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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CIlMRI,'RI.^,JI)
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The petitioner(s) above-named swear(s) or affirm(s) Ihal Ihe
slalements in the foregoing petition are true and correcllo the beSI
of Ihe knowledge and belief of pelitioner(s) and thai as personal
representativc(s) of the above decedent petitioner(s) will well and
lruly administer Ihe eSlate according to law.
Sworn 10 or
before "'F-this
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affirmed .IIBd subscribed {
23K day. of
:~:z MAY _J~~
: II! I " ,..(. "("fa r (,
,.; ,/ Register
) MARY t. LEWIS
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No. 21-96-419
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Estate of
Herman C. Wentz
. Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW MAY 24, 19~, in consideralion of Ihe pelition on
Ihe reverse side hereof, salisfaClory proof having been presenled before me,
IT IS DECREED Ihal Bettv W. Lebo
is/are enlitled 10 Lellers of Administration, and in accord wilh such finding, Lelters of Administration
are hereby granted 10 Betty W. Lebo
i~~iate or Herman c.-w'mtZ--.----
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FEES
Lelters of Administration ,.... S 50.00
Shorl Cerlificales( 1) .. . . . ., . .. S 1.00
Renuncialion ................ S ~ no
JCP S ~ nn
TOTAL _ S li1 no
Filed..... MAX. 2~......... A.D. 19....9.6-
Jacqueline M. Verney 2)167
A1TORNEY (Sup. CI. 1.0. No.)
7 Irvine Row, Cariisie, PA 17011
ADDRESS
(717) 211)-9190
PHONE
Called attorney on
Gl(lld iDe J"<\'{
5-28-96
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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21 - 96 - 419
In Re Estate of Herman C. Wentz
To the Register of Wills of
RENUNCIATION
deceased.
Cumberland
County. Pennsylvania.
The undersigned Marv ~,. Russell and Frances M. RurJ, nHlle:ht.pr<;
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to Bettv W. Lebo
WITNESS their
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hand this dl .') t'day of ' tJ~ ' 19.-U.-.
'l17"71. ;(~
(Signature)
fo'.ary E. Russell
1148 Newville Road
Carlisle, FA 1701)
(Address)
_JJ' ~ 'm l,i..
(Signalure)
Frances M. Burd
19 Bridgewater Road
Newville, FA 17241
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(Address)
(Slgnalur.)
(Addr...)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
II:
Betty Lebo
b.ing duly sworn___.___ .ccording to I.w, d.po... .nd ..y. th.t s h. ls_tbfLAdminllltratrllL_
.___.._.__..___ ...__. _..._.. __. of tho E.lat. of Herman C. Wentz
I.t. of _Bora. of CarUsle _ ___. ___, Cumb.rl.nd County, P." d.c....d .nd that tho
within i. .n inv.ntory mad. by .u__.B.c.tty__~llbo_ _ .__.__.___ _ ____, tho .aid Administratrix
of tho .ntir. .stat. of ..id d.c.d.nt, con.i.ting of .11 tho p.rson.1 propdrty .nd r.al .st.t., ..c.pt r..1 .stat. ouhid.
tho Commonw.alth of P.nn.ylv.ni., .nd that tho figur.. oppo.it. .ach it.m of tho Inv.ntory r.pr...nt it's fair valu.
as of tho dat. of d.c.d.nt's d.ath,
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and sub.crib.d b.f? m.,
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'--'-7eltcutor .~clminhlrlto'
1402 Trindle Road
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Carlisle FA 1701)
Addr...
C IMI . anken, NoIIIty PublIc
1If1s1e 11010, Cumberland' Countv
My CommlniQO Ex,l..s Sa,t. 25. to!!!
,PIMS~Assodjbon.' H.1It1es
Oat. of Death __L___
D.y
Hay
Month
1996
Vu,
INSTRUCTIONS
I. An inv.ntory mu.t b. fil.d within thr.. month. alt.r appointm.nt of p.rsonal r.pr...nt.tive.
2. A suppl.m.nt inventory must b. filed within thirty days of discov.ry of additional ....h.
3. Additional sheets may b. attach.d .. to person.lty or r..lty
4. See Articl. IV, Fiduci.ri.s Act of 1949.
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Inventory 01 the real and personal estale of
lIerman C. \lentz
_.~_._-------_.- -"._~-'.- --
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Real Property
Personal Property
1. Refund - Care Health Systems, Inc.
2. Refund - Capital Blue Cross/Blue Shield
3. Refund - Hoffman Roth Funeral Home
4. Prepaid funeral account Hoffman Roth
TOTAL
deceased
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$216 94
67. 05
Ii 112. 19
B 2. 00
6.288. 18
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ESTATE OF HERMAN C. ImN'I'X, DECI';ASED
FILE NO. 1996-00419
FAMILY AGREEMENT
The circumstances leading up to the execution of this
instrument are as follows:
1. Herman C. Wentz died May 3, 1996, intestate. On May 24, 1996,
Letters of Administration were issued to Betty Lebo, daughter of
the decedent.
2. Under the Intestate laws of the Commonwealth of PennSylvania,
the sole heirs of Herman C. Wentz are his three daughters, Betty
Lebo, Frances M. Burd, and Mary E. RUssell.
3. It is the desire of Betty Lebo, Frances M. Burd, and Mary E.
RUssell that their shares of the Estate of Herman C. Wentz,
deceased, be distributed without the formality of a Court
acCounting, and the said Betty Lebo, Administratrix, is Willing to
make Such distribution upon receipt of this executed Agreement.
4. An informal accounting of the administration of the Estate of
Herman C. Wentz, has been prepared by Betty Lebo, Administratrix
and is attached hereto as Schedu.le "A".
5. In consideration of the foregOing and intending to be legally
bOUnd hereby, Betty Lebo, Frances M. BUrd, and Mary E. RUssell:
A. Do hereby waive iln illldit of an account of the
administration of the Estilte of lIerllliJn C. Wentz, deceased, by the
Orphan's Court Division of the Court of Common Pleas of Cumberland
County.
B. Do hereby declare that they have examined the attached
account of the Estate of Herman C. ~Ientz, deceased; that they find
it to be true and correct in all particulars; that they accept and
approve it with the same force and effect as if it had been
prepared and duly filed with, audited, adjudicated and confirmed
absolutely by the Orphan's Court Division of the Court of Common
Pleas of Cumberland County.
C. Do hereby acknowledge that Betty Lebo, Administratrix, has
distributed all assets of the estate of Herman C. Wentz, deceased.
D. Do hereby absolutely and irrevocably remise, release,
quitclaim and forever discharge Betty Lebo, Administratrix, her
heirs, executors, administrators and assigns, of and from any and
all action, reckonings, liabilities, claims and demands relating in
any way to her administration of the Estate of Herman C. Wentz,
deceased.
E. Do hereby declare it to be their intention that this
instrument shall be legally binding upon them and upon their heirs,
executors, administrators and assigns.
6. Betty Lebo, Administratrix, docs hereby indemnify and hold
harmless Frances M. Burd and Mary E. Russell their heirs,
executors, administrators and assigns, from and against any and all
claims, losses, liabilities and damage of her administration of the
Estate Herman C. Went;'. iJnd l.he disl.rihution of till! esLiJte without
an accounting or the appnJVitl of l.he Orphiln' s Cou rL D i vis ion of the
Court of Common pleas of CUllllwrliJnd County, including, but not
limited to, any liability for iJny Vcdcrat Estate Tax, Pennsylvania
Inheritance Tax or any oLher deaLll Laxes, together with interest
and costs incidental thereto, relating in any way to the estate.
this
IN WITNESS
)(, 1-h
WHEREOF, we have hereunto set our
day of 1('-1-<':/\ ....../l..e'>.../
hands and seals
, 1996.
WITNESS:
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BETTY 'BO
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FRANCES M. BURD
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MARY Jr. RUSSELL
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
On ;/'('.j\'. r..!.-&-<-' ) (, ,IS (1(" before me,)~\((' .1/[ I hl.." ~O!'J ,
personally appeared Betty Lebo, personally known to me (or proved
to me on the basis of satisfactory evidence) to be the person whose
name is subscribed to the within instrument and acknowledged to me
that she executed the same for the purposes therein contained.
WITNESS my ha~d and official seal.
. ,\ ((( :' I ,; ~'::h,.J:. -~
Notary Public
My commission 8xpires:
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_ ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECI5-'oI"TH~~-..(-~ .
Und~r penohitn of PClp,W,. I declare thai I howl! t1J,o.,,,nt.d thi, lelufn, includ.ng accompany"ng Hheduh:!, cnd Sfalem"l'1IS u!\d Il' !"t< tJt'\' 01 ..." ~N"",!,'d;jt. :1"J :w,,"
.' .\ Hlle. (OffU'! cnd (tomplt"lt" I dedolt' thol all ,colesIOlt! hus bl'C" fl'POIIt>d atlful' matl..t'1 ...olutl OI!~IOf(]IIOn 01 P't'j.Jllt,H <.>lJ,,'; '~hl\l .".. l~t",~I".l' It'P"'WI",' ..' ,',
t...hed on all inlotmution 01 whIch plepuror ha\ on, ~now'ed9t1
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~~t.........t........-:"1h V~: ""',L(J7 Irvine Row. Carll"1,, , FA 1701)
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fOA DAIlS Of DIAIH AnlA 17/JI191 CHICK HIMI
If A SPOUSAL
POVIAIY CAIDIlIS ClAIMID
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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. Went;.:, Herman C.
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:;arah Todd M"morla I lIome
1000 W",d. :;outh ::treet
Car'j!:;le. PA 1'101) Cumberlanu
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(Allach copy of TruSl)
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(Anoch copy of Will)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
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3 Clolely Held Stock/Partnership Inlorlllt lSchedul" CJ
4 Mortgog"s and Not"s Receivable {Schedulo D}
~ Cash, Bonk Depos.h & MiiCellan~oul Personal Proplllly
IS,hod,lo EI
JOlnlly Owned Property (Schedull' fJ
Troniferi (Schedule GllSchedule l)
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(101 552.05
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funeral hpenun, Adm;ni,lrollve Co,", MllCelloneoul
hpenuI\ lSchedule HI
Deb". Morlgage liobililies. L'en~ (Schedule I)
T 0101 Deductions (loleIUne, Q & 10J
Nel Value of eSIOI" {Une 0 minul line 111
Cheri table and Governmental Bequel" lSchedule Jl
~_e!_~~~~~u_~ieCf 10_ToA Ilin~~2~minuI Line 131
Spouial T renlfen (for dole' of deu!h oher 6-30.941
See In'ltuctlonl for Af,plicoble Pur(,l!Ologe on Revene
Sidl' (Include voluo, tam Schodulo K or Schedulo M )
Amount of line 14 tOAoble 01 0<1.... lole
(Include value, hom Schedule K or Schedule M I
Amounl 01 line 14 taAable 01 1 ~lJ;" 1010
(Include volue, Itom Schedule K (JI Schodule M )
PlimlpolloA due (Add lo...lrom L,no, 15. 16 and 17)
Crodlll Spou,ol Povelty Cred,1 Prior Poymenh
.
1111
1121
1131
. .LI_41.
7.772.09
17.491.97
o
17,491.97
(151
x =
i
lib
,
17,1191.97
x Db =
1.0/19.51
lib)
1171
x l~ =
z
o
;::
'"
-
"
~
,.
o
U
K
'"
~
i 17
I
,
,
,18
! lY
:1~1
1181
1.0119.51
52.47
Illll'r~,'
O'l(ount
52./17
.
!20 II line lY i, gronltH lhon lino HL ..,nlor tho d1lforonco on line 20 'hi, 1\ tho OVERPAYMENT.
a:
Check hor. If you or. "quilting a r.fund of your overpayment.
997.0!1
o
997.0/1
,'1,
121 llllflc 18.~ gltlOltlr lhon lino 1t,I !'nll!!f tho J,llorcnlt" on LIfII< 11 Tll" 1\ 1~1I' tAX DUE.
A E nl~1 Ihe tnlOllnl on Ihe ltUltl"lO duo un llflo 2\ A
I.''''
BEnter Ihe 10101 0' Line 21011\1 11A on Linu 218 Th,\ Illho BALANCE DUE.
Mak. C~~_~~!ayabl. .'~.:R.gl.t.' ol~~lII.~_ A~.nl~.~
1""1
'.'.
'-'-.;{J .0'..'.'
. ~ /1..('
.,',
7- 2::5
en:
Act #48 of 1994 provide. for the reduction of the tox rote. Impoled on tho net voluo of tronsfon to or for
the ule of the Ipoule. The rate. 01 pre.crlbed by the Itatute will be:
e 3% (.03) will be applicable for eltatel of decedents dying on or after 7/1/94 and before 111196
. 2% (.02) will be applicable for eltatel of docedentl dying on or after 1/1196 and before 1/1/97
. 1% (.01) will be applicable for eltatel of decedentl dying on or after 111/97 and before 111/98
e Spoulal transfen occurring on or after 1/1/98 will be exempt from Inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (.;0) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transler and:
a. retain the use ar incame 01 the praperty translerred, .......................................................
b. retain the right ta designate who shall use the property translerred ar its incame, ...............
c. retain a reversianary interest; or ...................................................................................
d. receive the promise lar liIe al either payments, benelits ar care~ .......................................
2. II death occurred on or belare December 12, 1982, did decedent within two years preceding
death transler property without receiving adequate consideration' II death occurred aller
December 12, 1982, did decedent transler property within one year 01 death with aut receiving
adequate consideration'..."." .....,......."..," .......,.....,.,. ........,."....",......,...,.. ...........,., ........
3. Did decedent own an 'in trust lor' bank account at his or her death'......................................
r_l
IF THE:-ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
('J
I
.._J
.; ......
.1
'.''1
-_:' ::>
00
IIYIWlIlh 11"1
-t~
(OMMONW(AlIH Of ,[t4NSVlVANIA
INHllnANCI TAX InUIN
IUIDINT DICIDINT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ploalo ~rjnl or Typo
FILE NUMBER
2196-01119
ESTATE OF
HF.RMAN C. WENTZ
(All prop.rty lolntly-own.d wllh Ih. Righi o' Sur"lvonhlp mu.1 b. d~~lo..~ on Sch.dul. F)
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1. Refund- Care Health Syntems, Inc. 216.94
2. Refund- Capital Blue Crosnl Blue Shield 67.05
J. Refund- Hoffman Roth 112.19
4. Pre-paid Funeral Account Hoffman Roth 5892.00
TOTAL (AlIa onlor an lino 5, Rocapilulatian) S 6288.18
(Attach addiTional eYJ" x 11" thee" if more 'pace i, needed)
..., Capllol B1ueCl'081
... . ~~~~~~u:~.:l~
HARRISBURG, 1'1\ 17177
'ifN'5lf9
THE ESTATE OF
HERMAN C WENTZ
1402 TRINDLE RD
CARLISLE PA 11013-9141
AGREEMENT NUMBER
114051658
......................... EXPLANATION OF REFUND .........................
PERIOD OF REFUND
FROM: 06/01/96
TO: 01/01/96
REFUND REASON: CANCELLED DECEASED
TYPE OF COVERAGE:
REFUND AMOUNT:
SECURITY 65
$61.05
TOTAL REFUND AMOUNT:
961.05
~
I
.
;1
i
I
,I
\
.1
I
ii
'i
:\
.[
i
.
.
'.
r----..--o--.~~ ..~. ,- ,.. - - --... --
,
!
.'"
f ~ .
, ,
.Rw'O.J {,.m ibrn!!!!!ldlRM~ (Jt'.
~tu4~Uvv - 1'1/IDO 7>.11.,0
FUNERAL
SERVICE
~I.lhl"hl
CI ~h
[Uo'theck .
o SOCial Seturi1V
o V A Beneh'
o Insurance
5Jl,
Au.' ND
ORIGINAL
2861
o
~~' .58Cf,1
.nt S."
Chy,l.'.
p..mDf\1
S\lb lot
/dp/1~f!.DJ!lU%
CI~'"
LeuP.,ml
I~
HOFfMAN.ROTH
Funeral Home, Inc.
jJyt~E.HOjri{;'M
!By' ')JI../)' &)
'':Jr...r. <!J2 -
.
.
'-
,,'V'~I"llJ"l J
~~
COMMONWfAl1H Of PlNNSYlVAN'A
INHlItlTANCl 'All. RnUAN
RUIOlN' DlC[OlN'
----- --
ESTATE OF
HBRMAN C. Wl'NTZ
SCHEDULE F \
JOINTLY _OWNED PROPERTY
- -~.---- ,-,-~-'-' ---~ . ----- --, _.-----_. -------------------~--_._-
.______----.------ .________JFIL~~~:~~: 19
Joint 10nonl(')1
RELATIONSHIP TO DECEDENT
daughter
NAME
ADDRESS
1402 Trindle Road, Carlisle,
FA 1701:3
A,
Betty Lebo
B.
C.
ITEM LmER DATE
NUMB'U FOR MADE DESCRIPTION OF PROPERTY TOT AL VALUE DECD'S DOLLAR VALUE OF
JOINT OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A 1/2:3/95 York Federal Bank Account# :35,:309.75 50% 17,654.88
020-16871
2. A 8/29/90 York Federal Bank Account # 2,642.01 50% 1,:321.00
090-694951
- ----
TOTAL (Aho enter on line 6. Recapitulalion) 518,975.88
-------.
Jolntly.ownod proporty'
(II more space is needed inset' addItional sheeh 01 some size)
'h'~ll fit (1 IIi
ESTATE OF
V "~l ~~
~~ 'to!-';......
COMMONWlAITH Of PENNSYIYANIA
INHERITANCl TAl RETURN
.._.~RESlorNt D(eW.WT.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
! Ploaso Print or Typo
I _ __ _ - _
-"-~---:FtLE NUMBER
I
1
HERMAN C. WENTZ
- --_._,-~--
ITEM
NUMBER
DESCRIPTION
A. Funoral Expon.e"
1.
2.
Hoffman-Roth
Monument Lettering
B, Admlnistrativo Cast"
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
1.
2.
3.
Personal Representative Commissions
Social Security Number of Personal ReprC\cnlativc:
Year Commissions paid ______~_~_______~___
Allarney Foes
Jacqueline M. Verney, Esquire
Family Exemption
Claimant _______..
Addre.. of Claimant at decedent', death
Street Addre..
Relationship _._
City
u .____.._ _____5tole .. _.___ Zip Code
Probate Fees
Cumberlan County Register of Wills
Mlscelloneou. Exponses:
Cumerlan Law Journal- Advertise Letters
Sentinel- Advertise Letters
2196-01!19 ------------
TOTAL IAlsa enler on lino 9, Recapitulation)
(II moro spoco is neodod, insert additional shoots 01 somo size.)
AMOUNT
5,892.00
119.00
1,000.00
78.00
60.00
71.04
S 7,220.04
0 00 0 00 0 0 0'" '"
0 00 ~ 00 0 0 0.... ....
. .
'^ '^O ~ 0 N 0 N N .. N
'^ ...'" .... ... .... 0 In '" 0 --:
'^ '^'" 0 .... In In 0 .....
N .... '^ '^ '"
... .. ... ... ...... ...
C
Z
::l
.... ...
.... '"
c a:
... s:.
N 'tl .... :c ... !Il ~r~ ~
... a: CD
c: 0 ] " ] 'g""'"
" .D " <t 'tl "".i!~ ~
'" =- " .... 11.
'" ..J 'tl .. ~~
'" c: . "
.... U ... " ... U
=- .. .... 0.
c: '" .. 0
III .. >. ... u
S ...N....
>. .. "'c .. 'tl
CD " ".. CD "
:I: '" "'....u I ...
9 ...
.lI ...
l ! i ...
.. ..
1 >. " ..
'S 1 '" u "
] .~ B ii .. .
.ll J " x 0
~ '" .... ... .... "
~ !i ~ II
Q ... ~ .l! ... ~ UIIl ... ,s
.~. II
:a j
t
~~ ]
E .l!.a ]
:f ~Jl
'g -g:f 1
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11 ;S II
u.~ ."
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III <
<- ~e~ ~
e 11 ... u
~ -
~ In!
ClIMUEI{LANI> LA W ,JOllHNAL
2 L1UEHT\' A VENlIE
CAI{L1SLE, PA 17013
JUNE 28. 1996
Cumberland Law Journal is published evel)' Friday by the Cumherland County Ilar
Association and is designated by the Court of Common Pleas as the olliciallegal publication lor
Cumberland County and the legal newspaper for publication onegal notices.
TO: Jacqueline M. Verney, ESQUIRE
RE: Herman C. Wentz, ESTATE
Legal advertisements must be received by Monday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
===============================
Advertisement inserted on following dales:
JUNE 14,21,28, 1996
Advertising Cost
$ 60.00
Proof of Publication
$ 0.00
Second Proof Request
$ 0.00
Payment received
$ 60.00
..--....................
Tolal Amount Due
$ 0.00
---------
--------
Payment received JlJNE 12. 1996
biBecky H MorllenthallExecutive Director
.'
..
.. J
.,...-..---........ ..~.
'-'
'-
trg~~
RET\JRK POSTAGE GUARANTEED'
THE SENTINEL - LEGAL
PC DOX 1:30
CARLISLE. PA 17013
INVOICE NO ClASS BILUNG DATE
e6C'23
INDEXlNO TERY
6/30/96
ADM!NISTRATR!X'3 NOTICE
START DATE TELEPHONE NO. ORDER NO.
C'O, :.~/96 3602
t.HS'l'ItlADI nYES
VISAtMASTERCARD PAYMENT OPTtON ON BACK
.L&6,P'Jt--
POll !,Je;-ot: c.ot
CLASSIFIED ADVERTISING INVOICE
71. 04
Ad \I
78.14
86023
SODUS ~ 'JERNEY LAW 0
7 IRVINE ROW
P.O. BOX 936
CARLISLE
PA 17013
.
1-.lOOF OF PUBLICATION ....
State of Pennsylvania.
County of Cumberland.
ss:
Marian M, Welsh, Classified Ad.Visor of THE SENTINEL,
of the Counly and Slale aforesaid, being duly sworn, deposes and says thai THE SENTINEL, a newspaper of
general circulation In the Borough of Carlisle, County and State aforesaid, was established December 131h,
1881, since which date THE SENTINEL has been regularly Issued In said County, and that the printed notice
or publication allached herelo Is exactly tho same as was printed and published In the reular editions and
Issues of THE SENTINEL on the following dales, vlz
Copy of Notice of Publication
I.
1
June 6,13,20.1996
ADMINISTRATRIX'S ~
Lell,rs 01 Admlnlslrallon on Ihe ellelt 01
HERMAN C. WENTZ. lale 01 Ihe Borough 01
Cartille, Cumbertand Counly, PA, deceased,
hav. been grenled 10 Ih. undersigned.
All plrsona knowing Ihemlllvealo be indebl.
.d to Hid Eatll. will mike plymentlmmedl.
al.I)', and tho.. having claims will presenl
them lor IImement 10:
Affiant further deposes that he Is not Interested In
the subject matter of the aforesaid notice or
advertisement, and that all allegations in the
foregoing statement as to time, place and character
of publication are true.
BenyLebo
Admlnislralrll
cJoJacqullln. M. V.mey, Esq.
. 7 Irvine Row
Clltiate, PA 17013
7~ ~ t:':~
JlcquIUne.... Verney, Esq.
Anomey
July 5, 1996
Sworn to and subscribed before me this 8 th
day of July .19 96
Wwi; ~ ~~UbIJC
My commission expires:
'.
JU~
. ,_f'
,,,.:;;0
NccaIIal Seal
Wr6( L Metzoer. Nolllty PIdo
Ca/IsIoi Bora. CUtrbeI1anl CcllI1Iy
iii( Convr;ssiotl E>Pras.u... 2. 1997
"'-'QlICilaliI8
.
EMERALD DRUG BILLING DEPT 2300 NORTffTH"IRD" 'STREET' 'HAi'iF'l'isBURG, PA 17110
. ACTIV TY FOR W'N1Z,
1/29/96 56173132 120
PAST DU
ACCOUNT
. EIIl.I~DE
"~VE IIOT eE T US KNOW
~ pLEASE LE
) Vi
f ~~
fJ
I I I I I I I I 2.49 I
NOJ>J-LEGEND
For~ MONTH
~~~~......
194.-3B~1+J -- - i.49-.1+r-----------:C;Ol=r- - -1%:87"1_ r-------- ----:c5i)-1
.. -, .....,
.. - ..
!'IlOIlo:. ~tib'b~~
'I'IIREE SPa I NCS P AMILY PRACT I ex
H. ROBERT DAVIS, M.D.
MICHAEL O. DANIELS, M.D.
DAVID A. DELL, M.D.
303 N. BALTIMORE AVENUE
NT. HOLLY SPRINGS, PA 11065
(L.tLJ ~.J~
/ Y 0.1. 1/...:.1....a.... ~
L"a-1-W ~1.q.. I;~ / ]
==========================================================
FOR PIIOFESSIOIW. SERVICES /Jt.!.,~ __ 0~ JL-t:;
-('-'.)..L. /J...n--
After the Medicare payaent, JOU owe for the following:
Deductible S
.L.f S:dJ (.)
for services I /1 'i l; l...
for services
Co-paJ $
Please refer to the explanation of benefits JOQ received
fro. Medicare.
Thank ynll
/\,ild
(L--Q
/0
vl ')j
.
'.
In 1\1)1.. 11"1
~:Jh:~C\
- .Pfiu.o
(O"'''Ot.W'ill I.. at 'tt<t<~'I....t.'.
INHllnANCI fAl _nUIN
Il1lDINtOICIDIHI
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
HERMAN C. WF:NTZ
2196-01119
~----------,--_.- ---.--------
ITEM
NUMBER
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
NAME AND AODRESS OF BENEFICIARY
_._-_.._~-~.- ..-.._---,-~-_._~ ---...-.-----.--
A, Taxable Bequos":
1. Betty Lebo 11102 Trlndle Road, Carlisle, FA daughter 1/3
17013
2. Frances M. Burd 19 Bridgewater Road, Newville, daughter 1/3
FA, 17241
3. Mary E. Russell 1148 Newville Road, Carlisle, daughter 1/3
FA 17013
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AIIO .nl.r on line 13, R.copilulolion) S
(If more spac. II n.ed.d, Insert addllionallh.... of same she)
DNO.AA
146550 COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
d1~
.1~1l62Ill''''1
ACN
ASSESSMENT r;t
CONTROL ~
NUMBER
AMOUNT
RECEIVED FROM:
D
lOt
....,..,} .04
VERNE V JACQUELINE M
7 IRVINE ROW
CARLISLE. PA 17013
ESTATE INFORMATION,
~ FilE NUMBER
~ 2t-199b-0419
et NAME OF DECEDENT (lAST)
i;I WENTZ HERMI'\N C
II DATE OF PAYMENT .
m POSTMARK DATE
COUNTY
BSN 171,-05- 1658
(FIRST) (Mil
CUMBERLAND
DATE OF DEATH
fa TOTAL AMOUNT PAID
'0997 . 04
PO
REMARKS
.'
BETTV LEBO
C/O JACQUELINE M VERNEY
CHECK" 105
RECEIVED BY
. .',. . ~. "
REGISTER OF WILLS
,
,- SIGNA.TURE, ,I /
MI'\RV C. LEIHS "-""
REGISTER OF WILLS I
SEAL
,:../;
, { : /:. \
...1/'
/
-- .7 - - - -.--.. --,--:
j
-r~
..u--..~. ~_ _. ,.-:...
() //y-
, .
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU Of INDIVIDUAL TAMES
INlllRIUNCl fAIt DI\l1SION
DlPI. :eObOI
IlARRISBURC. PI 111111-0bDl
NOIICE Of INtlERITANCE TAN
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSHENT Of TAX
JACQUELINE M VERNEY ESQ
7 IRVINE ROW
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-28-96
WENTZ
05-03-96
21 96-0419
CUMBERLAND
101
Anaunt Renitted
C' ~*
fl'-Ih'" ,., 111."1
ftERMAN C
-l
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT ftOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
it EV: is'4-j-Eif-jiFji-ioY: 9&Y-NO~"-ic E--ci F -YNHEiii TANCE-~"-AX- APPRiii SEHENT-; -jii.i:ciWAN-CE-ejli----- - - - --- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WENTZ HERMAN C FILE NO. 21 96-0419 ACN 101 DATE 10-28-96
If an assessment was issued previously, lines 14, 15 and/or 16, 17
reflect figures that include the total of ~ returns assessed to
ASSESSMENT OF TAX:
15. Ahount of lina 14 at Spousal rat.
16, Anount of lina 14 taxable at Lina.l/Class A rat.
17. Anount of Lina 14 taxable at Collat.ral/Class 8 rat.
18. Principal rax DUB
TAX RETURN WAS: I X l ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1, Raal Est.t. (Schedule A J (1 J
2. Stocks and Bonds CSchedule 8) (2)
3. Closely Hald stock/Partnership Interast (Schedule C) (31
4. Hortg.gas/Hota, Raceivable (Schedule DJ C4J
5. Cash/Sank Deposits/Hlsc. Parsonal Property (Schedule E) IS)
6. Jointly Owned Property CSchedule F) (6)
7. Transfe,.s CSchedule G) (71
8, Total Asset.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.. Costs/Misc. Expenses (Schedule H) (91
10, Debts/Hortgage Liabilities/Liens CSchedule II ClO)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern..ntal aeque,ts (Schedule J)
14. Net Value of Estat. Subject to Tax
NOTE:
IlS)
1161
1l7l
TAX CREDITS:
PAYHENT
DATE
07-23-96
RECEIPT
NUHBER
AA146550
DISCOUNT I+l
INTEREST I-I
52,48
CtlANGED
.00
.00
.00
.00
6.288.18
18.975.88
,DO
IBl
7.220,04
552.05
1111
1l2l
1l3l
1141
.00 X .00=
17,491.97 X .06=
.00 X .15=
IlBI
AHOUNT PAID
997.04
I TOTAL TAX CREDIT
IBALANCE OF TAX DUEl
INTEREST AND PEN.
TOTAL DUE
NOTE: To insure proper
credit to your account,
sub. it the upper portion
of this for. with your
tax pay.ent.
25.264.06
7.777 09
17.491.97
,DO
17,491.97
and 18 will
date.
,DO
1.049,51
.00
1.049.51
1.049.52
.0ICR
.00
.0ICR
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS TtlAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY BE DUE
A REfUND. SEE REVERSE SIDE Of THIS FORH FOR INSTRUCTIONS.l
(';
RESERV,TION' E...... .1 d.c.d.n.. dvlnG .n ., b.I.,' D.c....' IZ. 10.Z ,- II .nv I.'." In'''''' In tho ....t. I. .,.n.I.".d
In .......Ion ., .nl.v'on' .. tl." . Ic.ll.t.,.11 b.n.llcl.,I.. .1 .ho d.c.d.n' .It., ,h. ...I,..I.n .1 .nv ..t... I.,
III. ., I.' ...,.. .h. t....n...lth h.,.b. ...,...1. ,...,... 'h' ,I.ht .. ...,.1.. .nd ...... .,.n.I., Inn.,I'.nc. T....
at the lawful cta.. a (collateral I rate on any such future lnt.rl.t.
PURpOSE OF
NOTICE 1
T. lulllll tho ,..ul,...n.. .1 s.ctl.n ZI" .1 tho Inn.,I..nc. .nd E...,. T.. 'c,. 'c, ZZ .1 1"" 7Z P.S.
s.ction 2140.
O.t.ch .h. '.p p.,.I.n .1 .hl. H.tlc. and .ub.l. .I.h .ou' p....n. .. tho R..I.t., .1 "III. .,Int.d .n tho ,...,.. .Id..
.-"ake check or .oney order payable tal REGISTER OF HILLS, AGENT
'II p....n.. ,.c.I..d .h.ll II'" b. ...II.d .. .nv Int.,..t .hlch ..v b. duo .Ith .nv ,...Ind., ...II.d .. .h. ....
. ,.Iund .1 . ... c,.dl'. which ... no' ,.qu....d .n .h. T.. R.tu,n. ..v b. ,.....t.d b. c..pl..ln. .n "..pllc.tl.n
I., R.lund .1 p.nn..,..nl. Inn.,ltane. .nd [.t.t. T.." IREV-ISISI. ,.pllc.tl.n. .,. ...II.bl. .. .h. Olllc.
.1 ,h. R..I..., .1 "III.. an. .1 tho ZS R...n.' OI..,lc' Olllc... ., b. c.llln. tho ...cl.1 Z,'hou'
.n...,ln. ..,.Ic. """b'" I., I.,.. .,d.,ln., In p.nn..I..nl. I....'S.Z-ZO,.. .u'.ld. p.nn..I..nl. .nd
within laclt Harrisburg ar.a (llll 787-8094, TDOI (7171 772-2252 (H.arlng lapalred On1yl.
PAVttEHh
REFUND (CA)1
O.JEtTIOHS' lnV ..,.. In In'''.'' n.' ...I.,I.d .I.h ,h. ...,.I....n., .11..anc. ., dl..I,...nc. .1 d.d.c.l.n.. ., ........n.
.1 ... 'Includln. dl.c.un' ., In..,..'1 .. .h..n .n thl. H..lc. .... .bJ.c' .I,hln .1.', "" d... .1 ,.c.lp' .1
this Notice bYI
--.,I...n .,.t..t t. ,h. P' O.p.,...n' .1 R...nu" ...,d .1 ,....1., D.p'. Z.I.ZI. H."l.b.'" P' 17IZ.'I.ZI. OR
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~ lnter..t AlllI DallY tnterut fllctor ~ tnt.,..., Rate Dl'Iilv Intlr..t Fllctor
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198) 16X .DDOltS8 1988'1991 UX .DQD~Dl
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1986 lOX .DDDZ74 pJ'9S'I'9'96 .. .OODl47
.-Interut 1. calcullted a. folio".:
INTEREST = BALANCE OF TAX UNPAID X NUnBER OF OAYS OELINQUENT X DAILY INTEREST FACTOR
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Hotlce, add1tional 1nterest .ust bl calculated.
AOMIH
ISTRATlVE
CORRECTIOHs:
DISCOUHh
PEHALTY:
IHTEREST'
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Hennan C. Hentz
Date of Death: ~Iay ;, 1996
Will No. Admin. No. 1996-001119
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 estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: II/A
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X .
b, The separate Orphans' Cuurt No. (if any) (or
the personal representative's account is: II/A
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.
Da te : / :;-! 'I /it
.
, ,<, (,-(
ignature
,
Jacqueline M. Verney, l'squire
Name (Please type or print)
7 Irvine How - Carlisle tA 1701;
Address
(717) 2/1;-9190
Te 1, No,
Capacity:
Personal Representative
!.
Counsel for personal
representative
(MAH: rmf/ AM3)