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Home My WebLink About94-00991 ;..l,i , ';:,,-, Sworn to or Ilrnrn~elN lInd berore me thl~...,.;,: D 7. l'N IcR 11 fARtt ./. " IJ.&.J.J Mil C. LEWIS ftf- ;;),,/q - / . _. ,,,",'- l..~~M",..c"~ ' ~-- PETITION FOR PRODA TE and GRANT 01<' UnTERS .;l J - 9-'1'_ - '?CJ I Estate (if l/ /.! e: ~ n also known as M Wh"ATt. No. To: Reglsler nI' WUldU~lbl' Deceasec/. CllllJlIy or CUM, tlCLAND In Ihe SocIal Securlt)' No. 190 <,iL (,,~ 1./ ConlJnonwenllh or "enn,Ylvnnln The pellllon or the undersigned respeclrully represenl. thlll: Your petllloner(.), who Is/are 18 years or Ilge or older Iln the exeeuI.l.!A In the la$1 will or the abol'e decedent, dated and eodlcll(.) dilled named , 19.93- ('llue reJe,'anl drclllmlan"-cil e,g. renundallon, deOlh or e\"'lIlnr. elt.) Decendent wa. domiciled at death In ~",l! tJL'nI.A.vLJ h p II la'l ramily or principal re.ldenee at :J 7,:) f"t:> fi" 41f t:' ,/9#1' "'n. e.. (list 'Irecl, number and rnul1dflolh)') Connty, Pennsylvania, wllh /' H" /k:LJ A;(1 Deeendent, then g~ years or age. died Ot:T /~ .19 f'f' at~.,r: P/Mr:~ #Av~,I/ 1t/~5' . Excepl 0. rollows, decedenl did nOI marry, was nOI divorced and did nol hove n child born or adopled aner execution or the will orrered ror probnte; was nOlthe victim or II killing nnd 11'11. never adJlldlcaled Ineompelent: ,A/ /J Deeendenl at death owned property with e.timated I'lIlues ns rollows: (II' domiciled In Pa.) All personlll property (II' not domiciled In Pa.) Personal properl)' In "ennsyl\'nnlll (II' nOI domiciled In Pa.) Personal property In Connty Value or real estate In Pennsyl\'ania .lIualed as 1'011011": S-Nt'OtJ. (J(J S S S_ WHEREFORE. pelitloner(s) respeetrull)' rellllJ:\lL\)Mtl\~Tl)lOhllte ur Ihe III.t 11'111 and eodlell(s) pre.ented herewith and the grant or lellers I tST/I EN /IllY Iheron. (h'\llllllenllll)1 Rllllllnhlllllllll1 ",I.Ii.; RtlmJnhlflulon d.h.n.e.t.a.) 'Ii j~ ~. ~oJ~-<;/-,....92 .1'Ji.:= l~ M$OLJAA/N ./JtNU-J~/~..2I1.tJ":' -" -0. E- 00 a 5. Vi ".>, '_','q_~."_._.__-.,,u,~,~~ ,- -,~-~. ',"-' "'.~..~--,,-...- -'--~------ -=.;:;''!lo:!'~~~--=''''\',f~t!i.'4Jf~~::;';;'~~~' OATH OF .JEHSONAL IUWHES.~NTATIVE COMMONWEALTH OF I'ENNSYI.VANIA } HH COUNTY 01<' CUMBERLAND The pelltloner(.) abo\'e.nllllled .",eurls) or IIrnrlll(S) Ihlll Ihe S1l1lelllelll. IlIlhe rllregolng pelillon ore true and eorreel to Ihe best Ill' the kllllwledge 111111 heilerill' pelill,,"er(.) 1I11l1IhlllliS persolllll repre.en- Inll\'e(.) or the abo\'e deeedelll 1><'lltloller(.) \1'111 lI'ellllllll truly lIdllllulsler Ihe e.llIle lIeellrdlng 10 law. . ~,?"d--t[-U'fSL ~!-~. !!> ..' ~ ~ ~ .\ . No, 21 - 94 - 991 Estate of VELMA M hERTZ , Deceased DECREE OF PRODA TE AND GRANT OF LETTERS AND NOW NOVEMBER 23, 19~,ln eon.lderatlon of the petition on the rever.e side hereof. .atl.factory proor having been pre.enled berore me. IT IS DECREED that the In'lrument(s) daled 1993 described therein be admilled to probale and filed or record as the la,t 11'111 of VELMA M WERTZ I ESIAMENIARY DALE A WERTZ SR and Lellers are hereby granled to FEES Pro bale, Lellers, Etc. ......... Short Certificate.( 1) .. . . . . . . . . Renunciation ..........,..... . X-Page JCP \ /j ~' f:i'1 BwKtJ ilf /1-,,;/ l / , 1 n.n f L<...lt::JJn . (j Rell.ter of Will. MARY C. LEWIS Filed S 25.00 $ 3.00 $ $ 3.00 5.uO TOTAL - $ 36.90 .... .~9mmR .~~,. .m~.......... ADDRESS A170RNEY (Sup. Ct. 1.0. No.) PHONE Mailed letters and order to Executor on 11-23-94. III nl "." II ~ \' ',... n..~ * H....~"' """... This is to n.:nil)' Ih.1t 1111..' illlUllI1;llillll hl'll' ~i\t'n ... 1I1I1P Ih ll'I'II ,III' fill III 'flll'lIr.d II 111111 ,111'111 \11,1111 Illd)' lilt'd wilh 11Il.' ilr. I.ndl Hl'gislf<lf. The origill.tl n'rlificlll' '0\ ill IX' tlll\\ .lfd"llll lilt ....t.l11 Vlld HI' 1,1\1-. I 11111' 'HI I't 1111.1111 III III"I~ WARNING: ilia lIIogallo dupllcAto lhll copy bV phololtAl or photogrAph. Fcc (or this n:nificlllt.'. $1.0(1 sI./v.1u .8.cCJ~ ,7It'1I Hl'~I~llilt 2523172 > {)(k',-lf;.. LffY---- \l.lIe --.--.'--..--- No. "'l'II4JAt.'" COIllMONWU\.1H 0' PENNSYLYANIA 'D[PAR1MfH1 0' HUUH' VITAL RECORDS CERTIFICATE OF DEATH . , ,,"'u' .. - r'" _' Ii. \.l).~,'\::... I ~f:lY'I,\,: .. ....,. .....0 .~D (,.), '" :.t IJ '! ....~.".. ., . .'"J."-: 1_ ,..,r~ ,............, -'.,1 - ~ ~'"w 7lt .. . ',~^', ...._~~ . -'. 'v)\";\'(~ " . , \ '-.. J(""lj~..,."..,...1 """ ,..~:~..,;;.::;J.;'f' ,"",\' ....,\...,.. ..... ,..-.'1.....".......... 1...0-.___. tJ('1C(11T.t,IA'_~......... ~', I- C..\v,.. 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(,- '-~ ,..~ #1..( [i II ...... -....... , /'. . .,.,_.'u............,. ....DIUl.........".cIll'lC...1II 000.........-'..__..._...........'1_ ...""..._......._...lilflt._ ................ ....._..""......1.'.... Il'--'" "'lH ' ... " .11.,,' t.. ."';""'1'1,"..""......' ..;:., ---.- ....)- _ " ~"\'1 L.f . ).f l ....... .':'r _1""'_1..,_ L(J"f\L~1 .. ,,,< .~.._~. 21 - 94 - 991 . '"'-,. -.3-".- ., ~_i ., j ,I 1.1 .-.- :-, .). ,...... -""'.' a . ....... LAST WILL AND TESTAMENT OF VELMA M. WERTZ, I, VELMA M. WERTZ, married woman, of the Borough of Mechanlcsburg, being of sound and disposing mind, memory, and understanding, do hereby make, publish, and declare this as and for my Last Will and Testllment, hercby rcvoklng and making void any and aU Wills by me at any time heretoforc made. 1. I direct my hereinafter named Execulors to pay aU of the expenses of my last illness, my funeml expenses, and nil of my just debts not barred by the stlltute of IImitlltlons as soon after my death as may be found convenient to do so. 2. I declare that I am currently married to Chester A. Wertz, and that I have three (3) children, Dale A. Wertz, Sr., Betty Shapiro, and Norman Wertz. I further declare that I have no other children by this marriage or otherwise. 3. AU the rest, residue, and remainder of my estale, real, personal, or mixed, and wheresoever the same may be situate, I give, devise, and bequeath to the exclusion of my husband, Chester A. Wertz, in equnl shares to such of my children as shnll survive me by a period of ninety (90) days, the share any deceased child would have received to pass to his or her Issue per stirpes, and if there be no Issue such share shnlllapse and be added to the remaining share or shares per stirpes. At the present time I have three (3) children as aforementioned. 4. Should any person less than 21 years of age be entitled to distribution from my eslate, In such event the share that person would otherwise have received shnll be pnld to my hereinafter named Executor, In trust. I authorize the herein named trustee or guardian 10 receive and invest the same, and to pay the Income arising therefrom, together with so much of the principnlthereof as in his or her opinion Is necessary or desirable to be expended for the proper maintenance, support, and education of such person, to or for the benefit of such person, and upon such person attaining 21 rears of age to pay to him or her the then remaining principal together with any undistributed Income. S. I have personnlly made no provision for my husband, Chester A. Wertz, not for any want of affection but because I have made adequate provisions for him during my lifetime. 6. I hereby nominate, constitute, and appoint my son, Dale A. Wertz. Sr.. as Executor of this my Last Will and Testnment. but should he predecease me or fail to qunllfy, then in such event I nominate, constitute, and appoint my daughter, Betty Shapiro, as Executrix, and I further direct that neither of them shaU be required to pOSl any bond to secure the faithful performance of his or her, duties in the Commonweahh of Pennsylvania or In any other jurisdicllon. 7. In addition to the powers conferred by law. my herein named Executors and Trustees are empowered: a. To Invest any part of the tnJst corpus in such securilies, investments, or other property as may be deemed advisable and proper, irrespeclive of whether the same are authorized for the inveslment of trust funds under the laws of any governing jurisdiction. b. With respect to any corporation, the slocks, bonds, or other securities of which may be held, to vote In person or by proxy on any shares of stock; to consent to the merger, consolidation or reorganization of such corporations; to consenllo the leasing, mortgaging, or sale of the property of any such corporallons; to make any surrender, exchange or substitution of such stocks, bonds, or olher securities as an incident to the merger, consolidation or reorganization of such corporations; to pay aU assessments, subscriptions and other sums of money which may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations; to exercise any option or privilege which may be conferred upon the holders of such stocks, bonds, or otter securities of such corpOlations either for the conversion of the same Into other securities or for the purchase of additional securities, and to make any and aU necessary payments which may be required in conneclion therewith; and generaUy to have and exercise as to nil such stocks, bonds, and olher securities, the powers of an individual owner who is under trust obligation. c. To hold the tnJst corpus in one or more consolidated funds in which sepomte shares shnll hove undivided interests. d. To seU al public or private sale for cash or upon credit, or partly for cash and partly on credit, and upon such terms and condilions as shaH be deemed proper, any part or parts of the lJ'Ust eSlllte, and no purchaser at any such sale shall be bound to mqulre into the expediency or propriety of any such snle or to see to the application of the purchase money arising therefrom. Page 1 of 2 pages . . ,..., e. To keep on hand and uninvested such moneys as may be deemed proper and for such period as may be found expedlenl, f, To compromise, scllle, or arbllnlte any claim or demand In favor of or agalnslrhe trusl estate. g. And authorized In the discharge of fiduclnry duties, to employ counsel and to detcnnlne and to pay such counsell'Cl\sonable compensation which shall be charged against rhe principal or lricome of the trust fund, and shall further be entitled to charge agalnstrhe principal or Income such orher reasonable expenscs and charges as may be ncccsSlll')' and proper to Incur for the proper discharge of fiduclnry duties and for the proper management and ndm1nlslnltion of rhe trUst eslllte. h.ln mn1dng any division of property Into shms for the purpose of any distribution thereof directed by the provisions of rhe trust, to make such division or distribution, elrher In clISh or In kind, or plU11y In clISh and plU11y In kind, lIS shall be deemed most expedient, and In mn1dng any division or distribution In Jdnd may allot any specific security or property or any undivided Interest rhereln to anyone or more of such shlll'Cs, and to that end may appraise any or all of rhe property so to be allotled and the Judgment as to rhe propriety of such allotment and as to the relative value for purposcs of distribution of the secUrities or property so allotled shall be final and conclusive upon all personslnteresled In the trust or In the division or distribution rhereof. IN WITNESS WHEREOF, on rhls page 2 of2 pages, I have hereunto set my hand and seal to rhls my Last WII1 and Testament wrI11en rhls day of , 1993. 7111)1.A'-6 CJJ2.,1*,,- ,({. tu~ . \,:,.Jl VELMA~. WERTZ (SEAL) . . . Signed, scaled, publlshed and declared, by VELMA M WERTZ, rhe Tesllltor above named, lIS and for his Last Will and Testament, In our presence, who, In his presence, at his request, and In rhe presenccof each other, have hereunto subscribed our names lIS atlesting witnesses. . .. Nctllllj~n1 ~..... ~ J,JCl'J1 A. Sl<rot. N<:I-11Y 'vvov l!<r.1P",,",llOOlTw ..lfwbn,~CoJrIY t.\iC',(lI""""",R'1'IIl.AlI\l...,OO3 lz:fL tL",U (I~t _ McnW. f\JrR:\t.nrio 1\:,,.ocllo\04 JII;J\.,o\f." ~\r-. ~\1 ~n ). ~ ~. Page 2 of 2 pages 21 - 94 - 991 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF WITNESS TO WILL J<;XEC;LJn:U DY MARK Q0 c. , ') . \/.: "T' :t)i"'.\ ':, "J C-l .....;;: \J ~ ~ ~C'l "\\\. \..De ~ ~ f'"..l hj \rJ J; D"J (;1(, ,,-,'I .\j< )"::4. , (ellch) codicil a subscribing wllness to the 11'111 pre.ented herewilh. (ellch) being duly quullned uccllrdlug 10 law, depo'e(s) and say(s) thai: leslal__ 11'11. unllhle '" .lglI h__....._ nlllllC Iherelll; te'III1.. ..___'s nllllle was subscribed therelo In le.tuI__'. presence; leslllL_ mude h._.___ IIIl1rk Ihercon; leslat_ and deponelll(s) was (were) pre.ent when leslllt.__'. nllme wa. 'lIb.crlbed und codicil when leslat__ made h_ murk; and le.laL.___ was pre'CIIl whelllhc undersigned .Igned the will ns wllnes.(es). Sworn 10 or arrlrmed and slIb.erlbed before me Ihls If JJ. dUY or /:J~"::::~ "-U- 7 RCI/lster E'\.. f' : ,. n ~ 1 \er \-P,) tNlIl11d) 6/)~~~~~~\~ 0' I (Nomc) -~aiiil.' J.xft1A.Sld,~ ~:OIlicr1~ec..iO,~ (AlltJrL'~~1 . ".'........,- ,..., .. ... _.~.','" ,-.,....---,-......-.~--..~~---......~ --~." .-.,.,,>-,'....-, 21 - 94 - 991 REGISTER OF WILLS OF CUMBFRI AND COUNTY OATH OF WITNESS TO WILL f;XECUTED DY MARK on c: ..,' :,1 I' \d ~'''l :u .,".([) ';"i to, ".',:.) :. I.J~ JlI. (u'~ G ""':.;.; r-...> ,-...> 'i) ~_ "f. "J \,~) !.' .,l.,. (; " '(rllch) codicil a subscrlblns witness 10 the will prrsented herewith, (ellch) heing duly l\llIIlIncd IIccllrdlllg 10 luw, depo.e(.) and say(.) that: Icstat_ was unable III .lglI lice..... nll/lle IlIerelU: lesllll. ..__.'5 nlllllr wa. subscribed Iherelo In teSlat_'. presence; tcstlll_ Illudc lIe.c_ mllrk thereon; le.tal_ and deponent(.) Wll. (were) present whclI lestlll.___'. nlll11e was .ub.crlbed und codicil when lestat__ made II.!3:- murk: and te.tat____ wu. prL'sclII whcnlhe undersigned sign cd the will us wltness(e.). Q"~'d. ./4.'''''''- 4 IN."'.I 770 .A~4tkd &.C'Y1U t^tl~'l:U} Sworn to or arrlrmed and .ub.erlbed berore me thl. ~/ INulIll:) . Seal Tn.'m1'( 1:.' Ni'lter. _~~'IV.JlY.' "'.Y Twp,. UCl1;s eooJr.ty MvCormssion exp;c""foo, :'5.1!l(\'.) oI/11Dl.11'oc!' (Alldr~"\J -..;~~.;"';';;";'i.~..,;o.~~~"-"-~"'-'C- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Velnla M. Wertz Date of Death: October 14. 1994 Admin. No. Will No. 21-94-0991 To the Register! I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court :Rules was served on. or mailed to the following beneficiaries of the above-captioned estate on December 12, 1994. : Name Address Mrs. Betty Shapiro, P. O. Box 20B, Rockhaven Road, Kerhonkson, N. Y. 12446. Mr. Norman Wertz, 318 Gardon Avenuo, Wllllamstown, N. J. 08094. Mr. Dale A. Wertz, Sr.,126 North Locust Polnt Road, Mochanlcsburg, Fa., 170.5.5. Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Datel December 12, 1994 rf)~ Ii .(J 4- ]:1-- Signature Name Dale A. Wertz, Sr., , , "'.-,. Address 126 Narth Locust pt. Rd., r,,:', ('J MeohanlcsburK, ra., 17055. Telephone (717) 76 6-5640 Ll ,.:::1 Capacity I x Personal Representative Counsel for personal representative "T~ I '-~ ""-.. f)"~ , '," .~"; '::'1 UU ; . .EY.Ut'lbr'll:. 1M') 8 Iil &l '" ~ ":Sl:/ &lIEu "''''9 uE'" 1iI8 "'= "'. 132 z ~ ! '" '" ~ .. = u ~ ... * ,lv,J. ';J.-;;{3'.9 'I " 'O~A~ O. DIA'H AnlR 12/31/91 CHICK HIRI " A SPOUSAL POYIRTY CRlDIT IS CLAIMID 0 fill NUMIIR INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) COMMONWEAltH Of ,fNNS'flYAN1A DE'ARtM(NI 0' -IVlNUl DEP!. 2110bO H....IlIUUIIQ 'A 11 211.0bOl o I IN' NAMI ItA'" fillS, AND MIOOI W,rb V,1.II& ". SOCIAL lIeUIIII'f NUMa~1I 190 46 6261 INIIAtl 2104-0991 COUNTY {ODE , YEAR 1 NUMBER DlelD N. OM" . DOl B1111 Rid<<l Hay. t w,t 710 poplar Churoh lid., OIutp H111, fa., 17011 Co",n' _~~"'u INStIIUellONSI DAII Of alllH Mar 12,1910 1. O,lglnal Return o 2. Suppl.m.ntal R.luln o 3, R.malnd.r R.tu,n (lor dOl" 01 d.o,h prior 1012.13.82) o 5. F.d.ral fllat. To. R.tu,n R.qulr.d .Q.. B. Total Numb.r 0' Safe Oepodt BOlli. o A. lImlt.d Ellal. 0 40, futuII Inl.r..1 Comp,oml.. Ifor dalel of d.ath ah.r 12.12.82) o 6, o.c.d.nl DI.d Tellale 0 7. Dend.nt Malnlaln.d a lI...lng Trult tAllach copy 0' Will) IAllach copy of Truu) ALL.CORRUPONDINCI AND CONPIDINnAL TAX INfORMATION IHOULD BI DIRICTlD TOI. OM'U I MAIUN A 011 1l&1' A. Vert. 126 Horth Loouat PDlnt Rd.. M,chanic,burs, fa. 17055 ".'~'.\h;;.: i ;.' '1'~'-~-; .: ;~'-;J-; " '-r':: 1. R.al E,'OI. (Sch.dul. AI (I) 2. Slac~. and 8.nd. (Sch.dul. B) (2) 3. Clo..ly H.ld 510c~/Par'n...hlp In'"..' (Sch.dul. q 13 ) A. Mortgag.. and Nol.. Rec.l...abl. 15ch.dul. OJ t .. ) So Co.h. Bonk O.po.lh & Mllcellan.ou. Peuonal Prop.rty ( 5 ) (Sch.dul. E) 6. Jolnlly Own.d Prop"'y ISchedul. FI 7. Tranal"'ISch.dul. GI(Sch.dul. II 8. Tolal Gran Au." Ilotallln.. 1.7) 9. Fun.ral Ellpen..., Admlnlllratl.... CO'I', Mlleelloneou. bp.n... ISch.dul. H) to. D.bl., Mortgog. 1I0blllll.., II... (Sch.dul. II 11. '0101 D.ducllo.. (Iolollln.. 9 & 101 12. N.t Valu. 0' EIlal. (lln. 8 mlnu. L1n. 11) 13. Cha,itabl. and Go".,nm.ntal B.que'" (Schedule JI lA. Nel Value Subl.cllo To. (line 12 mlnu. Une 13) 15. Spousol T,anll.,. (for do'" of d.ath aft.r 6.30.94) 5.. In.uuellon. for Appllcabl. P.rcentag. on R.....rll (1.5) Side. (Include ...alu.. (rom Sch.dul. K or Schedule M.) 16. Amount of line 14 ta.obl. 01 6% rat. (Includ. ...alu.. from Sch.dul. K or Sch.dule M.I 17. Amount of lIn. 14 ta.abl, 01 15% rat. llnclud. valu.. f,om Sch.dul. K or Schedule M.) 18. Prlnclpallax due (Add tax from lIn.. 15, 16 and 17,1 19. Credl" SpouscO ,d)Q.ty Credit P,lor b:5lfI. + + 20. If lIn. 191, gr.al.r than lIn. 18, .nler th. diff.r.nce on lIn. 20. Thl, I. th. OVERPAYMENT. ElD 21. If lIn. 18 It gr.aler than lIn. 19, .nl.r ,h. difference on lIn. 21. Thh I. ,he TAX DUE. A, Ent.r th.lnl.r..' an Ih. balance due on line 21A, B. Enl.r ,he 10101 of lIn. 21 and 21A on lln. 218, Thi. I.th. BALANCE DUE. Mak. Check Payabl. tal R.gII'er 0' Will., Ag.nt 256,.8J (61 (7) 6422.43 .xxxxxx" (9) };}"'7.' , ,. . (8) 256s.83 (II) ~.43 (12) OlIO 0.00 (13) IJ) 0.00 (141 x._- 0.00 )( ,06. 0.00 )( .15. 0.00 (18) (19) 0.00 (20) 0.00 (211 (21AI 0.00 (2t8) (10) 0.00 (16) 0.00 (171 Di'lJVOO In~:/jo Chcck hell' if you ore requl'sling a Il.fund of your overpayment. BI SUR. TO ANSWER ALL QUIUIONS ON RIVIRII SIDI AND TO IICHICK MATH Und.r p.nalll.. of p.rjury. I d.dar. that I ha.... lJtamin.d thi. r"urn, Including accompanying tch.dul.. and .Ial.m.n". and to th. b." of my knowl.dg. and b.li.f. It It tru., con.ct and campI.,., I d.c1a,. Ihal aU r.al ..10'. has been report.d 01 Iru. mark.1 value. D.c1aration of pr'parer olh.r than the p.r.onal r.pr...ntoU.... I. bated on all Information of which pre ar.r hat any ~nowl.do', " lu", 0"'1'0~'ON" 110' ""NG ""UIN 1 'If 1 Loou,t Polnt. Rd. ,M,ah, 1'&..1705S i~i'22/94 SIGNAlUlIIl 0' '1IIf.'AII(III OlH! MAN lU'"UINIAlIV! AODIl!U DAIf j ~. I . . lli~-,"::-.'':;'_.\ t..:"_"",,... '~"' ',...",-.~,C_',.,,,,,..~,.._..;,,:.~,.-....., '".'0..-", . .._- '" ....- -"'~; . r 4". Ad .41 ef 1994 provld.. for the r.dudlon of the tax rat.. Impo..d on the n.t valu. of tran.f.r. to or for the UN ef the ....u... Th. rat.. a. pr..crlb.d by the .tatut. will bll . 3% (.Nt wIN IN appllcabl. for ..tat.. of d.~.d.nll dying on or aft.r 7/1/94 an" b.for. 1/1/96 . 2% (.111 wIN IN .ppllcabl. for ..tat.. of d.c.d.nll dying on or aft.r 1/1/96 ond b.for. 1/1/97 . 1% (.111 w>>1 IN appllcabl. for ..tat.. of d.c.d.nt. dying on or aft.r 1/1/97 and b.for. 1/1/98 . Sp,v'" .,...fer. occurring on or aft.r 111/98 will b. .x.mpt from Inh.rltanc. tax. PLEASE ANSWER THE FOLLOWING QUESTIONS IY PLACING A CHECK MARK (.--) IN THE APPROPRIATE BLOCKS. IS 0 1. Dill _....nt mok. a transf.r and: y \ a. r.taln the us. or Income of the property transferred, ...,............................................,....., b. r.taln th. right to d.slgnat. who shall us. th. prop.rty transf.rred or Its Income, ............... . c. r.t.ln a reversionary Intere..; or ..."..........,.....",..............,.......,..................................., \( d. rec.lv. the promise for life of either payments, benefits or care' ....................................... 2. If death occurred on or before December 12, 1982, dId d.cedent within two years preceding d.ath transfer property without receiving adequate consideration' If death occurred alter D.c.mb.r 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration............,...."........,.. 0.'...'...............,......,.., '"I....'."".",.......... ,.,.. ...,. x 3. Old deced.nt own an 'In trust for' bonk account at his or her death'...................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,t; '<i'l2""";'....,~,c::_.,;,..oc''O,:_,., a'lll.lI. P.'lI '* SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Ploa.. Print ar l 0 FILE NUMBER 2l9lt-099l COMMaNW!ALfN ar ~!NNmYANIA INN.IITANC. fA lnulN ...IDlNt DIC DINT ES~ OF .. ft. left. IAlI ,repe"" Jolfttly-ew"'cI with the light .f aurvlvonhl, mu.I be dl.clo..cI 0" Schodul, Pt ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH 1 a.. II.... ..... ...... AOO\ :2 'l'laYe1en tMlda_ 00., ....flolaly oheok frCII hll8lan4 56,.8, 2000.00 t"nach additional 8)\- )C n- &hu,.1f 1110" .pac, I. needed,) ,.1M M. V.rt. ; ITEM NUMBER DESCRIPTION A. Funeral Explnsesl 1. Plank, Stitt, , stevena lunen.l Hell. . "'\"SIIII.I,.II . .e_\._~ . SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Plla.e Print or T e NUMBER 2194-099l COMMONWEAltH O. P(NNSYlVANIA INHUIIANCE TAX UIURN AUIDEHT DleEDENI AMOUNT 5521.00 B. Admlnlstrallve CoStsl 1. Pe"onol Repre.entallve Comml..lon. 209 _ 20 - 'l4O' Social Security Number of Pellonal Repre.enlallve: Year Comml..lon. paid __ 0.00 2. Allarney Fee. 3. Family E.empllon Claimant Addre.. of Claimant 01 decedent's death Street Addre.. City Slate Zip Code Relallan.hlp 4. Probate Fee. 36.00 C. MI.cellaneous Expensesl I. .. R. OUpplll, Maye .tOM and. .1I8ft" dati death dat. lIarMra nowra 55.,00 193.18 2. 3. 6.00 lIlul Rldp *ven V.et cabll tv b111 PlaDk, Stitt, , Stevena burtal Draee ItO. TellJlhCllll b111 ralatlvee, fUMftol paUar, lnauranOl oa'e u11 , oertlfled Mall HIlln Vattl1'l flo..n far a"l~ HoUlda~burs, Pa, , upkelP 4. 110.00 111.60 17.65 3og..00 s. 6. 7. B. TOTAL (Also enler on line 9, R,copltulallon) (If more space I. nllded, Insert addlllonol .hll', of saml size.) s ~~~ 12Z.Ij.J . ~, .~y UII"_ 111'1 -!ti COMIrIIONW'''''" Of .',......"Vlo,..I' INHII"ANCIIAI _nUIN IIIIDINIO"IDINI SCHEDULE J BENEFICIARIES ISTATI OP ,.. If. v.n. PILI NUMBER 1194-099l ITIM NUMBIR NAMI AND ADDRESS OP BENEPlCIARY RELATIONSHIP A. Taxobl. S.quII"1 AMOUNT OR SHARI OP UTATI 1. 1la1e A. ven. 11'.116 I. LOOII8' pt.. 114. "'011. III 110ft 0.'" 170" I. IGNaa v.n.. . OadOll AnINI. VUU...,OIl1I. BOft 0.'" II. J"., e8 ,. '" IJhaplro. P.O. ba 208 Jloallhaftn M. ,ltUhonb n Ilav&hwr 0.'" II. TCRIl 124116 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY 8. Charltabl. and Gov.rnm.nlal a.quIslll 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Allo .nlO, on IIn. 13, Rocopltulallon) 5 (II mart .pac. I. nood.d, Inoo" additional .hoo'. of .am. ....J AMOUNT OR SIlARI OP ISTATE IJ. ;?.; 7 - p- / JI/,Jllt/ - / RIV01547 IX AFP (12094* C~Al'H or PENNSYLVANIA IlEPAATMH' Of R[V[NUE: IUREAU Dr INDIVIDUAL fA.r, OEPJ. 11060. HARRIIIURO, Pi 1'."'0'01 ACN 101 DATI 03-20-95 !lOnCE OF INNERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX FILl NO. DATI OF DIATH 10-14-94 COUNTY CUMBERLAND NOT!. TO INSUR! PROPER CREDIT TO YDUR ACCOUNT, suaHIT TNE UPPER PORTION OF TN IS FDRH WITN YOUR TAX PAYHENT TO TNE REGISTER OF WILLS. HAXE CHECK PAYABLE TO "R!GISTER GF WILLS, AGENT" REMIT PAYMENT TOI DALE A WERTZ 126 N LOCUST PDINT RD MECIlANICSBURG PA 17055 REGISTER OF WILLS CUMBERLAND CO COURT HDUSE CARLISLE, PA 17013 I ~." AMount H..tttad :\~)(.... -' CUT ALONO THIS LINI ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiiV:isi,i-iicuAFiiom-:94riloYici(-o"-i-riiliiiifANci-YAX-'A-piiii1iiiiiifiilT~uAi.roiiANCi-o-Ii--_m_m______- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ISTATE OF WERTZ VELMA M FILE NO. 21 94-0991 ACN 101 DATI 03-20-95 APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funarll EXPln.../Ada. Co.t"Hllo. EXPlnl.. (Sch,dull HJ (" 10. Dlbh'Hortgagl LbbJl1tta./Llana (Schadull IJ no) . DO 11. Total Deduotion. (11) 12. Nat Value of Tax R.turn (12) 15. Charitabla/Govlrn..ntal aequa.t. (Sch,dull J) (15) 14. Hat Valu. of Eat.t. Subjlct to Tax (14) NOTEI If an a.....m.nt was i..U.d pr.viou.ly, lin.. 14t 15 and'or 16, 17 and 18 r.fl.ct figur.. that includ. the total of ~ r.turn. a......d to dat.. ASSESSMENT OF TAXI 15, A.ount of Line 14 .t Spou..l rate C151 1'. AMOunt of Line 14 ta_abla at LJneel/CI... A rat. Cl') 17. AMount of Line 14 taxable at Collateral/CIa.. B rata (17) 18. Prinoipal Tax Du. TAX RETURN WAS, I X I ACCEPTED AS FILED RESIRVATION CONCERNING ~U)ij~E INTEREST 0 SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL 1. Raal E.t.t. ISchadul. AI /1/ 2. Stock. and Bond. lSchadula al 121 5. Clo..ly Held Stock/Partner.hip Int.re.t (Schedule C) CS) 4, Hortgege./Note. Reoeivable (Schedule DI (41 5. C..h/Senk Depo.it./Hi.o. Per.onal Property ISchedule EI C51 6. Jointly Ownad Property ISchedule FI (6) 7. Tran.fer. (Schedul. 01 (7) 8. Tot.l A..et. CHANCED 00 c: rr ..n 3 -. 0\ r'-:-' .00 . .00 ~ .00 ;a - ., .00-.1 2,665.83 ;', .00 ~ " "\J L:. 00 b )-...... 0 lal 6,422.43 .00 .00 .00 K .03. K .06. K .15. 1181 TAX CREDITSI PAYHENT DATE RECEIPT NUHBER DISCOUNT l+ I INTEREST I-I AHDUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE · IF PAID AFTER DATE IHDICATED, SEE REVERSE FOR CALCULATION OF AODITIONAL INTEREST. ::0 :IJ (,) ~l n <J 0 ~.. ~ r, ~~. '; / :: I; the.. 2,565.83 f...G::>>? G~ 3,856.60- .00 3,856.60- will .00 .00 .00 .00 .00 .00 .00 .00 IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" lCRl, YOU HAY aE DUE A REFUNO. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I ",. _._,-,.~,-< ','. ,"-,"'.'" ,. -"~,'''''-'' -" -:",.,-" '-" " ~,- .-.....,..-,'~".'.,;..,', ~",' " '_ .r _......_. ,..-""""""""'~ . ..",. ~ u STATUS REPORT UNDER RULE 6.12 Name of Decedent I Velma H. Wertz Date of Deathl Ootober 14.1994 Will No. Pa No. 219'1-0991 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estatel 1. State whether administration of the estate is completel Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete I January 1995 3. If the answer to No. 1 is Yes, state the following I a. Did the personal representative file a final account with the Court? Yes No_____ b. The separate Orr~ans' Court No. (if any) for the personal representative's accolnt iSI c. Did the personal ~~presentative state an account informally to the parties in ir.terest? Yes No d. Copies of receipts, re:eases, joinders and approvals of formal or informal accounts m,IY be filed with the Cerk of the Orphans' Court and may be atta,hed to this report. Datel 12/12/94 se~re~' t~ M_ Dale A. Wertz Sr. Name (Please type or print) 126 N. Locust Point Rd, Hechanicsburg, pat Address 17055 (717 ) 766-56110 Tel. No. ,. I:. ('.) ':.) i'" c_ " --~ ;j UU Capacity: X Personal Representative Counsel for personal representative (MAHI rmf/AM3) ; """^' / IV STATUS REPORT UNDER RULE 6.12 Name of Decedent I Ve1mll M. Wertz Date of Deathl \0/1'1/19911 Will No. 21 lJIIQ91 Admin. No. 21911991 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estatel 1. State whether administration of the estate is complete I Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the followingl a. Did the personal representative file a final account with the Court? Yes No ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. en b-a.t,e: 11;/10/1996 ~- Drib 1/ {~?~_ Signat.ure r,~ '. .. , o,~ ,.. - VJ p\ wL _:J UU Dale A. Wertz Sr. Name (Please type or print) 126 North Locust Point Rd. Address ~ f- r~, " Meohllnlceburg, FR., 17055. ( 717) (766-5640~ Tel. No. Capacity: X Personal Representative Counsel for personal representative (MAH: rmf/ AM3) I, . i