lAt", (b. - HOMe.owne./.s ..:rnsu~. Re~nd
I?-e.AwIJ 05';",,"11.. A.pot - JOutlr , of LtWlDy"r.J iJj#
F:rurtt1,s 1>> Ko~t ~tfin.s a.s (pal"t Df- share under r.u;1/
(Se.e esPy ,f ""pprflisa/ Jy C/qssl'c. F,'reo.fIYlS, 'Zac.,afhu.ht..d).
7.
IYJtnI~ 1st RJ""tlJ C'rt.e/,'f fAn/on
tf. S4V/~ ktl. AlP. 5'.1.'1 :l-O~
~. :rAt. A-~t:r. Ii ~. (J.e;t'. 4/1 A-.
c . CIt~~;1f AcU: IfIt,. sz '1 ~ - /1
1'. MOII'f IJtllltlJfelJteAt ~ Ala. SZ1:l. -oS
€.. Int". A-~~. Ii ".(J.eI. 4'" E.
(Stt YLllJ.tlh'.,. /e.ftu fro," Me.Mbu-t 1st lt/hlC,ht.d L
Y.
S cJe.' ~f. Per.sono..lty by "Do.vid Cordie.r A-n~tu.es
,4.. V,'q kternet $Al~s
6. A-ttr;-&J1.e /llo".sehol,J Aud-iOh {se~ ema.;/ aff-a.c,he.J ~J.
SAle " T"km.s f" I=ht /J1a,.~e~t.r
'1.
TOTAL (Also enteron line 5, Recapitulation) $ <;'0, J.. 0 'f. 5 I
(If more space is needed, insert additional sheets of the same size)
i S c J.I G' ]) . 12" Ctrrt/ rI.
/
Esr: 01=' CtJL(../A/S/ Xd-/IIES _L.._._ 1=, LE !tit). 2/-oS-- Z7tJ
~
/ D.i /9'1'1 AucI,: - ~~/tJ"I-.f('/fer I YIIt'_I!.U!,lf.y:j)X~'fltx f(AJ 0 (l. 3 ol~~oo. N)
iGeemltrllhRI1 fJr~I?4'e~ hJ'lJ1e(!.,lrltn/c~bfA.!'j Spt1rt~ (ir Cef/hr
i c ltae6t!,/).
/1. t q~~'I Ee4'c/'lIl_ h!'.Jlll1al.z;;Ct)l1Je~.I?e~J1t1
'~'l~SSDt'te-lll-~rnr "f_CD.~h-M1d.-CMrrUl'7lfR' J46:. ~r.if 4x
i.;!" v'.~~!t?'::!I. fA)h'GhlAleNsdrL fP___p t.)_~!'11$
- . - -.-.( -- (s.ee!~c~/Jt.__~"uSA~ .,,-#ack.(?'__6~1i)_._
- - -- - ..~~L 1>:~/~ueh.uk_('YL.vA_ -_.~$.y,r.4MU.--L~slW1JJf!~_.t!~o.c!..
i
_Ii.! _5,4E~ - pep~s.(r-i?J!~_.._L/lJJI.~A["@~Y_=.d$~~_/gL4> Ir~A1/zED
/T~ /!l~~ a L ~"I1t._$;lJ'-4.f1Jllt.t/.sh4/lLiz .'Iet 114i' ';"e~ b(l'$, lA/s
__liem__ _-tw.!leri-~aL-tz,o{k_I1e.._g_dt~/J1P./1t:/4!t/Il~Jllf .
J2[4.lfttr/ 8j2/lt'..kd _All(~rf_c5.q/e- _~s__..__. _ .
./11. ~!_I1C~--,___/J1.~IJ_~_ -jt1.K._tj!1j_tfi.$JPt{;/I~e/ ../;y
(}r/~(1Jliej~ c,. G"/~ 4tf!ij..r__J;}"lirl ~ l/tlktl tJ7(
;5ejJttr (/tela/JUIY _ rettIJbt:7/!__selreM _ a /ldciU4.
(e) IeNlttll m.ecla/&/ /r/7.
~
/a;O.O-O
Schedule E
Items of Personalty
James L. Collins
THESE ARE VALUES FOR SCHEDULE E AND FOR APPORTIONMENT
AGAINST SHARES OF DISTRIBUTION.
MARY ELIZABETH:
Tool chest and some old tools
Silver candlesticks (per opinion of Dave Cordier)
Old television
Bose speakers
Pocket watch
Copper and brass chafing dish
TOTAL MARY ELIZABETH
CORINNE
10kt gold and diamond ring (per opinion of Dave Cordier)
Silver candlesticks (per opinion of Dave Cordier)
Small sterling bowl (per opinion of Dave Cordier)
Silver-plate hollow ware (per opinion of Dave Cordier)
TOTAL CORINNE
STACEY
Bed, headboard and lamp
TOTAL STACEY
GREGORY
Wrist watch
TOTAL GREGORY
ROBERT
Assorted firearms (see separate listing and appraisal)
TOTAL
$ 125.00
25.00
50.00
110.00
20.00
15.00
$ 345.00
$ 250.00
25.00
20.00
25.00
$ 320.00
$ 110.00
$ 110.00
$ 45.00
$ 45.00
$ 820.00
Page 1
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{7 i7) 73:.~_..0991
CUSTOMER'S ORDER NO.
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NAME
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ADDRESS
SOLD BY
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Gonditioll~; ,jf Sale;
;41r~tems .r>:~~ 1$ ';:.::,:i::::c~(tr
\;'0 (;I..I~l""'Y.~t'~~ ~':.'l .~) -_;,f":~}utrn~ ;;afr'i'
TAX
./" \",,'
RECEIVED BY
TOTAL
~~ .~ !:
__ ~-'" 1;.....
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f
Thank YOU!
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
MONEY MANAGEMENT ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
VISA CREDIT CARD ACCOUNT:
Account Number/Suffix
Date Account Established
Balance at Date of Death
Name of Joint Cardholder
Estate of: JAMES L. COLLINS
Date of Death: 03/16/2005
Social Security Number: 175-22-4796
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
Cfftl JLJ eM
5292 -00
10/03/1960
$1,680.71
$.69
$1,681.40
None
5292 -11
02105/2002
$2,460.15
$.00
$2,460.15
None
5292 -05
02/05/2002
$64,087.72
$39.21
$64,126.93
None
4121449999052926
11/26/1997
$411.32
None
MrJERS 1STJT...DERAL CREDIT UNION
Y/tAA- a r::t:-?d~
Denise A. Wolfe ;--
Insurance Services Supervisor
April 27, 2005
SOOO Louise Drive . I~o.13ox 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.memberslst.org
Page 1 of 1
Mary Coble
From:
To:
Cc:
Sent:
Subject:
"Ellen Miller" <emiller@cordierantiques.com>
<mecoble@paonline.com>
"Dave Cordier" <dcordier@cordierantiques.com>
Tuesday, November 29, 2005 2: 13 PM
Collins estate
Dear Ms. Coble,
David is out of the office today and asked me to forward the information you requested regarding the Collins estate. I've laid out
the various amounts below:
Internet $921.91
Antique/Household auction $5.329.00
Total
$6,250.91
Less 35% commission <$2,187.82>
Less packing fee (10 hours) <$150.00>
Net due
$3,913.09
There are five items that didn't sell (cut glass bowl w/ plate, Talking PJ doll, Tammy doll, 2 lighters and Complete Works of John
Bums book). We can sell them privately to a flea market dealer for $15.00 or we can return them to you. We'll be closing out the
estate by December 15 as planned. I hope this information is helpful. If you have any questions, please let us know. Thank you.
Regards,
Ellen Miller
Cordier Antiques & Fine Art
IL-'~
~
W- ~s: "!. '" f-w- ;:::: .4J
~1~~~1;~
~~
1217/2005
. "_\._.",\~ .......~:. /'. '~::" ~ '<~...' '-:-. -' ~< I . ,\..
DIANA L COBLE
So 7 /v. L~4J'&~ry ~.
l1echa..ril'cSh(./;'[f- pA I ?dS'S. Date cn;ay'- ~77 ;<~o5
(2JS) Lao - A...tp?CI ../
PA..... 'fhI<[ ./J/A"'?.t)~) #/4) hf Q,/Lvn4) I $ 2- 5o(] ~.. v.
TO THE ORDER OF ) 4U
~ -t/UYZM?JtM1..d__~~p'm) -JuuJ1d?tJ?J! ;; tl~ot:J 1100 DOLLARS ft1 ~I~~::l,~,",,,
Membersl8r Won.",,_
FEDERAL CREDIT UNION
P. o. Box 40
~hanicsburg. PA 17055
60 -- 8224
2313
103
-~~4~_____.____..M"
I: 2 :1 * :18 2 2 ~ * I : 2 * 8 2 * ~ * 8 g * II- 0 * 0 :1
Ma'kel Plaza
MEMO 4u 7)/
I~ UBERTY
MV-3 (07-03)
Commonwealth of Pennsylvania
Department of Transportation
Bureau of Motor Vehicles
Harrisburg, PA 17104-2516
MOTOR VEHICLE VERIFICATION
OF FAIR MARKET VALUE BY
THE ISSUING AGENT
This form is used in conjunction with Forms MV-1, MV-4ST,
MV-217 A and an on-line processin Applicant Summary Statement.
TYPE OR PRINT ALL INFORMATION AS REQUESTED
A VEHICLE DESCRIPTION
Mot Year
fLf
Last Name (or Full Busmess Name)
0.00LC
Co~Purchaser
D PURCHASER/SELLER EXPLANATION
FOR DEPARTMENT USE ONLY
PURCHASE
PRICE
J50D. Q)
of a
Agen~~e: cfLj () l
!dl ()~
First Name
.D( 41J p,.
Middle Initial
L
Explain in detail why the purchase price listed on Form MV-1, MV-4ST or MV-217 is less than 80% of the average Fair Market Value, or if the vehicle is over 15 years old and
the purchase price is less than $500, explain how the purchase price was determined, or if the vehicle is not listed in a PENNDOT approved publication, explain how the
purchase price as listed in Section A was determined. Please use additional paper if more space is required. NOTE TO PURCHASER: An additional audit of this vehicle
sale bv the DeDartment of Revenue mav occur Please retain copies of this form, your cancelled check or original cash receipt, and your receipt from the seller of
this vehicle, along with either your copy of the Application for Certificate of Title (MV-1), the Vehicle Sales and Use Tax Return/Application for Registration (MV-4ST)
or the.. Application by Financial Institutions for Certificate of Titl~ After Default ?y ow~. .er (MV.-217 A). LJ. . _ __ /"
.-:"J.,~ ~ ~'-:j- ~r~p1- /}~f-~ ^---~~-r-~ ~
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~- '-4.-dL-/...vL, ~.' .. I .~ i ,-')-'<..~.e..~_~
~-
E SEAL AND SIGNATURE OF SELLER - NOT REQUIRED FOR VEHICLES PURCHASED OUT-OF-STATE
A
L
F SEAL AND SIGNATURE OF PURCHASER
SUBSCRIBED AND SWORN
TO BEFORE M
YE/)5
E
A
L
N
THIS FORM MAY BE PHOTOCOPIED
I/We state that I/we have read and signed this form after its completion, and I/we
?:, swear or affirm that the statements made herein are tnue and correct, and that any
~ statement made on or pursuant to this form is subject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false swearing), which shall include punishment of a
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
or both.
'gnat
677-dy1'i
l!We state that I/we have read and signed this form after its completion, and I/we
swear or affirm that the statements made herein are true and correct, and that any
statement made on or pursuant to this form is subject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false swearing), which shall include puniShment of a
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
or both.
Signatur~ of Purchaser
Telephone Number (;2)5):::?...-tJO 2..,0 7 ?
Messenger No.
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COMMONWEALrH Uf PENNSYLVANIA
- Notarial Seal \
Erik R. Nordstrom, NotalY Public
echanlcsburg Bore, Cumberland County
My Commission Expires Apr. 25, 2009
Member. ?ennaylvanll. A,lOCIlllt\On 01 Notaries
D & S COINS
224 FOURTH STREET
NEW CUMBERLAND, PA. 17070
(717) 774-4182
Customer's
Order No.
SOLD TO $s~~
ADDRESS
DATE s-/ n-/d ~ .
.
L,
19_
/
SALESMAN
TERMS
CASH CHARGE C.O.D. PAID OUT RETD. MDSE. RECD. ON ACCT.
QUAN.
DESCRIPTION
PRICE
AMOUNT
:s Y L. 7)---
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1/
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,
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-:+.:~~--_.._-_._--".._,.....,--_."-_.,--"._-,.,"^"-,_._.-._-_.__..._------~,...?
5589
50-8224/2313 ,'/'fJ,
DALE L. RISHEL '0'1373960
DBA D&S COINS 'AN __. / /
1432 RAVEN HILL RD, /iI'r," J //Z/OS---
_'.'. ' MECHANICSBURG, PA 17055 -'-'-'~ -. -:L _ _ 1_
J);;:;~;~,,~"r~ueJj:~~~ $ 3'12. ~
~~..h";;;tru ..~.)~ry-- C!./1"Mfi 6l
fv1Sl.fEMBERS 1"
i HJlERALCREDITUNION ~' ~
j"edwUc.'iba~ PA 17055 ! - tt
I www.memben18t.on; ,
:
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 1"._ I..,.
~UIN.}, V I4-ME.s
SCHEDULE F
JOINTLY-OWNED PROPERTY
L.
FILE NUMBER
2(-05- ~70
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. MaYJ E/;Z4 befit CoMe.
Sf) 7 AI: LeJVIJk,,/ If';:{
lJ1€eAllllic~bu,.!, /lJI'I /7f)SS-
d tt..u3h ter
B.
c.
JOINTLY-OWNED PROPERTY:
LffiER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1. A. 4/llf h'1 C ITIZeJ.5 J3A-NK-Che.e~:(j A-e et: #"
'/~OfD3I;1.&/q
P";I1t:.,'pa.l tif1tf.'!1 i - ~
4/11/ I"'" so~ , ~ 07.. Z{
:l. A-. :.f~D :z. C.lilzeNS BIfAJK. - Chectl.,'{J /feU: it
r..101 :(00 :1.41
fJ""lJc/p41 ~1.f7, ,/l.{7.tJS ., 4f 0 'if '/7. (J '$; sor., ~ ~3, 953.S2
(S!e ~y d J/ft/f,(Qh~n Ie Ittr frfltJf C,"fizUl ~ }
13a 11 K ~:tf-a.ched ).
I I I I
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I
TOTAl (Also enter on line 6, Recapitulation) S J. Lf, Ita 0 I 13
Ilf more space is needed, insert additional sheets of the same size)
'+: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsburgh, PA 15219
April 28, 2005
CHARLES E SHIELDS III Esq
6 CLOUSER RD
MECHANICS BURG, PA 17055-9735
Estate of JAMES L COLLINS
Date of Death: March 16, 2005
SSN: 175-22-4796
Dear Sir:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his date of death.
The decedent had 2 active accounts at the time of his death and he had no Safe Deposit Box.
Both accounts were already joint accounts before the Mellon Bank conversion on 06/21/2002.
For 1L or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884.
7J~~
Philip Lynch
Operations Services
. .
.~ CITIZENS BANK
Account Number 6100631249
Account Title JAMES L COLLINS or MARY E COBLE
Date Opened 4/19/1999
Account Type Checking
Principal Balance as ofDOD $414.41
Interest from Last Posting to DOD $ .00
Account Balance as of DaD $414.41
YTD Interest to DaD $ .21
I
.~ CITIZENS BANK
Account Number
Account Title
Date Opened
Account Type
Principal Balance as of DaD
Interest from Last Posting to DaD
Account Balance as of DaD
YTD Interest to DOD
6101200241
JAMES L COLLINS or MARY E COBLE
2/5/2002
Checking
$47,847.05
$ .00
$47,847.05
$102.20
REV-1511 EX+ (12-99) "
, . ~~:9.
~;jf
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF C
OLL/NS,
.:TA/J1E'S i..
FILE NUMBER
:2.1-OS.';<70
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
1.
I'tJYGllS FlOJErlA!.. I!Oh!?"; .,f /J1eelttlJ1;~>bL{7
~~;end~ ~/Dr;st
;(,/16$ FaIt,'1y "reshuyant FLtnun./ h1ea.I
PI urn ~rreet GOUrMe.t I Ltw<<:-4Sfey FUl1U'a./ W4-kt! lYJe4/
( $ te a flrtdu.d)
Jt: ffro/s ,c~W'er,J I Cas ke.r Spr~
Re;hlhll~hfMfi ~ CDrilll1e fl. f!.. 6-,;I/urt., ~era..~s, elz. :h6r wake
J.
1-
'I.
s:
fD.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) hla '.J ~/j Z4 bt!.fh ~k Ie
Social Security Number(s)/EIN Number of Personal Representative(s) ;]/)3 - "'~_ 7/ s'l
Street Address 5() 7 AI, LUAlIS berry IfJII'.
-
City l11ecJ"u'''~$6"r? State~Zip /70SS-
Year(s) Commission Paid:
2.
Attorney Fees C IlIu./~J' t:--' Sh:~Us 1!I
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
4.
5.
6.
7.
i".
'f,
Ii.
1/.
,~.
Claimant
/l/OA/G"
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees awl ot';!" no-! ,. S S ~ ,~ short cuh'.f.,' c..res
Accountant's Fees 1 JllYlt.f e,r~~)(b~ II I H ~I< t3/fJc.K
Tax Return Preparer's Fees S (Jt'tf 10'+0, PI'r I/O) PIl- 41 J 104', eJz .
AlI(flert-i~i"3 in C CA.m b.e.r/QtIJ LAMJ TOLC.rl\a./
Ifdverr/s;,,! In (.'.,.I;.s/~ rSo.f/nel Ntw,$fApu-
MClr Ii H; I bc....t J R e 4.1 e s tuft A-pprl1 i oS Q I s
'Re.-probo..Te. of aftt.r d;sc.ollt.re..t/ frusf w;"
If "tI"h~".1 sA.,.! Cerl-'hca.1i!s
/'i-tJt'.'//J"A4/ ,<1l'YJb4f~ fe~
AMOUNT
F7, ft,S7.tJO
? ;;;'13.8"0
,
3 00. :u,
r/
3J C; 7 s. 9'1
It .2 7 /. ..3/
f4
J, If /7.75"
~
10" 97t7"'o
~
/0) 97tJ"tJ)t)
AlONG"
rI, '(e). 00
If&, ~ S.oo
--
7S: 00
'f r 2.Z. S J
'3 DO. 00
~ 'SS.oo
".
~o.ot:;
; ~d.()' Oil
TOTAL (Also enter on line 9, Recapitulation) $ '13,197. Sf
(If more space is needed, insert additional sheets of the same size)
. f:Sr: of Ct>UtttJ~, JltIJtE~ L. Flt..€ Nt). ;l, 1-05- ;l70
13. C,,"sSic. F;YUrms, hc.C. _ of LLn1.b!f)1.~ I PAl aptJI'a"Jalof !f'tns ~?t~/.2LJ
1'1. 84lt.s (j1Jf/t};.$$ ;0" I "'t.ofalepfiJel".[()/u'!1f .iy{J'efJ~r /brhiUe5 ~,187, iZ
IS""" Packi1/ Fee $ (};rtl/er ~/i'lt(~J ~/S(). ot)
(.re~ entlZ/1 IZlfaek.t! ~ Scied'. p-.)
!
I'. i I+~ J E)C(Jen~ Q'$oeia:teJIJJ~~ $alt. of. R~ Eshdi.[pu
IfJeHitrYlt~. Sheet a~"ltuJ f.i_sc~eeI.lf..)
i Q
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17. i 'R1~ of 1)GL~ CheeKS. .._
It. I?ejmbf.(~ ~ IY/a", Clhltu .~r H"n. ~Itre: CJvUAIM;'~ !"G/<s
JCj.J Vui2Dnu'-'/I71
.,4,. fJ P + /.. .
:11. Peerless :I;,$U,V', Cb.
:I~. l<e;l1Ibursunarl ~ !hilI" ~b/~-
l(eil1/"u~ntMti t AtIZII)' ~6/e-
fJ~AAfI. ,loA!. 1IJa1ir a.
Lazur ~fc/ kJV~ L:,re.
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-~'lLiil'iztPd__________ ____ _________ ____
-- - -~._1_f!eI4__ ---_ _ _________ __m__
- ------ -----?:t.;----I!~._.bt._k4kr _ _ _ _ __________________
52.:_ ;:::;;'~~i .:z;,Aer/~e ~_ R~Nt
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Myers Funeral Home, Inc.
H-A-ll/
Boyd L. Myers k. Supervisor
37 East Main Street
:v1echanicsburg. Pennsyhania 17055
(717) 766-3421
Fax (717) 795-7291
i\ stand,lI',! of excellence in Cl:ntral Pennsylvania since I C) 1 ()
Monday, April 18, 2005
Miss Mary Besty Coble
507 N, Lewisberry Road
Mechanicsburg, Pa, 17055
Dear Miss Coble,
Thank you for selecting ,jur fUllera: home to provide services for your family during your bereavement
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends, The following is a summary of the service charges as previously explained and
provided in written form on the services for:
James L. Collins
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
LESS. Credits granted
LESS Total Payments
CURREN, BALANCE
$9,354,00
1,69500
0,00
$7,659,00
Credits Granted 51.695.J P'lc:k2'Je ?~'C:2 c;,scount
imerest at the ,'att: ,]f 1.5010 oer' ';-,O.'1th ( 1'3 ll, per annum) Will be added to balance after 30 days.
if there are.any-q'uestions ,Jr concerns that remain unanswered. please call me
Sincerely.
/
/1'/
/
C
/
~'
~L, / ~~.~:iIJ
/ ------- ~~J~~~B~~1:OMES l COl~'NS '. .'."
MECHANlCSBURG PA 17055
50.. 8224
2313'
100
foA~... t'I" .
., HE ORDER"" '- --,.~.
-=', L L-.jft"..
M' -'. "C.'c<c-'.
I-'EnR~mberSlsr
P.O.8o~40 CREon" UNION
Mocl1anlCsbuJ9. PA 17055
Data~~{" ,
__,cc:_,._--,-~~.~_("
\...: /:....
'$ )';.-,.<
!_, ,_~~' I
'/,
,1i0Q. DOLLARS ffi
r~ossmoynO
MFiAO.__~~~~.:,~_,_
~.' {
':23~d822~.,: 2
· 8 2 b 2 ? b g ."- 0.80
'- ":{'-r./
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I" . '. ' . .....
liJEfFREY'$FLOWE~;5, AND ,'H6Mf.'ACi1FrlTS .' .
L MECHANICSBURG (7.1715.9-1'-"0244-.
, . . .
I.-
13.2496
I',
!
j
j CASKET SPRAY
~'." ,
1 ~"'liv",ry Char9'"
1,:;,a1",$ Tax
I
!
250.1)1)-
'5.95
iS~ 36
3/18/05 J~'1}9P .Slit
r TOTAL ..,--- .'.
i;'M~st",rC.3rd TENDERED
I
~ f
271.31
271. :u
I
I'..
~~e:
I
I.
Card: 5490 '199J)'H6Tla13~
P .
~~p Ht: .li06 ". . ...... ." '.. . . .
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ly<........ ....., ',' '.."""'''''''<:l ,i
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i~:';":''':_-:-:-.,..~,:;-:;"",__":",,,_~,-
l4:~s,~~~I..~t\Ir~'.i . ...... .... '."
le.:..._______. TICKET SUMMARY .-----~---
I'":"---~----,; ,..~.".-.l_:_.._' -------:--':""
~"'cipi ",Fit: .
!itl1iE5L COLLINS
~VERS FUHERAl HOME
I
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i
I
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. '.J . ,
iiECI-lAtHCSBU~:G, PA.
)€'livE'ryDatl?: W",dnE'sday, 3/23/05
l# TIMED ** iHter Befar
!tEASE CALL FOR APPROPRIATE'
uELIVERY. DH~ANO TIME
:, d ,.
Jo3f i1essage:
I . . . . .
~~=============================~====
!'. .
i '
I
:lottom Copy: CustOIlll?f lap Copy;. :;t;ore
I
. r
THANK ',IOU FOR YOUR BI1SINESS
SORRY NO' REFUNDS'
PLUr\ fTQ.CCT
+GOURMET +
347 N. Plum St. · Lane.. PA 17602.717-394-3882
Oc:^.
if
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, "-!I'"
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7580
DATE
3.J Z~/,g ~
~ IIr~V5/~fz;t~'r
NAME
ADDRESS
QUANTITY
DESCRIPTION
2
3
4
5
6
7
8
9
10
11
12
13
14
VLful J
CC(~j)
PRICE
AMOUNT
., t:A.. .
(
'.
RECEIVED
BY
All claims and returned goods MUST be aClXlmpanied by thi~bill.
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154935
STATEMENT f'V Vl n. n p~ AI -1i'YJ5ITERMS
TO ^rvI;w. ~ ~/\.o1'YJ Cl/) I r\; O}}@},-j-;
ADDRESS a~J ~~. ~ Rol '
t~_ ,Cia. P7c,D~
IN ACCOUNT WITH
FRIENDS FLORIST
,),)0 1'1. l.!ueen ::>t.
Lancastar, PA 17603
1 11-_
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.
Corinne P. C. Gilbert
27]1.. Brook Farms Road
Lancaster. P A ]1..760]1..
April 13, 2005
Mary E. Coble
507 N. Lewisberry Road
Mechanicsburg, P A 17055
Dear Mary,
I am requesting reimbursement for the following expenses for Dad's (James L. Collins) funeral
luncheon on March 23,2005:
Beverages:
Service Personnel:
Total:
$779.75
$638.00
$1417.75
Receipts for the beverages are enclosed. I have no receipt for the servers. Also enclosed is the
invoice for the flowers at the luncheon which you said you would pay directly.
If you need anything else, let me know.
Love,
"'-
C~7{;JJ~
.
WINE & SPIRITS STORE 3614
2076 FRUITVILLE PIKE
LANCASTER PHDNE #519-4300
GIFT CARDS
THE PERFECT GIFT
3614 002 A 00514277 9848
~REWERS OUTLET
111 BUTLER AVE
LANCliS I ER. PA 17601
4587 BOLLA CHARDONNAY
* 6 AT 14.99 89.94
7666 MONDAV PVT CHARD
* 6 AT 21.99 131.94
6756 COPPOLA CHARDONNAY
* 12 AT 15.99 191.88
6321 STOLl VODKA 80 PF
1 AT 33.99 33.99
5412 BACARDI LIGHT RUM
1 AT 20.99 SALE 20'99
7082 DALMORE SCOTCH
1 AT 32.99 32.99
7609 KAHLUA COFFEE LIQ
1 AT 37.99 37.99
4288 CHIVAS 12YR SCOTCH
1 AT 61 .99 61.99
23698 TERRALE PRIMITIV02
1 AT 6.99 6.99
23698 TERRALE PRIMITIV02
1 AT 6.99 699
6001 COPPOLA MERLOT
1 AT 17.99 1 -, 99
( .
6001 COPPOLA MERLOT
1 AT 17.99 17. 99
5383 COPPOLA ROSSO
1 AT 8.99 SALE 899
5383 COPPOLA ROSSO
1 AT 8.99 SALE 8.99
6632 R ZABACO DB ZNFDL
1 AT 9.99 SALE 9.99
6632 R ZABACO DB ZNFDL
1 AT 9.99 SALE 9.99
SUBTOTAL 689.63
6.0% SALES TAX 41 .38
TOTAL 731 ..01
Merchant TO: 309200101781
Term !D: 767qq996
Ref U: 0002
~ale
rmuuml8~lb
~~~r tntrv ~et100: ~wiPed
r otal: d~, (~
~~/12I~~ 11:4~:~~
Inv n: ~~~112 ~ppr ~ooe: ~~11
~pprovea: ~nli ne ~atcn ff: O~~
Customer COPY
THANK YOU'
INVOICE NUMBER 08194039
Credi t Card 731 .01
MasterCard Card Nu~ber
************8576
Auth It: 080517
TOTAL UNITS SOLD 37
ORDER PREMIUM WINES AND SPIRITS
ON THE PLCB WEB SITE
WWW.PAWINEANDSPIRITS.COM
CUSTOMER COpy
3/22/05 12: 42
.
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REV-"'2 EX. (1-97) ..
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
L.
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COLLINS. JA/J1ES
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
;? 1-0$- ~7o
1.
AMOUNT
~.
8,fll1A'CG" DUG" 0'" ~/.r/f C!tedd 0urI Me/: ar Ih~ 1st
Tedem/ ~r Un/on (See J'IlIJUzhiJ" /e./Iu- ~/hukd E' .fdtul..G.)
Pe.trntl. Am. Iverkr t1,.
~
~/I. 32
Jl' 3o.s8"
fell. if 0
~27. cff
1'2.:?i?1
~7 'I. 3S
JI'
if 39, s-3
~, 3,.. S'~
" 9f.. () ~
~;;07.bl
13tJ.oo
3.
Ver/u"
~
~,cJJL
eo/ll~qst {'/t-6kv/st',11
L'M/er ;f.//M /PU//1S-kj:!" JelVer/7Tus4.
lPJo//A/e -f. /Jt//ltr, /.A-~ &/1.
S-Io ra.~ '11y6 sit a, .
L 4,....ys A-c.cto Stt./blJ
FD ~ter$ Au,iDtI1DH ve, :MG.
l<e,'mbl.l.rS(W1lrl" ~ Ch4J-'les E. 511;eld~ TiI -h,r Pb~~J
cer+"~'ed h1ll;"'n'1~, pht;/-r;Ct>P;~$1 dz. relaJeeJ 1i> E:~f. A-&/".,;". (~sh4,.)
.s:
6,
7.
3.
9.
/0.
II.
TOTAL (Also enter on line 10, Recapitulation) $ I, ~ (J 'I. f 0
(If more space IS needed, insert additional sheets of the same size)
REV-1513 EX + 11-97)
SCHEDULE J
BENEFICIARIES
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CO/..t/AJ5, THA/€S L.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. IYI a.rJ /Ef,"ZtJ bef!. (11, Ie
5"07 AI. UW,',sburv lit/., liIechtJ.n;csbu"'~, I1A
../ (/i70~
~. Cor;nn~ P.c. (;;Jl3ut
;l1/ g"<<JK Htrl11.$ RtI., LfJ,nC/lsnr, fJA /7"01
.3 . R.D lat.r-t 13. &If; n.s
"3 13/u.e.~i /I 1:>...., Elfers, PI'} /13/Cf
If. G,.e.!/)ry t<. ~I//n.s
~f1 LtL",d Dr., Ha./twooal,I'A /7S3'Z
.s: stac;~ L. I(''''S$~//
5/)61 .E E/AlUJl'Jlu/ Me. /!pi: 'I, 1J1~e/,lln;cs 61.{ ~
~A /7DS"r::
(sh4N. Ii ~ lWP"'f 7i-.,.s~e "Pl4~)'E. t}6~)
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
dau.B'" f-~
d a.ugh fer
SOh
~()n
e;/~nter
~/-OS"-:l70
AMOUNT OR SHARE
OF ESTATE
y:;-
Ys-
y:!:"
Ys-
)/S'
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 JAMES L. COLLINS
I, JAMES L. COLLINS, of the Township of Lower Allen, County of Cumberland,
Commonwealth of 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 five (5) children in equal shares, per stirpes, to
wit: MARY ELIZABETH COBLE, CORRINE PATRICIA GILBERT, GREGORY RICHARD
COLLINS, ROBERT BRENDAN COLLINS, and STACIE LOUISE RUSSELL.
2a. (1)
The share given immediately above to my daughter, STACIE L. RUSSELL, shall be paid
over to MARY ELIZABETH COBLE, Trustee, in trust, to be administered upon the following terms
and conditions:
My beneficiary's said share shall be maintained separate and apart and shall be invested in
good and safe investments with a reasonable rate of return. The income therefrom shall be payable
to her for life. However, the frequency and period of such payments shall be strictly, solely, and
absolutely in the discretion of my said Trustee. In the event that my said Trustee, in her same
aforesaid discretion, deems it wise and/or prudent to do so, she may make such payments directly to
anyone or any entity providing services or care to my said beneficiary instead of directly to my said
benefi ciary .
In the event my said Trustee, in her aforesaid discretion, deems it necessary for the absolute
welfare of my said beneficiary, after taking into consideration all other sources of funds, support, and
maintenance, as well as other properties, of my said beneficiary, my said Trustee may invade the
corpus of said Trust and make payments from the corpus in the manner aforesaid.
In the event the said MARY ELIZABETH COBLE is unwilling or unable to act or to
continue to act as Trustee, I appoint my son, GREGORY RICHARD COLLINS, to act in her
place and stead. In the event he also is unwilling or unable to so act, I appoint my son-in-law,
PATRICK COBLE to act in his place and stead.
2a. (2)
I direct that the interests of my beneficiary in the Trust hereby created, whether in the
corpus or income thereof, shall be free from liability to attachment or other legal process issued at
the instance of any creditor or assignee of such beneficiary, and I direct that no payment shall be
made by way of anticipation of sums which may thereafter accrue to my beneficiary.
T/'- /~
'"'
....
"
3.
I nominate, constitute and appoint my daughter, MARY ELIZABETH COBLE, to be the
Executrix ofthis my Last Will and Testament. In the event my said daughter, MARY ELIZABETH
COBLE is unwilling or unable to act or to continue to act as Executrix, I appoint my son,
GREGORY RICHARD COLLINS, to act in her place and stead. In the event my son,
GREGORY RICHARD COLLINS, is unwilling or unable to so act as Executor, I appoint my son-
in-law, PATRICK COBLE to act in his 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 Of sit day of
~ ,A.D.2003.
~ J~(~AL)
ES L. COLLINS
Signed, sealed, published and declared by the above-named JAMES L. COLLINS 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.
~~~4
9:1~ 71:~