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ESTATE OF Robert W. Herlt
Date of Death: Oct. 25, 2005
I
Social Security Number: 174-36-0237
RECEIPT, RELEASE, REFUNDING,
AND INDEMNIFICATION AGREEMENT
The undersigned, both Legatee and Executrix of the deceased
by virtue of marriage, does hereby:
1. Acknowledge that her husband, Robert W. Herlt, deceased,
died testate on Oct. 25, 2005;
2. Acknowledge that she has been granted Letters
Testamentary for the estate of Robert W. Herlt, her husband, and
that said Letters were taken out on November 8, 2005;
3. Acknowledge that preparation and filing of the within
First and Final Account, named Exhibit A, which has been prepared
to acquaint all interested parties in the transactions of the
estate.
4. Acknowledge receipt of the sum of the following:
(a) refund from Tricare Health Services in the amount
of $603.14;
(b)
refund from HP Invent, Citizens State Bank of
$50.00;
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(c) refund from eMachines of $50.00;
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(d) refund from Hershey Medical Center of $loo.do;~'
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(e) refund from Sprint Nextel of $13.69
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5. Release herself, as Executrix of the estate of Robert W.
Herlt, and her heirs and personal representatives, from all
liabilities, whether due to her negligence or otherwise, which
she may have by reason of her administration of the estate; and
6. Declare that this instrument shall be legally binding
upon her, her personal representatives, successors and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~~ day of May, 2006.
~ <..J- t.A~seal)
ancy C?Rerlt /
Executrix and Legatee
Subscribed and sworn to by
Sherry A. Rosenberry before me this
~_~ day of May, 2006.
~ a .1bu'~lf
Notary ublic
Notarial Seal
Sherry A. Rosenberry, Notary Public
Fannett Twp., Franklin County
My COMmission Expires May 5, 2007
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Exhibit A
FIRST AND FINAL ACCOUNT
FIRST AND FINAL ACCOUNT OF
Nancy C. Herlt
FOR
ESTATE OF Robert Wayne Herlt, Sr., Deceased
Date of Death:
Date of Executrix's Appointment:
Accounting for the Period:
October 25, 2005
November 8, 2005
October 25, 2005 to
May.25., 2006
Purpose of Account: Nancy C. Herlt, Executrix, offers this account
to acquaint interested parties with the transactions that have
occurred during her administration.
The account also indicates the proposed distribution of the estate.
It is important that the account be carefully examined. Requests
for additional information or questions or objections can be
discussed with:
Richard L. Bushman, Esquire
Counsel to the Estate
16767 Path Valley Road
P.O. Box 51
Spring Run, PA 17262-0051
SUMMARY OF ACCOUNT
Proposed Distribution to Bene-
Principal
Receipts
Net Gain (or Loss) on Sales or
Other Disposition
Less Disbursements:
Debts of Decedent
Funeral Expenses
Administration Expenses
Federal and State Taxes
Fees and Commissions
Balance before Distributions
Distributions to Beneficiaries
Principal Balance on Hand
For Information:
Investments Made
Changes in Investment Holdings
Income
Receipts
Less Disbursements
Balance Before Distributions
Distributions to Beneficiaries
Income Balance on Hand
Combined Balance on Hand
Page
Current
Val ue
$ 0.00
287.47
0.00
1,000.00
2
Fiduciary
Acquisition
Val ue
$816.83
$816.83
0.00
816.83
1,287.47
-470.64
0.00
-470.64
$
0.00
0.00
0.00
0.00
-470.64
Cash:
RECEIPTS OF PRINCIPAL
Refund from Tricare Health Ser-
vices
Refund from Hewlett Packard
Refund from eMachines
Refund from Hershey Medical Center
Refund from Sprint Nextel
Tangible Personal Property:
Realty:
Residence
TOTAL RECEIPTS OF PRINCIPAL:
603.14
50.00
50.00
100.00
13.69
3
Fiduciary
Acquisition
Value
816.83
0.00
0.00
11/8/05
11/8/05
11/8/05
11/8/05
11/28/05
12/12/05
11/8/05
DISBURSEMENTS OF PRINCIPAL
Debts of Decedent
Administration Expenses
Register of wills: JCP fee
Filing fee for Letters Testamentary
Short Certificates
Cumberland County Automation Fee
Cumberland County Legal Journal
Carlisle Sentinel
Recorder of Deeds (recording fee on
Family Settlement Agreement)
will
Filing fee for Release
Notary Public
Register of Wills (inheritance tax
return filing)
Federal and State Taxes
Register of Wills-prepayment of
inheritance tax
Register of Wills-balance of inher-
itance tax due on estate
Fees and Commissions
Richard L. Bushman, Esquire, attor-
ney's fees
4
0.00
10.00
45.00
20.00
5.00
75.00
93.47
15.00
5.00
5.00
14.00
.00 287.47
0.00
0.00
0.00
0.00
0.00
1,000.00 1,000.00
1,287.47
DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES
TO:
Risk Distribution
TOTAL DISTRIBUTIONS OF PRINCIPAL
TO BENEFICIARIES
0.00
, .
Cash
Interest
PRINCIPAL BALANCE ON HAND
RECEIPTS OF INCOME
5
0.00
0.00
0.00
DISTRIBUTIONS OF INCOME TO BENEFICIARIES
None.
0.00
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
Per Article
Cash
of Will:
Current
value
TOTAL:
Fiduciary
Acquisition
Value
0.00
0.00
6
Nancy C. Herlt, Executrix under the Last Will and Testament of Robert Wayne
Herlt, Sr., Deceased, hereby declares under oath that said Executrix has fully
and faithfully discharged the duties of her office; that the foregoing First and
Final Account is true and correct, and fully discloses all significant
transactions occurring during the accounting period; that all known claims
against the estate have been paid in full; that, to their knowledge, there are
no claims now outstanding against the Estate; and that all taxes presently due
from the estate have been paid.
~C?~6- ~A~
Nancy C:t 1 t ,
Executr~x
Subscribed and sworn to
Sherry A. Rosenberry, a Notary Public,
by Nancy C. Herlt this~th day of
May,2006.
Notarial Seal
Sherry A. Rosenberry Nota p
M Fanne~ T~p" Franklin C~n ublle:
COMmISsIon Expires Me 5, too?