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PETITION FOR PROBA n: and GRANT 01' LETTERS
No. _,;u - ?b -L~
To:
Estate oJ Hazel M. RelU:Qth
also known as
Regisler of Wills for the
, Dec.'ased. Cmmly of Cllmbe ria nd in the
Social S<<urlty No. 162 - 2 2 -713 7 Commonweallh of Pennsylvania
The pellllon of the undersigned respectfully represents Ihat:
Your pelllloner(s), who is/arc 18 years of age or older an Ihe execul r i x
in Ihe lasl will of Ihe above decedenl. daled Novembe r 12 ,
and codlcll(s) dated
named
19 90
,-
(,latc rde,,'ant cirCllm\lanCC~, C.I. renuncialion. dealh of CUCUlor, tiC,)
Decendent was domiciled at death in Cumberland e COJlDly"PeesnrsYylvaoJar'iwvileh,
h last family or principal c"idence at Bethan Villa 3Z5... e D
'-owe.. ll,-" IV' -
(lIsl 5UC'tI, number and munclpalilY)
Decendent Ihen 98 years of pge, died December 19, , 19 95
at 325 wesley Dr1 ve, Mecnan1csburg, PA .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probale; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled In Pa.) All personal property
(If not domiciled In Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate In Pennsylvania
situated as follows:
S150,000.00
S
S
S
WHEREFORE, petilioner(s) respectfully request(s) the probate of the last will and codlcil(s)
presented herewilh and the granl of lellers Testamentary
(testamentary; administration C.I.B,: administration d.b.n,c,t.a,)
theron.
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304 Shughart Ave.
Boilinq Sprinqs, PA 17007
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } as
COUNTY OF CUMBERLAND
Sworn to or affirmed and subscribed {
b~fore me this 5 th ~:g of
.January 19_
'tYJa"{j c. B:~'B~~~rL\ Register
J~ -7'- - 7
The petitioner(s) above. named swear(s) or affirm(s) that the stalements in the foregoing petilion are
true and correct to Ihe best of the knoy,ledge and belief of petilloner(s) and that as personal represen-
tative(s) of the above decedent petilioner(s) will well and truly administer the estale according to law.
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No. 21-96-12
Estate or Hazel M. Rexroth
, Deceased
DECREE OF PROD A TE AND GRANT OF LETTERS
AND NOW January 5 19-2L, In consideration or the petition on
the reverse side hereor, satlsractory proor having been presented berore me,
IT IS DECREED that the instrument!s) datrd November 12, 1990
described therein be admllled to probate and filed or record as the last will or Haze 1 M.
Rexroth
and Lellers Testamentarv
are hereby granted to Ann R. wi n ton
'/17rl IUd (l,.~. e:J?A 1A
Real.l.. of W b
FEES
P b L E $235.00
ro ate, ellers, tc....... . . .
Short Certificates! f) ..... .. ... $ 1 R . 00
Renunciation ................ $
x-ages $ 6.00
JCP TOTAL _ $ 26~:88
Filed ..... ..JA~1ll!RY..5 1.1 !l.!l6. ..... ..
Anthony Deluca, Esq.
ATTORNEY (Sup. Ct. 1.0. No.) 18067
P.O. Box 358
113 Front st., Boilinq springs, PA
ADDRESS 17007
717-258-6844
PHONE
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LAST WILL AND TESTAMENT
OF
HAZEL M. REXROTH
I, HAZEL M. REXROTH, or tho Borough of Camp Hill, County of Cumberland
and State of Pennsylvania, being of sound mind. memory and underatanding. do
hereby make. publish and declare this as and for my Last Will and Testsment. hereby
revoking and making void any and all other Wills by me at any time heretofore made.
I.
I direct that my Executrix. hereinafter named. shall pay all my just debts
and funeral expenses as aoon sa conveniently may be done after my decease.
II.
I give and bequeath the household goods and fur.nishinga of my room at
Bethany Village United Methodiat Retirement Center to my niece, ANN R. WINTON.
I trust that my Executrix. hereinafter named. shall inventory the contents of
said room before diatribution.
Ill.
I give. devise and bequeath One-Half of the rest. residue and remainder
of my estate, whether real. peraonal or mixed, and wheresoever situate to my
neice, ANN R. WINTON.and her husband. JOSEPH WINTON.
IV.
All the rest. residue and remainder of my estate whether real, personal
or mixed and wheresoever situate. I hereby give. devise and bequeath in Four (4)
equal shares. unto my sister. RUTH M. HUMBLE. of Peoria. Arizona. my friends.
MARY E. KROW and HAROLD C. MATTERN, both of the Borough of Camp Hill. Pennsylvania
COMMONWlALTH 01' PINNSYLYANIA
COUNTY 01' CUM.ULAND
}
III
b.lng duly
Ann R. Winton
sworn
.ccordlng to I.w, deposll .nd ..y. thetSh. is the Executrix
of the Est.t. of Hazel M. Rexroth
1.1. of ~OW_l!L~.n,~.!L'!'P!!'llsh!J2.._._ . Cumb.,l.nd County. P... d.c.lI.d .nd Ih.t the
within I. .n Inv.nlory med. by h..r . the ..Id Executrix
of Ih. .ntlre .st.l. of ..Id d.c.denl, conslstlng 01 .11 Ihe ptr.on.1 profl.rty end rul ....1.. exc.pt rul ....1. ouhld.
Ih. Commonwullh of Penn.ylv.nl., .nd th.1 the IIgurll opposlt. uch It.m 01 the In..nlory repre..nl II'. hlr ..lu.
II of Ihe d.l. of d.cedenl's dulh.
Sworn
.nd subscribed before me,
March 18,
19 96
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. Executor '. A Inlltrat.,
,",
304 Shughart Avp.
NOlarl.1 Sa.1 "
Marjorie A. DeLuca. Notary Pulllic
SouUi MildIelO!I TII';l. Cumb<rt'nd eo""y
My Commission Expires Nov. 1, 199'3
Member. Pcnn~I~-alltJ AS50Clalmn 01 Notaries
Boiling Springs, PA 17007
....dd....
D.I. of Dulh
19th
DIY
December
Month
1995
v..,
INSTRUCTIONS
I. An Invenlory must b. flied wilhln three monlh. .fter eppolnlmenl 01 per.onel reprll.nlltlv..
2. A .upplement Inventory mu" be filed wilhln thirty dey. 01 discovery of .ddltlonel en.h.
3. Addltionel .heeh mey b. e!tached ai to personalty or rulty
4. Su Articl. IV, Flduclerill Act of 1949.
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Invenlory ollhe real and personal eslale 01
HazAl M. RAYrn~h
deceased
1. 21,538.426 shares held in Kemper U.S. Mortgage Fund, 55,507 69
valued at $7.22 per share as of 12/19/95
2. Checking account at Dauphin Deposit Bank, Harrisburg, PA 3,726 03
3. Balance due from public School Employes' Retirement System 728 55
4. Miscellaneous items of personal property 581 00
60,543 27
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THE FIRST AND FINAL ACCOUNT
AND SCHEOULE OF PROPOSED DISTRIBUTION
OF EXECUTRIX
UNDER THE LAST WILL AND TESTAMENT
OF HAZEL M. REXROTH, DECEASED
BETHANY VILLAGE UNITED METHODIST RETIREMENT CENTER
CUMBERLAND COUNTY, PENNSYLVANIA
INDEX
Principal Assets
Personalty, page 1 ...........................
Income, page 1 .....................................
Adjustment to Carrying Value, page 2..............
principal Credits, page 2 ........................
Partial Distributions, page 3 ....................
Recapitulation, page 3 ..............................
Balance for Distribution, page 3 ..............
Schedule of Distribution of Balance of Estate
Ann R. Winton and Joseph winton
one-half residuary estate
Ruth M. Humble, one-eighth residuary estate
Mary E. Krow, one-eighth residuary estate
Harold C. Mattern, one-eighth residuary estate
Trinity Lutheran Church, one-eighth residuary estate
$159,820.87
1,512.75
(1,329.71)
39,857.64
70,000.00
50,146.27
$ 50,146.27
$ 25,073.15
6,268.28
6,268.28
6,268.28
6,268.28
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Ad1ustment to Carrvina Value
Decreaeed value ot Kemper
U.S. Mortgage Fund Shares
Adjusted Value
Value Per Inventory
154,177.98
155,507.69
Credits
DAn
1/23/96
1/29/96
1/29/96
1/29/95
2/2/96
2/2/96
2/2/96
2/2/96
2/13/96
2/22/96
2/22/96
2/27/96
3/7/96
3/18/96
3/18/96
3/18/96
3/18/96
7/8/96
10/30/96
10/30/96
Ann R. Winton - Probate tee advanced
Weis Pharmacy - Medicine
Bell Atlantic - PA - Final phone bill
Roy D. Gottshall, Auctioneer
Appraisal of personal property
AT&T - Final Bill
Alert Pharmacy at Bethany
Medication from 12/13/96-12/18/96
Bethany Village
12/11/95-12/31/95
East Harrisburg Cemetery Co.
Myers-Horner Funeral Home
Cumberland Law Journal
Legal Advertising
The Sentinel - Legal Advertising
Ann winton
Reimbursement for opening grave
Joe winton
Reimbursement for Minister
Register of wills, Agent
Inheritance Tax
Register of Wills
Filing Fee
Ann winton - Executrix fee
Anthony L. DeLuca, Esquire
Attorney fee
Holy Spirit Hospital
Register of Wills, Agent
Inheritance Tax
Commonwealth of Pennsylvania
1995 State Tax
Allowance for preparation of
inital and final federal and
state Fiduciary Tax Returns by
Greenawalt and Company
Total Credits
1,329.71
1IIrnlnt
$264.00
11.71
6.53
30.00
3.20
170.49
1,791.80
560.00
6,360.00
60.00
74.71
600.00
SO.OO
15,987.28
25.00
7,421.00
4,500.00
25.44
1,364.48
lIl2.oo
4SO.oo
$39,857.64
5/15/96
5/15/96
5/15/96
5/15/96
5/15/96
Principal
Personalty
Income
Partial Distributions
Ann R. Winton and Joseph Winton
Partial Distribution
Ruth M. Humble
Partial Distribution
Mary E. Krow
Partial Distribution
Harold C. Mattern
Partial Distribution
Trinity Lutheran Church
Partial Distribution
Partial and Total Distributions
35,000.00
8,750.00
8,750.00
8,750.00
8.750.00
$ 70,000.00
RecaDitulation
$ 159,820.87
1,512.75
Adjustment to Carrying Value
Total Principal & Income
(1,328.71)
$ 160,003.91
Principal Credits
39.857.64
$ 120,146.27
- 70.000.00
,
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Partial Distributions
Balance for Distribution
$ 50,146.27
(
Balance for Distribution consists of CASH
and balance in Mutual Fund.
$ 50,146.27
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APR 0 9 199#-
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IN THE COURT OF COMMON PLEAS
OF r.UMBERLAND COUNTY, PENNSYLVANIA
ORPHANS" COURT DIVISION
IN REI F.STATE OF HAZEL M.
RBXROTH, LATE OF LOWER
ALLEN TWP. CUMBERLAND
COUNTY, PENNSYLVANIA,
DECEASED.
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NO. 21-96-12
ORDER OF COURT
AND NOW, April 9, 1997, the within a~count is confirmed
and distribution directed in accordance with the schedule.
BY)~OUr~ ~/
. ~ P.J.
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.;,;.lP...:: n[SIDENT llECE\)[Nl
WIA^,OIlWlAllIlo,rummVAlIIA ((0 liE FILED IN DUJ>l.ICATE
DlrAkfMWI OF R[VIUUI
ICA..'sfJ:b3~f,I"o"', WITII REGI!;TER OF WILLS) ((llltllY (Olll
'6ituJiffl(rN;J.fllr^ir;tR~f.:^tH' i1It,j-;:{dihli^'lf . ._.. . ';:',~- . - ;"::.',-. . {)!(i(ll';ii'~'(flf,\"&i f('nlllll ~\
Bethany Village
325 Wesley Drive
Mechanicsburg, PA 17055
c","',_ cumberland. __._.___ ---- -,----
rl3, Rr.mclindor Relurn
(lor dolo. 01 doalh prior 10 11.13.81)
[ 15. rede,ol Estate T(I)(
Rolurn Required
_,.8. Tolol Numbor of Safo Doposil Sou,
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IlIl t1I1MI"N
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Rexroth Hazel M.
Sffi:ii;rIlcUii,"i1iU"i"- - -,-.---.. --rA'" OIli'-"',, ' rAl[O' ,;m,-- - ,
/ - ,l-:t:JLJ-7,.t.1krlp:--- _?1!!z7.
001. Original R,lurn U 1. ~uPJ>'.mo"'oll.~~n
fJ .10. Fulvro Inletel' Compiomho
(lor dnlo. 01 d.oth ohor 11.11.81)
[j(J 6. Do,odonl Dlod T..lalo 0 7. Doc.donl Malnlalned 0 living Trull
(AlCach copy 01 Will (AlCach copy of Trull)
L: OIlRE P.OND NCEAND-CO'!lli!.EtlW\]:'TAXINF.OnMATIO_" SHOULD BE:DIIlECTED 1'1':'
AM MPL MAlliN D II
o A. lImltod E,'al.
L. DeLuca, Esquire
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P.O. Box 358
113 Front street
Boiling Springs, PA 17007
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5.035.58
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( 81
19,944.71
1.983.73
(1~) 15 , 161 .00
(16)' 106,126.98
(11)
(121
(131
llAl
".06.
)C .1~.
-
(17)
160,543.27
21.928.44
138.614.83
17,326.85
121.287.98
909.66
15,919.05
16,828.71
841.43
15,987.28
-0-
15,987.28
Un.1I p_ltII. P;tI(voy, I ..1fwIt I haY. ...lIIln. thl. ....m. Including accompanyfng adl.dul.. and .le,'"..n". .nd 10 lho b... 01 my knawl.dg. .nd boU.f.
i,l. tNe, corred arKI ~I.te. I declare that an real estol. hat bltn reparted at tru. man.t .alu.. Declaration of pr.parlt other ,han the p....onol ,.p,...ntotlv, i.
baNd OIl .n I~ 01 whlcll ~p.,., ha. .~ bowled~..
~'~r.e:-'" ~ ~ . ,. Q'{:~.\ -,-.
_' . ---~ _ 9~ 1d:;~ -;;f~}Ji1$):;:~
"7 74'c 7
1. R.al E.lal. (Sch.dul. AI ( I)
2. Slodu and Bond. (Sch.dul. B) ( 21
3. CI.llly H.ld St.cIclPartn...hip Inl....1 (~ch.dul. C) I 3)
A. M.rtSaS" and N.I.. R"elvabl. (Sch.dul. D) ( A)
S. C."'. Bonk D.pa.lt. & Mlltollan..u. P...an.1 Prop.rty( ~I
(SCI1edul. E)
6. J.intly Owned Pr.porty (Sch.dul. F) ( 6)
7. Tran.lo.. (Sch.dul. G) (Sch.dul. L) ( 7)
8. T 0101 Grall A..." (I.,allln.. 1.7)
9. Funo...' Exp.n.... Admlnhlr.llv. C..... MII"lIanlOu, ( 9)
Expen..o (Sch.dul. H)
..1'1' .1. ,.
10. D.b". M.rtg.S' U.bmU... ~'". (Schedul. I) (10)
~d. . ", "
11. TaI.1 Dedudl.n.(r.I.lllnll 9 & 10) ,
12. Nil V.lu. .1 E.tali pIn. B mlnu. IIn. 111
13. Ch.rit~bl. and Gov.mm.nl.1 Boqu..l. (Schodul. JI
lA. N.t V.lu. Sub 1CI10 To. In. 12 mlnu.lln. 13)
1~. Amounl of IIn. lA t...bl..t 61\ rot.
(Includ. volulI lrem Schedul. ~ .r Schedul. M.)
,"r.' "Ii... ... -, l .'
16. Amount 01 b.. lA taxabl..t 1~1\ ral.
. (Includ. ""Iu..lrem 5chedul.'K.r Sch"'~I. M.l
17. Prindpalt.. du.(Add t.. From IIn. 1~ .nd From IIn. 16.1
1 B. Credit. Prior P.ym.nl' Dlscaunl Inllr..t
-0- + 841.43 -0-
19. "bno 181. g..otll thon IIn. 17. .ntllth. cIlff.renc. on llno 19. ThI.1a th. OVERPAYMENT.
IiIDU~II"."'~]J_IV"uI1J~ni't.t_lummn.'.I""-'L..l'ULU.lo.JiiLil~
20. 11 llno 171.'i..~;if,on IIn. lB, .ntor Ih. cIll/orenco on Un. 20. Thl.I. th. TAX DUE.
-'.Enl" ,h.,1_.t on th. bolance duo on IIn. 20A.
B. -Enlo, ill. totol of IIn. 20 and 20A on Un. 20B. Thl. I. tho BALANCE DUE.
<;:$.!~'AtI.7'cii:ct.', '-"..G; I....,.,.f WIlla. Ag.nt
(18)
(19)
(20;
(20AI
(20B)
.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK kIlN THE
APPROPRIATE BLOCKS.
1. Did decedent moke 0 tronsfer ond:
o. retoin the use or income of the property tronsferred, .......................................
b. retoin the right to designote who sholl use the property tronsferred or its income,
t. . . t t
c. re 010 0 reversionary In eres or ....................~...............................................
d. receive the promise for life of either poyments, benefits or core? .......................
2. If decth occurred on or before December 12, 1982, did decedent within two yeors
preceding deoth tronsfer property without receiving odequote considerotion? If deoth
occurred ofter December 12, 1982, did decedent tronsfer property within one yeor of
deoth without receiving odequote considerotion? .................................................
3. Did decedent own on 'in trust for' bonk occount ot his or her deothL....................
YES NO
X
! X
I
I X
I
I X
X
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAlC RETURN
RESIDENT DECEDENT
ESTATE OF
Hazel M. Rexroth
CAlf ro " oint! -ownlld wtlh the Right of 8u",lvorthlp mutt L. dllelDI.d on Schedul. "F".
SCHEDULE "E"
CASH AND MISCELLANEOUS
PERSONAL PROPERTY
FILE NUMUER
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT
DATE OF DEATH
Checking account, numbered 10-07299-3, at Dauphin
Deposit Bank, Harrisburg, PA
3,726.03
2.
Balance due from public schools Employes' Retirement
System
728.55
.,
3.
Miscellaneous items of personal property. See
attached appraisal.
581.00
,
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TOTAL (Also enter on line 5. Recapitulation)
S 5 35.58
Of more 'P.ce II nHded In.." Iddltlon.IIhHtI of Mm. I'")
J'y,1I10 u, P.1I1
.
C0MM01WIAIl~ 0' P1NNlYlVANIA
~ IH ""AN IIA. ./IU.N
!IIDIN DIUD NI
SCHEDULE "G"
TRANSFERS
Il'miop , -
---=----~r:-:.--.__.__,__: -=::;;"==--:-_='.~~:._-==-~"'------=~~__:=
Fill NUMBER
Hazel M. Rexroth
THIS ICHIDULI MUST II COMPLlTID AND "LID IF THI ANSWIR TO ANY OF THI QUISTIONS ON THI REVIRIE SIDI 0' THI COVIR SHEn IS YIS
ITEM TOT....1 V....IUE DECo. DOLlAR V....LUE
NUMBER DESCRIPTION 0' PROPERTY EXClUSION OF ....SSET I~ 0' DECEDENT'S
INTEREST
, NONE -0-
TOTAL (AI", ,nl.r on IIn.1. Recaplf\llatlon) S -0-
(If men .poce is rtHd.d ins,1f oJJitiottol .1tH,. o( lome aiu.)
,.
. -.'
NV,lI!"" 1"'11
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES!DENT DECEDENT
ESTATE OF
SCHEDULE "I"
DEBTS OF DECEDENT,
MORTGAGES, AND LIENS
FILE NUMBER
Hazel M. Rexroth
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Bethany Village, 325 Wesley Drive, Mechanicsburg,
PA - Personal care
$1,791.80
3.
Alert Pharmacy at Bethany, 325 Wesley Drive,
Mechanicsburg, PA - Medication
Weis Pharmacy #58, 101 Wesley Drive,
Mechanicsburg, PA - Medication
Bell Atlantic - PA - Telephone
170.49
2.
11.71
4.
6.53
5.
AT&T - Telephone
3.20
TOTAL IAIso ente' on line 10. Recapitulation)
S 1,983.73
II' mora 'PICI II "..d~ In.art Iddlllonll IhM" of lima '1111
....hltll. PI~
ISTATI O'
ITIM
NUMIIR
1.
2.
3.
4.
ITEM
NUMIII
*'
CQMMOHW....UM Of PeNHlnv.HI'"
"'"""*' 'AI liNIN
tlMMHf NClMNI
SCHED'ULE J
BENEFICIARIES
PILI NUMBIR
Hazel M. Roxroth
NAMI AND ADDRESSO' BENEFICIARY
AMOUNT 011
SHAIlI OF ISTATI
RILATIONSHIP
).. Taxabl. B.qu"11l
Ann R. Winton and Joseph Winton
304 Shughart Ave.
Boiling Springs, PA 17007
Ruth M. Humble
Good Shepherd Care Center
10323 West Olive Avenue
peoria, Arizona 85345
Niece and
her husband
50%
Sister'
12~%
Mary E. Krow
3509 Walnut Street
Camp Hill, PA 17011
Friend
12~%
Harold C. Mattern
14 South 30th street
Camp Hill, PA 17011
Friend
12~%
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
1.
B. Charitabl. and Gov.rnmental Bequ.st..
Trinity Lutheran Church
2000 Chestnut Street
Camp Hill, PA 17011
12~%
'.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also .nl.. an IIn. 13. Rocapituladon) S
III mate .pac. I. n..cIod. InMrt additional .h.... of aam. ....1
""'",~ .~~";,'
.~
. nnd 'PllNITY I.UTIIEIIN 1:lIunCII j,[ the lIul'ollr,h of Gllm)l Illll, l'ellllnylvIIIIJII.
IV.
I hereby nominnte, conntitnte nlld n)l)loint my niece, ANN II. WINTON,
of Cnrlisle, l'ennsylvanin, ns ExecuLrix oC this, my l.nst Will nnd Tentnment.
If my said niece should predecense me, or otherwise fail to qunlify or cease
to act as such, then I nominate, conr-titute snd appoint her husbnnd, JOSEPH
WINTON, of Csrlisle. Pennsylvania, as Executor.
IN WITNESS WHEREOF, I, IlAZELM. JID<ROllI, the Testatrix, have unto this
my Last Will and Testament, set my hand and seal this /1,'i1.. day of #t>/fl."hCl
1990.
A. { [t.''d; c.. 'm ,--!2c...b.rtfl
,j!: , (
(SEAL)
SIG~ED, SEALED, PUBLISHED and DECLARED by HAZEL M. REXROTH, the above-
named Testatrix as and for her Last Will and Testament in the presence of us who
have hereunto subscribed our names as witnessses at her request. in the presence
of the said Testatrix and of each other.
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(
ACKNOWLEDGME~T ~~D AFFIDAVIT
STATE OF PE~NSYLV~~IA )
) SS.
COU~TY OF CUMBERL~~D )
We, HAZEL M. REXROTH, KATHLEE~ E. LOYD and J);, ~ i ):. fJ I .4 ? I' j It ~ d
the Testatrix and the witnesses, respectively, whose names are signed to the
foregoing instrument, being first duly sworn, do hereby declare to the under-
signed authority that the Testatrix signed and executed the instrument as her
Page Two of Three Pages
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RIV-1547 IX AFP 112095*
CDMMQHW(llfH Of PfNNSYLVAHla
OlP"'''HI Of R(V[lrU:
IURlAU OF INDIVIDUAL 'Axtl
otPf. 111'01
tWttUIIURG, PI UlIl.OUl
ACN 101
NOTICE 0' INHERITANCE TAK
APPRAISE"ENT. ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESS"ENT Of TAK
DATI 06-10-96
FILl NO.
DATI OF DIATH 12-19-95 COUNTY CUMBERLAND
HOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUB"IT THE UPPER PORTION Of THIS fOR" WITH YOUR TAK
PAY"ENT TD THE REOISTER Df WILLS. "AKE CHECK PAYABLE TO "REOISTER OF WILLS. AGENT"
REMIT PAYMENT TO:
ANTHDNV L DELUCA ESQ
113 FRONT ST
PO BOX 358
BOILING SPRINGS PA 17007
REGISTER OF WILLS
CUMBERLAND CO COURT HDUSE
CARLISLE, PA 17013
AMount R..Uted
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECDRDS ~
iiilj:is4TE'j{"iii:p"nZ:9sT"Nci'rIcE"-OF"YNHEiiii'ANcE-YAX"jiPPR'A"iSEifiNT",-",\LrOiiANCE"olinnn-"nmn--
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
HAZEL M FILE NO. 21 96-0012 ACN 101
ESTATE OF REXRDTH
DATE
06-10-96
NOTICE
TAK RETURH WAS' ( I ACCEPTED AS FILED
( Xl CHANGED
SEE ATTACHED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. (Schedul. A) III
Z. Stock. _ Bond. (Schedul. Bl IZI
5. Clos.ly Held stock/Partnership Int.r..t (Schedul. C) (3)
4. Hortgagel/Nat.. Receivable (Schedule OJ (4)
S. C..h/Bank Deposita/Hi,c. Parlon.l Property (Schedule E) (5)
6. Jointly Own.d P.op..ty (Sch.dul. Fl (6)
7. Transfars (Schedule C) (7)
e. Total Au.t.
.00
155.507.69
.00
.00
5.035.58
.00
.00
IS)
160.543.27
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral ExPans../Ad.. Casta/Hi.c. Expan... (Schedul. HJ I')
ID. D.bt./"o.ta.a. Llabilitl../Li.n. (Sch.dul. II IIDI
11. Tot.l D.ductlon.
12. Net Value of Tax R.turn
15. Ch.rlt~l./Gov.rn..ntal aequ..t. (Schedul. J)
14. Hat V.lu. of E.t.t. Subject to T..
19,944.71
1.983.73
(11)
UZI
USI
U41
~1 .Q~R 44
138.614.83
17.326.85
121.287.98
If an assessment wes issued previOUSly, lines 14, lS and/or 16, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. A~unt of Lln. 14 at Spou.al rat. (15)
16. AMount of Lln. 14 taxable at Lin..l/Cl... A r.t. (16)
17. Aaount of Line 14 t..abl. .t Coll.t...l/Cl... B ..t. (17)
18. Prlnclp.l Tax Due
NOTE:
.00 K .00=
.00 K .06=
121.287.98 K .15=
US)
.00
.00
18.193.20
18.193.20
TAX CREDITS:
PAY"ENT
DATE
03"18-96
DISCOUNT 1+ I
INTEREST 1-)
841. 44
RECEIPT
NUIlBER
AA1l2628
AI10UNT PAID
15.987.28
PAVMENT MUST BE MADE BV 09-20-96-.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
i
I
L
I
16,828.72
1.364.48
.00
1.364.48
. IF PAID AFTER DATE IHDICATED, SEE REVERSE
FDR CALCULATIDN DF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN .1. NO PAY"ENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YDU "AY BE DUE
A REFUND. SEE REVERSE SIDE DF THIS FOR" FDR INSTRUCTIONS. I
'\1""~" ..
COMMOHWIAlTH 0' PINNSYlY....NI....
DI'....UMENT 0' RIVE NUl
IUllAU or INDlYIDUAL tAXII
DEPT. 210601
HARRISIURO,'.... 17121.0601
DECEDENT'S NAME
INHERITANCE TAX
EXPLANATION
OF CHANGES
filE NUMBER
Hasel Rexroth
2196-0012
....CN
101
SCHEDULE
ITEM
NO.
EXPLANATION OF CHANGES
_!le~r~_~Le..!:,ax.~Je,aLI5 ,p,or.c:ollt,!.,.... '" __' __. u ,____..m_____H,.._n_______.__,__m______
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-..,- ------ ----,------._-- ---~ .-..--- .- -.. - -,-~-,._-,+ .. - .' -~.~. .-,-_..".'. -..,-. .,--------_.'+ ----,----,------------'--
----,---_.---,----'----------'.'-.- -----.. ---.------. -, .---... --'..'.- ---,-----_.'--_.'_. ,'.-----'._,---,---------------
-------_-.',---,_.'.----'-'.'---.-- ---~-,_..,._-._,-- - - -. _.- - ' ---,- - -- - ----,------ .,..,.. -~,-,-_..- --------------- -----~-_.
._,~ '
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_,________'__ __________ ____ ,.._,___,*_____ ___,0____...'._ ,.. .., __. _ ~~ ~ __, ,__ _ _ ___'._ --,-... - -.. -------...-------------------- ~-----
________'_.. _ __ '_ ,_~_~V~. _. _,'. ._._,_~,._.__.'~__.'~_._~~~..._ ~~. .__,_'. n _,___ _.V*,_~.. .'__'_ ___,__._,_,__ .~,~~ .--------------.--.-~-
_____*_ *___. _ _ _.___. __,_..0 __ ,.._ _____'. ,__~_ _,_ ,~ _. _,_, ____,* _'__ . .u,_
---,---'~_.._-'~ ------,- -- ------- - --- --. .-..,----- --_.'---'.-- - -- - -------', ~
Lisa Garland
PAGE
TAX EXAMINER,
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CONTROL .:II
NUMBER
AMOUNT
DELUCA ANTHONY L ESQ
POBOX 3~a
113 FRONT STREET
BOILING SPRINGS, PA 17007
lul
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RUH'Ui
SSN 162-22-7137
IflRST) IMII
M
EI POSTMARK lW'E
CO NTY
CUMBERLAND
DATE 0' DEATH
REGISTER OF WILLS
m TOTAL AMOUNT PAID .1~.9a7 .2a
VZ
RECEIVED BY 9;!(/ll~{ ~U 7~'''AJ..dI ".//1)
v, .....AfU.~ I
YI'.I.-.)
MARY C. LEWIS . I '
REGISTER OF WILLa ~'p'Lt
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REMARKS
SEAL
ANN R WINTON
C/O ANTHONY L
CHECK" lit
DELUCA ESQ
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C_ALl" Ill' I'fHHlYLVAHIA
llll'AlllHlHl Ill' IlfVllU
IUIlfAU Ill' INDIVIDUAL lUtl
."."IOIL
~IIIUIO. PA L7111"IAII
ACN 101
NOTICE OF IHHERITANCE TAX
APPRA1SEHEHT, ALLOWANCE OR OISALLOWANCE
OF OEDUCTIONS AHD ASSESSHENT OF TAX
DATE 06-10-96
FILE NO.
DATI OF DIATH 12-19-95 CDUNTY CUMBERLAND
HOTEl TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUB"IT THE UPPER PORTION OF THIS FOR" WITH YOUR TAX
PAYHEHT TO THE REGISTER OF WILLS. HAXE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
ANTHONV L DELUCA ESQ
113 FRONT ST
PO BOX 358
BOILING SPRINGS PA 17007
REGISTER DF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
A.aunt R..ltt.d
CUT ALONO THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
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BUReAU OF IHOIVIDUAL TAXES
U.tEAlTAHCE TAX DIVISION
DEPT. 2I06D1
HARRISBURG, PA 17121-0611
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT DF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
tn,I'" I' iI. m.tu
ANTHONV L DELUCA ESQ
113 FRONT ST
PO BDX 35B
BOILING SPRINGS PA 17007
DATE
ESTATE DF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-06-97
REXROTH
12-19-95
21 96-0012
CUMBERLAND
101
A.ount R..1ttod
HAZEL
MAKE
TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HDUSE
CARLISLE. PA 17013
NOTEI To insure proper credit to your account, lub_it the upper portion of thil far. with your taM p.y..nt.
CUT ALONO THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ....
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ACN
~ ASSESSMENT P:' AMOUNT
RECEIVED FROM: g CONTROL ~
NUMBER
ANTHONY L DELUCA I13&lUIRE
113 FRONT STREET
POBOX 3:58
BOILING SPRJNGS, PA 17707
101
'1,!64.4S
ESTATE INFORMATION,
!II 'IL N MIER
) II 21-1996-0012
!II NAME 0' DECEDENT lLAST)
~ REXROTH HAZEL M
II DATE 0' P....YMENT
EI POSTMARK IWE
COUNTY
SSN 162-22-7137
(FIRST) (MI)
CUMBERLAND
DATE 0' DEATH
REMARKS
C/O ANTHONY L DELUCA ESQUIRE
m TOTAL AMOUNT PAID
.1,364.48
SK
SEAL
CHECK" 2:5
RECEIVED BY
REGISTER OF WILLS
MARY C. LE
REGISTER OF
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COHHDNW!ALTH OF P!NNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
BUREAU OF INDIVIDUAL TAXES
INHlI.TlHCl Tax DIVISION
0[". Zl060.
HAlRI.IURa, PI 171""0'01
In.IIIIII"'fll''''
ANTHONV L DELUCA
113 FRONT ST
PO BOX 358
BOILING SPRINGS
ESQ
DATE
ESTATE OF
DATE DF DEATH
FILE NUHBER
COUNTY
ACN
01-06-97
REXROTH
12-19-95
21 96-0012
CUHBERLAND
101
HAZEL
H
..ount R..itt.d
!'A 17007
HAKE CHECK PAYABLE AND REHIT PAYHENT TOI
REGISTER OF WILLS
CUHBERLANO CO COURT HOUSE
CARLISLE, PA 17013
NOTE I To in.ur. proper credit to your account, lubMlt the upper portion of thl1 forM with your t.. pay..nt.
CUT ALONG THIS LIN! ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REii:iliiWix-"Fji-nF96yum-Jiiiii-iNHERiYANCE'-TAX-STAYiH'E-tiT-oF-Alfco[iiiY--iiiJiuuum-mumm
!STATE OF REXROTH HAZEL M FILE NO.21 96-0012 ACN 101 DATE 01-06-97
THIS STATEHENT IS PROVIDED TD ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHDWN BELOW
IS A SUHKARY OF THE PRINCIPAL T....X DUE, APPLICATION DF ALL PAYHENTS, THE CURRENT BALANCE, AHD, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 12-09-96
PRINCIPAL TAX DUE, 18,193.20
PAVMENTS (TAX CREDITS),
PAVMENT
DATE
03-18-96
12-13-96
RECEIPT
NUMBER
AA112628
AA184958
DISCOUNT (+)
INTEREST (-)
841. 44
28.65-
15,987.28
1,364.48
AMOUNT PAID
INTEREST IS CHARGED FROM 12-14-96 TO 01-21-97
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM.*
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
28.65
.28
28.93
18,164.55
. IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TDTAL DUE IS LESS THAN .1,
NO PAYHENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.
Roco;(" ,
fle~J:" ,"
\...... of
\,\'i:15
'97 JAN 17 AlI:4 8
Cieri,
Comb,:
vJr\
,'.() fJ^
H \: '-' f'\
PA'mENTI
DetKh .he top portion af thh NoUe. and ,ubIIlt with your p.yaent ..d. PIyab1. to ,,,. n... Met add,...
prlntad on the rava,.. .Ide.
If AUIDENT DECEDENT ..... check or 8oneV' order paYable tal REGISTER OF WILLS I AGENT.
If NOHaRESIDENT DECEM"' a.e check Dr HMV' order paYahla tal C0Ht10HWEALTH OF PENNSYLVANIA.
All "penh rllCalvH .hall be; .,,11" flr.t to ."y Int.,ut which ..y ba due .,lth WlY r...lnda, IIpplJad to the "JIl.
RUUHD (CRU It nfund of I ta. credit, which .... not requettad on the hlC A.turn, ..y ba r.que.tad by cOIIPleUng WI
~Appllc.tlon for R,fund 0' Penn,ylv."., Inh.rlt~. ~ Elt,t, T'Jl~ (REV-IS.S). application. ar. avalllbl. at
the OfficI of the A~I.t.r of WIll., eny of .he ZJ .avenue DI.trlct OfficI' or 'ro. the Deptrt.ent", Z.-hour
....wer1"' ..rvlel ~r. for far.. orderlngz In Pann,vlvanla 1-800-36Z-Z050, out. Ida Penn.vlv~la
~ within local Harrisburg araa (717) 717.1094, TOO' (717) 77Z-ZZ5Z CHe.rlnt 1.,.lr.d onlv).
Rf:PLV TDI
Outstlons r..ardlnt .rrar. contained on thl. notlc. should b. addr....d tal PA O.p.rt,ant of A.venue, lur.1U
of Individual T.x.., ATTNI Pa.t A......ant A.vl.w unit. a.pt. Z10601. H'rrllburg. PA 171ZI.0601. phone
(717) 717-65OS.
DI~TI
If InV t.. due I. plld within three (3) c.l.nd.r lonth. aft.r the d.cedent'. d..th. . flv. p.rcant (5~) dllcount
of the t.x p.ld I. .llowed.
PENAL TV I
The 15~ t.. .-ne.tv non-p.rtlclpatlon pan.ltv I. co.,ut.d on tha tot.1 of the t.. ~ Int.r..t ......Id. Ind not
Plld bafar. J~.rv II, 1996, thl flrlt d.. .ft.r the ~ of the t.. .-ne.t. p.rlod.
INTEREST I
Int.r..t I. char..d b.glnnlna with flr.t dl. of dellnquencv, or nine C') aonth. and on. (1) d.. fro. thl d.t. of
de.th, to the data of p..-.nt. ,.... which bec... delinquent be far. Janu.rv 1, 191Z b..r Int.r..t .t the r.t. of
.1. (~) percant p.r ~ calcul.ted at . d.llv rat. of .000164. All t.x.. which bee... delinquent on Ind .ft.r
Januarv 1, 191Z will b..r Int.r..t .t a rat. which will v.rv fro. calendar v..r to calend.r v..r with that rat.
announced bV thl PA O.p.rtaent of A.v~. Th. ~pllcabl. lnt.r..t r.t.. for 191Z through 1997 .r'l
V..r Int.r..t Alta Oall. Int.r..t Factor
Int.r..t A.t.
0.11. Int.r..t F.etar
V.ar
1912 lOX .000541 1917 'X .000Z47
un I6X .00043a 19Ia.I991 IIX .DODSOI
191~ IIX .00OSOl 199Z ox .000247
1915 15X .00OS56 1995-1'" 7X .ooal9Z
1.16 lOX .000U. 1995-1997 'X .000247
--Interllt I. c.lculated .. follow..
INTEREST . BALANCE OF TAX UNPAID X NunSER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
"An. Notlc. I..ued ,fter ttM t.. blc:0II. d.lInquent wlll rafllet an Intlr..t e.lculatlon to fifteen (15) d.y.
tM.ond ttM dlte of ttM ........"t. If p.~ant 11 ald. .ft.r the Int.r..t cCMIPUtatlon date Ihowt on thl
Notlc., additional Int.r..t ault be Cllculatld.
--..--,.'....,-.. '-
,
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~ ft" I "". ~'< " ,'J,"''' ~ ,j,l,;, ,~. '\' ,,'-" ~ " . /. , '" I,'" ,"<" i1-
, .: . '~t' , . NWIALTH O'.PINNSY"VANIA"':;'~ij~!.('4";;;.',~~~;;'"
, I m"<~C94.Mf!!M9.~...,,, - H'''' UYJN" A" ('<" .,,\ ,'" <,,'" ....\'~.,. ,
, , ". , ''''''1lIMIrMINT0I' UI cf' '.' . , .. ~,"",." "<Ow,. ,. .
r. f....,~. ".i: ~! "..'I.) t.;;.. ",')"" ,._~"",.,F~,t\.!~~I'-~...~,;."""",~," ~
"""'. ''''4' <"~ I" __, ~l .'-".,- , " . "''\:' '., ~ -_~~ ~
~j~D~CIAL~'-"Vt. ..,..,. 1",'1""" h-:. "l""~" ,',.,!~. .~. ,,\. '..'<1; f', f.", I ,pi,..>;,;:,.,."', ,-r1\...~~,".".,~.,
, '! -". .1N-.."...AINH-.."NClAND...,......',..V(~:;,. ';":',::i',r,,,t:l
J\s;.; ... "_~... ~.:, n.'..."", ....... , ,,~~,. ~/ --, '....v',' ......'!..-..~
RECEIVED fROM,
6
ACN
ASSESSMENT fl'I
CONTROL ~
NUMBER
AMOUNT
.~l L DELUCA ESQUIRE
101
.C:t1..,,;:l
113 FRONT STREET
BOILING SPRINGS, PA 17007
ESTATE INfORMAnON,
!I I E NUMBER
Y 21-199b-0012
!I NAME 0' DECEDENT lLAST)
~ REXROTH HAZEL M
II DATE 0' P....YMENT
EI POSTMARK E
COUNTY
SSN Ib2-2e-7137
(FIRST) (Mil
CUMBERLAND
DATE 0' DEATH
REMARKS
m TOTAL AMOUNT PAID
I
1'1. '
9&" '.'
RECEIVED BY (l~(~;<.~/ 1':<' c..f' ,
MARY C. LE 1 S :.I...I);~;(/ /..1/,l;t.
REGISTER OF WILLS I~
I
.2e.93
CW
ANN R WINTON
ANTHONY L DELUCA
CHECKlI 27
ESQUIRE
SEAL
I
I
I
L-_,______.-__,______ _________,_,__~-._._
u '. f',. ~
, .1 ..,.
I.' f /\. ,
REGISTER OF WILLS
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
BURIAU Of INDIVIDUAL TA~ES
INHlJlfANCE fAX DIYIIION
OUT. II""
HABIIIl.ItO, PA LPUt-061l
1".""11'" 111'''1
ANTHDNY L DELUCA ESQ
113 FRONT ST
PO BOX 358
BDILING SPRINGS PA 17007
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-10-97
REXROTH
12-19-95
21 96-0012
CUMBERLAND
101
A.aunt R..ltt..t
HAZEL
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE. PA 17013
NOTE I To inaure proper credit to your account, lub_it the upper portion of thia far_ with your t.. p8y.-nt.
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY:ifiifi-EX-"FP--r03":m-------ii..--iijj.jERi:fliiicE-iAX-STATiHEtii-OF-A'i:"COUNT--.-iii---m---------mm
ESTATE OF REXROTH HAZEL M FILE NO.21 96-0012 ACN 101 DATE 03-10-97
THIS STATE"EHT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE. AND, IF APPLICABLE.
A PROJECTED IHTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 12-09-96
PRINCIPAL TAX DUE.. 18.193.20
PAYMENTS (TAX CREDITS),
PAVMENT
DATE
03-18-96
12-13-96
02-20-97
RECEIPT
NUMBER
AA112628
AA184958
AA185186
DISCOUNT (+)
INTEREST/PEN PAID (-)
841. 44
28.65-
.20-
15.987.28
1.364.48
28.93
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
18.193.20
.00
.21
.21
TOTAL DUE
. IF PAID AFTER THIS DATE. SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAH t1,
HO PAY"EHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR),
"..... ,.." .r "'Ie' A .~~11N1\ -;FF .FVF~F !ll.lnf OF THIS FOR" FOR INSTRUCTIONS. )
M