HomeMy WebLinkAbout96-01048
No, ~ - , q Cn~ - 010 t/-i
Estatc of
CUIITJS II. 1l1l0CKI",MAN
. I>cccascd
()I~CREE OF PROBATE ANI> GRANT 01: LETTERS
DECEMBEIl 19 96
AND NOW 19_, in comideration of the petition on
the reverse side hereof, satisfactory proof having been presented before Ille,
IT IS DECREED that the instrulI1el1l(s) dated OCT. 5 I 1987
described therein be admilled to prob:ue and filed of record as the last will of
CUIlTIS H. BIlOCKELMAN
and Lellers 'I'F,!,;'I'AMENTARV
arc hereby granted to
AVERILL B. SHEPPS
MARY C.
-:v" VlI'(:j~(J..p}[t
R lti~ll:r or With
375.00
Probate, Lellers, Etc. ...,..... S
Short Certificates( ~ . . .. .. . ... S 15.00
~~liIRllft8ln ................ S 9 . 00
JCP S 5.00
TOTAL _ S 404.00
Filed .... D.ECEMBER .1.9 ,. .1.~9.6... ..,
FEES
ATTORNEY (Sup, Ct. J.D. No.)
ADDRESS
PIIONE
CALL EXECUTOIl LETTERS AND ORDEIl '1'0 EXECU'I'OIl
2~ ~ ::0::0
<ll~
37 II" 0
IT -'~
~ Cl c
~i: f!.'
'" n '..
,. -- " ..,
CO
r: '';'\.'
b ,'. -0 :.:;: ('J
; " -- fjj g,
{}
"0(. ;;,
)>~ \0
I.....'
..
; JUlAHlwt
! !.AU"
'I'h;, " ,,, ",,,1\ ,h." Ii". ,,,I,,,,,,,,,,,,,, I,.." g'"'''' .",,,,d, "'I''''! 1'''111 .,,' ""f"".,1 ".",10",,,. "t.It,,,Io ,1,,1\ lilt-, I wllh ll1e ,.,
I ",.Ti I(q:"" .., 'I'lw ""!:,,...1 ,,,,,,10. "". ".Ilk I", ....." ,I< ,\ '" Ii" ".'" \ ,,01 I("",,!' lilt", I", 1",,".'IIl'''' 1'\"'1:
WARNING: It Is IlIullal to dupllcato Ihls copy by photostnl or photograph.
hTll'll\.l"I'llllh,llt ~.'t'll
,..i....IoJ...........'
. "",\,,\1~ OF fit.';'.;
#.... .. :tor"'
~..~./ ~\.,?,~\
~!. .'. \~
c> I;;
~( . \!.
~'"1:'~II/~~
'.9!i"" <'t-....'1!
..[/flU, ~
/...., _ //, - 0/.
/~ /u.: ..' ,T.u
\)"".
,-'
11I\.llltl'):I'II.lf
.'?.:'?22
I,":"
3929217
No
"1~IUA..l"
CO....OHWEALTHOf PENNSYl.VANIA' DEPARTMENT OF HEAl.TH . VITAl. AEconDS
CERTIFICATE OF DEATH
00\1101""'"
,..,_Ott_,
..,..,..,.~.ct,~_
"............c_..
. tL,oTco. Mu:,
-ii
'10 ,.
"".... .
t..Jl1\beQ.I.A,,~
o.
g ,1tOl"O 'OOD"'"
t./lRL.,S L -e
.........
..
,
3
_0
,
...
......
0001.11" 00
.. L/ .
It.HlltIl l_...__........----~...-OI..._...-"......
L.-...,__.......-
.....
0Iw..----..-....... III
...,......Il..~_....,,""'l
l~-.
,......--
/8 :z;;::;
(Of'/)
~
~.w..
\:
WllO~a.S.<<MllMoU.Clfl
ouctofOR"'.CI;fdlWVa.Clfl
.uvlt,IIIIl1Clf'1l.'
01 tcMt HOW!KNItf' CCQ.HIIO
OIlIOlIfltJUfl' ,,,,,coo,",,,,,,,,
........0.,_1
..........IIOJOl"'"
\1M 0 ,..0
wlN:AUlOI'I,'1HOIMCl1
............1 HIQIIII to
c.<lU'\lto.OIt.lU51
01 DlAf..,
-*
o
o
[1 """IOJ."'" ..........-.....--........
~_t'__'"
..
yf
o
o
-.
-..-
..-
c-""'........-
_0
..0
...
...0.,.eJ
..., ....
CUl1""~--
.tIJI1lt'1111G""IICUoIt,".~f........--.... ....~...~....."U'O^-.J..-.."'....I_I.....,I.
.............,...-.......___....._11....-......... ..,.,' .
"
i
&
1
, Q _.....UOOCllII''''_,..'ICo'W~__I'"..,..,''''iI.....-,.....'''"i.<-~-..
.............~.___"..._,_,...."........_....C"""'II...-........
.4<-
I~~.J ~
.MtDlCA&.llA...~1l
00l...1lMI................. ......""HlIfM*l. ...My....-....u._~ 11"'1_, "'.0.... ...... ........" IPIt ....MI.I....
__M........... -..............'..... ................-.. .......,..,,"" ""." , .
...
"
:lAf1"IO_,;>>o_1
W~;7,?o.l
1:2-
"".......
...
.
0\ t::~
- c:1 :.,0;:
0!!1 - .)
t:)~ Q. 0
.~7 .~U
'r ".. IX)
r.~ . - ..
"' -
"0 ;;; Co) '''':
~.
0-:; c:l ,OJ
~.... ~.o
001
ldll) ~ ~E
lI)B
a: a: 0
1Last lllill a1t~[l\shtntr1tt
I, curtis II. Brockelmiln, of the Eilton HOild, Town of
Franconia, County of Grafton, State of New IInmpshire, being of
sound mind, do hereby revoke all former wills and codicils nnd
declnre this to by my Lnst Will and Testament.
1. I hereby nominate my daughter, llVerill B. Shepps,
presently of Mechilnicsburg, Pennsylvnnia, to be Executrix of this
my Last Will and Testament. If Averill B. Shepps is not living,
or otherwise fails to qualify, then I nominate my son, Anton
Brockelman, presently of Southbridge, Massnchusetts, to serve as
Successor Executor. I direct that, to the extent permitted by
law, my Executrix/Executor not be required to post any bond.
2. I direct that all my debts, my funeral expenses, and
the expense of the administration of my estate be paid out of my
Residuary Estate as soon as practical after my death.
3. I give, devise and bequeath the sum of $1,000.00 to
Yale University, New Haven, Connecticut, $1,000.00 to Phillips
Exeter Acndemy, Exeter, New Hampshire, and $1,000.00 to the
united Church of Christ, Franconia, New Hampshire.
4. I give, devise and bequeath a three (3) acre portion of
my land located on the easterly side of the Eaton Road in
Franconia, New Hampshire to my daughter, Averill B. Shepps, such
three (3) acre parcel of land to be chosen by Averill B. Shepps.
5. I give, devise and bequeath all of the rest, residue
and remainder of my estate and effects whatsoever and
wheresoever, both real and personal, to which I may be entitled
or which I may have power to dispose of at my decease, my
("Residuary Estate") in equal shares to my two children, Averill
B. Shepps and Anton Brockelman.
6. In addition to and not in limitation of the powers
elsewhere herein granted, or those conferred by law, I give and
grant to any executor acting hereunder with respect to my estate
and with respect to any property, real or personal, held by him,
without obtaining prior authority from any court, the following
powers:
(a) with respect to nny such property (except any
specifically bequeathed or devised), to sell publicly or
privately, exchange and grant options therefor; to partition,
conveyor mortgnge the same at such prices and upon such terms as
deemed advisable; to repair, improve, develop or abandon any such
property; to modify, extend, renew or replace any mortgage which
Page 1 of 4
may be a lien thereon; to le~se the
even in excess of ten YD~rH, and
office of any fiduciary and the
thereunder;
same for any period of time,
extending beyond the term of
termination of any interest
(b) ~'o retain any IHH;h property (except any specifically
bequeathed or devised), and to invest and reinvest the same
(including accumulations of income) in real or personal property
of any class, kind or character and to acquire any such property
by the exercise of any rights to convert, exch~nge, purchase, or
subscribe therefor, without regard to any restrictions of law on
fiduciaries' investments;
(c)
mortgages
property;
otherwise;
To enforce or foreclose any obligations, security or
held hereunder; to bid on or purchase any such
and to take title by deed in lieu of foreclosure or
(d) To participate in or to oppose any reorganization,
recapitalization, consolidation, merger or other action which may
affect any securities or obligations held hereunder, and, in
connection therewith, to deposit any such property with any
committee therefor and to pay a proportionate part of the
expenses of such committee and any assessments levied; to advance
money to any persons, organization or corporation the securities
or obligations of which are held hereunder, for the purpose of
maintaining or increasing the value of such securities or
obligations;
(e) To employ and to fix the compensation of custodians,
accountants, experts, legal and investment counsel and such other
agents as shall be deemed advisable and to delegate discretionary
powers to and rely upon information or advice furnished by such
agents;
(f)
from any
secure the
To borrow money for any purpose deemed beneficial and
source and to pledge any property held hereunder to
repayment thereof;
(g) To make
or in property or
property (except any
use and allocation
interested hereunder;
any payme~t or distribution hereunder in cash
partly ~n each and to use and allot any
specifically bequeathed or devised), such
to be conclusive against all persons
(h) To exercise any and all rights, powers and
not specifically mentioned herein, which might or
exercised by one owning such property absolutely and
right, and in connection therewith to enter into such
and execute such instruments as may be deemed advisable;
privileges
could be
in his own
contracts
7.
executor
to see
No purchaser from or other person dealing with my
on any sale, loan, or other transaction shall be bound
to the application of any money or other property paid,
Page 2 of 4
.
received or delivered or to inquire into the validity, expediency
or propriety of any such sale, loan or other transaction.
IN I'1IT)lESS WIIEREOF,
this -.5 ~ day of
Hundred and Eighty-Seven.
1 have hereunto set my hand and seal
October, in the year One Thousand Nine
Signed, sealed and declared by the said Curtis H.
Brockelman as and for his will, in the presence of us, who at his
request, in his presence, and in the presence of each other,
hereunto subscribe our names as witnesses.
!t/.dk:.... M t:J....12.
~~
residing at~ .A.{ H.
residing at_~a.<..... HU..{. /'vi If-,
residing at 'J...a.n~ I -n. \':l.
STATE OF NEW HAMPSHIRE
COUNTY OF GRAFTON October s-ti , 1987
The foregoing instrument was acknowledged before me this
day of September, 1987, by Curtis
Testator, L.tl//~v Wtd.<t.-Iv
and 1'M/Vf;p, --t ~-,
swear as follows:
H. Brockelman, the
J . M
C"'fUk'W. <-?1.A.Ut-r
the witnesses, who under oath do
1. The Testator signed the instrument as his will;
2. This was the Testator's free and voluntary act for the
purposes expressed in the will,
3. Each
in his
witnesses.
witness
presence,
signed at the request of the Testator,
and in the presence of the other
Page 3 of 4
"
. .
4. To the best of my knowledge, at the time of the signing
the Testator was at least eighteen years of age and was of
sane mind and under no constraint or undue influence.
__~0f./~
Notary Public
My commission expires:
11/2/88
Page 4 of 4
Recorood ()ilico 01
Regi~ll!r ol Wills
'96 Ole 18 P 1 :39
C1e",O', <:,', ,'!c. Court
CUmbell:.u:d Co., PA
t I t
t $:; 0
. ..... CD
~ Z ~
~ "
..: 0
a :E: :l w ~
..., 3: CD a: =
Clt [il W j "r ':'
--= ~ III 't"
~ =: ...... u ~.. q ~:
I t ~ c 0
U':'t s=:s a: n:~~~~~
I t III
~ U':'t . lJ pH;;
:c ~~~~z~
~L ~ III
.... <l: <l: 0 ~ ~
td fo< ~ .. ~
a:
:;) u
u ~
.
,
.
E:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: (1;li5
Date of Death: 12. ' l'b - r6
will No, ''1'/6 - 010</8
/I, Brode/man
Admin. No,
zl9.!- 10<18
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 fallowing beneficiaries of the above-captioned estate on
~
Address
.4nfM 73YtJC,l.e.lman ,.q ~. -66.. 9/)1 FYanl!tM~i1o. Al/I .1JaS80
fre4s""t./', t/",.h/ ~44"d ,,/ r1hr,.~", h-aru:or"... ANI 03$8t:J
;t;s...h'e. ~n4if ssf. TIU'liUY .~ '()BZ~/ Mw ~ Crt1~5Z()-
8Z.~'
3n,,/1. &y...,6,J. V/ru.ftw fII:l/.;'st..c.Iw~/le6ti'e",'1 ZotJ1a.in <;f. E...e.h,. NI( d3B3!>
. ,
Notice has now been given to all persons entitled thereto under
Rule 5,6(a) except
Date:
1- e - '17
~6JY_.-
Signature (J-~
Name /1ver/// ~, -M e-1-"S
Address 1/817 ZJd61'Od,L .e/
/lfecha.n/C'sb/<';l Ih /?/JbS
Telephonec7111 76/-3.883
Capacity: ./' Personal Representative
-:r
...~
':':'CL
'0 !'1
'i."~
('.I
f\:
o
~
: ~ ' .
~
-,
Counsel for personal
representative
c,
o I~'
me:
a:
.-
P'
\I
:. E
<ll:J
UU
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I_
I
u:
______4I!-u/1/ P:_-$'/,~~- - ----- --------------
being duly 5'wt:>N-L____ according to law, do pas.. and says that .she --- .------
_ G!~~~,!____________ of the Estato of ('",,.Iis tI. 73r"t:&~/Man
late of ___ ._ _ /"/ecl.a",'e"b(.l_!1::___ ___, Cumberland County. Pa., deceased and that the
within is an inventory made by .__$a//L _~ Y'~_ ___ _ ____, the said .0c t?t!I!l!0l)<.
of the entiro estate of sold decedent, consisting of all the panonal prop.rty and reel estete, except real ..tate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of tha Invantory represent it's fair value
as of the date of decedent's death,
j
/~rf:: ~~
?I~ / 7 '7J~"'(JoJ: ~
hl!C'''n/~Sb(.t-!J I?A I~S5
Add,.,
and subscribed before me,
) Pl t/'-.(/I,,--, I J
~/ 11j~.:"'_.'-
/ -"'" .
I"",
f_d .__~ .~
19 f!?
"
D.y
'Z)ece/116~,...
Month
19r~
Date of Death
13
V..r
INSTRUCTIONS
I, An inventory must be filed within three months alter appointment of penonal representative,
2, A supplement inventory must be filed within thirty days of discovery of edditional ellets,
3, Additional sheets mey be attached as to penonalty or realty
4, See Article IV, Fiduciaries Act of 1949.
~ ~ -ti
w ..
~ ~
~ .... ..
w ~ ..
Do U
I 0 VI .. D
0 W C '" ...
'" w .. ..
~ I- :r: Do Do c:
.... ..J U. ~ ~
Z jj 0 0
U. ..J Do ~
I W 0 <( i-
~ > Z '"
Z 0 c:
C ~
- VI Z 0
0 '" U
Z w <( ...
Do ."
c:
- ..
-.:
0 ..
.D ." .><
.. E 0
- .!!
.. ~ 0
..J U u: lD
f..'
-
Inventory 01 the real and personal estate 01
a,.;,'':. /I. 13rc.!le!txa.-'l..- deceased
_._=7';:::':::;"--=-'-:::;;::=:==-::--=---~
$47,22 0
Cash, Bank Deposils & Miscellaneous
$560,70 .57
Slocks and Bonds
\
,
$607.92 '.17
TOTAL
'0$
'"
~
U <...'
1IlC:
a:
.-
r;')
C'l
r.:
N
.-
~
;i::
--'0('"
:-~~-:
~
I.lJC
-::>
OU
\:;:,- Il\q _ '--;
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
o 48. Futuro Inlorest Comprorn50
(lor dalOS 01 dealh aner 12-12-82)
~ 6. Docedenl Died Toslale 0 7. Docedenl MllinlaJned a Uving Trusl
(Anach COPV 01 Will) (Anach COPV 01 Trust)
AU. CORRESPONDENCl! AND COIlFlDENTlAL TAX INFOIIMATlOll 8HOLUl BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Tinoth C Wa ner, CPA Wag;pner Frutiger & Daub
TELEPHONE NUMBER 3310 Market Street
717 761-1222 Hill PA 17011
1. Reol Eslale (Schedule A) ( 1 ) None
2. Slacks and Bonds (Schedule B) (2) 560,708.00
3. Closelv Held Slack/PartnershIp Inlerest (Sch. C) ( 3 ) None
4. Mortgages and NOlos Rocewable (Schedule D) ( 4 ) None
5. Cosh, Bonk Deposds & Miscellaneous Personal (5) 55,226.00
Property (Schedule E)
6. Jointlv Owned Property (Schedule F)
7. Transfers (Schedule G) (Schedule L)
8. TOlal Gross Assets (10101 Unos 1-7)
9. Funerol Expenses. AdminisUOlive Costs.
Miscellaneous Expenses (Schedule H)
10. Debts, Mongage Uabollties. Uens (Schedule I)
11. TOlal Deduclions (10101 Unos 9 & 10)
12. Nel Value 01 Eslale (Une 8 monus Une 11)
13. Ch8fllable and Governmenlal Bequesls (Schedule J)
14. Nel VoIue Sub oct 10 Tax (Une 12 minus Una 13)
15. Spouul T,&n"It. (fo' 1:1",.. of "tatl'l 111., 8.30.0." S..
'nl1tuctlClnl tor Applll:..oll P"ul'I~g. on Pagll.llncludl
vltul.lromScPl'dul, KorSc"''''''IM,1
18. Amount or Uno 14 taxablo a1 GO'" raiD
(Include voluos Irom Schedule K or Schedule M.)
17. Amount 01 Uno 14 taxable 8115% rale
(Include values Irom Schedule K or Schedule M.)
TAX 18. Pnncipallax due (Add lax tiom Unes 15. 16 and 17.)
COMPUTA.. 19, CredllS SPOUI.IPovI'tyC,.c,: Prior Payments Discount
TION . 28,000,00+ 1,474.00-
20. II Une 19 is realer Ihan Une 18, ente' Ihe diNerence on Une 20. This is Ihe OVERPAYMENT,
A. Ch..k h..... "... I refund of ur OYI Il1l.
21. If Uno 18 is greater than Uno 19. onlor tho difference on Uno 21. This is tho TAX DUE.
A. Enter tho Interost on the balance duo on Uno 2tA.
B. Enler Ihe 10101 01 Une 21 Ind 21A on Une 21B. Thi. I. Ihe BALANCE DUE.
M.ke Chock P. 11>1010: R I.tor 01 Wills, A nl
.. .. BE SURE TO ANSWER AU. OUESTlOllS OIl PAGE a AND TO RECHEa< MAT11" ..
ndor ponalllos 0 perJury, dOClare thai I have examined thIS roturn. IncludlOg accompanYing SChedules and statements, and to the best 0 my knowledge
and bellof. It Is lrue, corract and complete. I declare lhat all real estato has boOn reported attlue markot value. Declaration 01 preparer othor than the personal
representative Is based on alllnlormanon 01 WhICh preparer has any knowledge.
S'CV'ATU " F PER ~I}iSPp/}81BI.E FOq F'I.I~G qEtl,/RN ADDRESS
.,; ~ . /4. . l,'~ :? .("k'~ See Schedule attached
SI~JIlrtfAE ~~ lPARE'}~rH THAN REPRESE",rATlVE ADDRESS
'--"~\W~r "'-'~ C-.'- 3310 Market Street
15001 NTF., CAnp Hill, PA 17011
REV.t!lOO ElhIP.i.)
COMMONWEAl. Tt1 OJ: P(NNS'fLVA~'A
OEPARTMENTOFREVENUE
OEPT.IIOeOI
HARRISBURG. PA 1712I1.oeOt
DECEDENT
DECEDENrs NAME (LAST, FIRST. AND MIDDLE INITIAL)
Brockellran CUrtis H,
SOCIAL SECURITY NUMBER
018-01-6322
II A LleA L b U VIVI'"
l=IRST AND MID I.E INITlALl
ou.
1. Onglnal Return
CHECK
APPRO-
PRIATE
BLOCKS
o 4. Umoled ESlale
CORRES-
PONDENT
RECAPIT-
ULAnON
CopyrllaPll FO""' SoUw". O"'y, Hli' N.I 0.1"(. N9.0AOOI
FOR DATES OF DEATH AFTER 12131,81
CHECK HERE IF A SPOUSAL
POVERTY CREDIT IS CLAIMED
FILE NUMBER
21 1996
COUNTY CODE YEAR
DECEDENrS COMPLETE ADDRESS
4905 E Trindle Rd
~aniCBburg, PA 17055
Coun CUrrber land
AMOUNT RECEIVED (SEE INSTRUCTIONS)
1048
NUMBER
Supplemental Relurn
3. Remainder Return
Irotd.t..a'd..lllpt,orIO'1.'3.121
~ 5. Federol ESlale Tax Return Required
o 8. TOlol Number 01 Sal. Depoar1 Bo.es
( 6)
(7)
None
14,450.00
(9)
17,197.00
(8)
630,384.00
(10)
12,231. 00
(11)
(12)
(13)
29,428.00
600,956.00
3,000.00
597,956,00
(14)
(15)
x.
=
(16)
597,956.00 x
.06 ,
35,877.00
0,00
(17)
0.00. .15 =
(18)
35,877.00
29,474,00
Interest
(19)
(20)
(21)
(2M)
(21B)
6,403.00
0,00
6,403,00
O~1E'J .. ~
V 7 -/1-'7'/
OA1, ., I
'VII,. ItiJ
'''.'
N
~
;",'j
'~-,' ...
.. :J
",.
~'-'
.-
PA REV-HlQO EX (7-~41 Fage 2
Acl H48 01 1994 provldel lor Ihe reduction 01 the lex rlt.. Impoled on Ihe net vllue 01 trenllerl to or lor Ihe uee 01
Ihl lPOUlI, The ral.. al pralcrlbed by Ihe IlaMe will ba:
. 3% (,03) will be appllceble lor IItalll 01 decedentl dying on or a"er 7/1/94 and belore 1/1/96
. 2% (.02) will be applicable lor IIlalea 01 decedenla dyIng on or a"er 1/1/96 and belore 1/1/97
. 1% (,01) will be applicable lor IIlalea 01 decedenla dying on or a"" 1/1/97 and belore 1/1/98
. spouaallranalera occurring on or a"er 1/1/98 will be exempl Irom InherItance tax,
PLEASE ANSWER THE FOllOWING QUESTIONS
BY PLACING A CHECK MARK (oJ) IN THE APPROPRIATE BLOCKS.
YES HO
1, Did decedent make a uanslsr and:
..,..........,.....................,....,....,..,..........,..
a. relain Ihe use or Income 01 the property n anslelled. . .
b. retain Ihe r1ghtlo designate who shan use Ihe property nanslened or lis Income.. . .. .. . .. .. .. . . . . . . . . . . .. . . .. . . . . . . . . .. .. . X
c. retain a reversionary Interest; or.. . . .. . . . . . . . . . . .. , . . . . .. , . . . . .. . . . . . . . . . . . . .. . .. . . .. . . .. . . . .. . . .. .. . . . . .. . . .. . . X
d. recelvelhe prorTiselor lite 01 either payments. benelits or care? . . . ... . .. .... .. ..... .. . . ... ..... .... . ..... , . ." , . . ... . X
2. II dealh occurred on or belore December 12. 1982. did decedenl within !WO years preceding dealh nansler property withoul receiving
adequale conslderallOn? II death occulled aner December 12, 1982. did decedenl uans!e< property WIthin one year 01 death without
receiving edequate consideration?.. . . . . . . . . . . . . . . .. . . . . .. .. . . . . . . .. . . . .. . . . . . . . .. . .. .. . .. .. . .. . . .. .. . .. . . . . . .. . , . X
3. Old decedenl own an 'In uustlo( bank accoun181 his or her death?.. . . . . .. . .. . .., .... . . ...' . , .., . . . .., . . ... . ..... . . ... . . 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,
PA1S002 NTF ""
COPY";"' Forml 5011011.111 O"'y, '99.& N.lc;a.I"t.. N'i.PA002
~.
X
.11.1, .tll: : I ~ 11 lil' .' :t ':1\';11 " I' d'
" ! ~ I ~ rill . ,rl~lll.ti ',tl\,I'l .-II tw i '!_t 11.1'1'
l\l'_" 111('.\ " " ,,, " ," 1.11 I ,~~ , HI'.t
.<
Ii. .t ~
, !Ilt
It'"~ lilt 11 'III..'
WARNING: It Is Illegal to duplicate Ihis copy by photostat or pholograph,
I'll' t..r thl' ll'll'!.'. jlt'. ~~ : /1
...,'.1 ..:. "~ "
__,Lj~~' '~y.I'r'
()J,e
.....,
'..1
-l.f-..:II~-~----_.
2:..:..:.....
.'
3929222
~tj
..10lt'4,1..''''
CO....ONWUUH Of PENNSYLVANIA' DEPAATMENT OF HEALTH' VITAL RtCOROS
CERTIFICATE OF DEATH
-'
.
-'
""'..
"1"","",,1"'._
""'.'~-rc.........
.
-!-1
; Ot
1>1"101"O OIDl
t^RL..iL -e
. tL,.T.". il11~:'
"
q'/
'10..
,,,,,,,.01 It
t,J I1\beQ.LA,,~
"
.
~
t
~
.
n.""" ...___._____.._tIII.._.._.......
UiI...,__...._
....,. c.-........._........-..
..-..........--...._......1IIWIl11
.
._-
'..--
ISC
(orb
~f;:J;:. u. ;,..."tA
l)
~w
\:
outfOtOfttlo.:.cMolOJl<lOf'l
MlOtOfttlO'.:MStOAoCtO'l
"""......-
-----..
""........
.......,
~.QfglA..
OAIIQf-.utl.
_Jfoo_'
'.....Of~.
-.-..1ItIIQIPfl1 OIICI'UOClltI...........a:z;ulIII'lILO
~
o
o
--
o
o
o 1'VOt10l.....ull. ..__.....--...... II
.......-~I
...
CJt,llOo500_~'"
-
-
... ~ ..D
-
c.._..__
...0
_c
... 0 ,zI
.. ...
c&In.....~__
.c:un..._"'"IlQoIIl............--.,-.- ..._~......---_.--....,),
".........-...-__.--.1--..-
-
"
i
a
I
__uClc&ln~","toM~_~_"'__'_.u..M~-'
"..-...,---...---....-'- -.....,--...-.,--.......
;;t....
I~~.J'
.....
.tlallCM...._.~.
Oot..._...,....................,--..-.....,--......-"" 11II,,-,............."'_"""""1'"
--........
,..
"G4tfW11'tlQJoMUNWOO~.
~;;I.1,?~1
1:2-
M
...-.. -- .----
1(ast lllill anD [cstamcnt
I, curtis H. Brockelman, of the Eaton Road, Town of
Franconia, County of Grafton, State of New Hampshire, being of
sound mind, do hereby revoke all former wills and codicils and
declare this to by my Last Will and Testament.
1. I hereby nominate my daughter, Averill B. Shepps,
presently of Mechanicsburg, Pennsylvania, to be Executrix of this
my Last Will and Testament. If Averill B. Shepps is not living,
or otherwise fails to qualify, then I nominate my son, Anton
Brockelman, presently of Southbridge, Massachusetts, to serve as
Successor Executor. I direct that, to the extent permitted by
law, my Executrix/Executor not be required to post any bond.
2. I direct that all my debts, my funeral expenses, and
the expense of the administration of my estate be paid out of my
Residuary Estate as soon as practical after my death.
3. I give, devise and bequeath the sum of $1,000.00 to
Yale University, New Haven, Connecticut, $1,000.00 to Phillips
Exeter Academy, Exeter, New Hampshire, and $1,000.00 to the
United Church of Christ, Franconia, New Hampshire.
4. I give, devise and bequeath a three (3) acre portion of
my land located on the easterly side of the Eaton Road in
Franconia, New Ha~pshire to my daughter, Averill B. Shepps, such
three (3) acre parcel of land to be chosen by Averill B. Shepps.
5. I give, devise and bequeath all of the rest, residue
and remainder of my estate and effects whatsoever and
wheresoever, both real and personal, to which I may be entitled
or which I may have power to dispose of at my decease, my
("Residuary Estate") in equal shares to my two children, Averill
B. Shepps and Anton Brockelman.
6. In addition to and not in limitation of the powers
elsewhere herein granted, or those conferred by law, I give and
grant to any executor acting hereunder with respect to my estate
and with respect to any property, real or personal, held by him,
without obtaining prior authority from any court, the following
powers:
(a) With respect to any such property (except any
specifically bequeathed or devised), to sell publicly or
privately, exchange and grant options therefor; to partition,
conveyor mortgage the same at such prices and upon such terms as
deemed advisable; to repair, improve, develop or abandon any such
property; to modify, extend, renew or replace any mortgage which
Page 1 of 4
-
. .....----.-
IJ........~. ~
"'-i'.
,
....- "
. .
---- .
may be a lien thereon; to lease the
even in excess of ten years, and
office of any fiduciary and the
thereunder;
same for any period of time,
extending beyond the term of
termination of any interest
(b) To retain any such property (except any specifically
bequeathed or devised), and to invest and reinvest the same
(including accumulations of income) in real or personal property
of any class, kind or character and to acquire any such property
by the exercise of any rights to convert, exchange, purchase, or
subscribe therefor, without regard to any restrictions of law on
fiduciaries' investrr.ents;
(c)
mortgages
property;
otherwise;
To enforce or foreclose any obligations, security or
held hereunder; to bid on or purchase any such
and to take title by deed in lieu of foreclosure or
(d) To participate in or to oppose any reorganization,
recapital.ization, consolidation, merger or other action which may
affect any securi~ies or obligations held hereunder, and, in
connection therewith, to deposit any such property with any
committee therefor and to pay a proportionate part of the
expenses of such committee and any assessments levied; to advance
money to any persons, organization or corporation the securities
or obligations of which are held hereunder, for the purpose of
maintaining or increasing the value of such securities or
obligations;
(e) To employ and to fix the compensation of custodians,
accountants, experts, legal and investment counsel and such other
agents as shall be deemed advisable and to delegate discretionary
powers to and rely upon information or advice furnished by such
agents;
(f)
from any
secure the
To bor:ow money for any purpose deemed beneficial and
source and to pledge any property held hereunder to
repayment thereof;
(g) To make any payment or distribution hereunder in cash
or in property or partly in each and to use and allot any
property (except any specifically bequeathed or devised), suoh
use and allocation to be conclusive against all persons
interested hereunder;
(h) To exercise any and all rights, powers and
not specifically mentioned herein, which might or
exercised by one owning such property absolutely and
right, and in connection therewith to enter into such
and execute such instruments as may be deemed advisable;
privileges
could be
in his own
contracts
7.
executor
to see
No purchaser from or other person dealing with my
on any sale, loan, or other transaction shall be bound
to the application of any money or other property paid,
Page 2 0 f 4
received or delivered or to inquire into the validity, expediency
or propriety of any such sale, loan or other transaction,
IN WIT}lESS WHEREOF,
this .s -Clt., day of
Hundred and Eighty-Seven.
1 have hereunto set my hand and seal
october, in the year One Thousand Nine
r7d ~r--
Curtl.s . rockelman
Signed, sealed and declared by the said curtis H,
Brockelman as and for his will, in the presence of us, who at his
request, in his presence, and in the presence of each other,
hereunto subscribe our names as witnesses.
aJd~ j,htJ-'2.
~~
residing at ,f!.:io~~ A..t /-+,
residing at ~a...<.... t-W, tv! 1+-,
ro ~. ~~
residing at}...o ~r4I\!i I 1\. H.
STATE OF NEW P~PSHIRE
COUNTY OF GRAFTON
October .s.ti.. , 1987
The foregoing instrument was acknowledged before me this
day of September, 1987, by curtis
Testator, /Ali}l~ Wa./A-iv
and 9M/l-f;p --I l ()~
swearvas follows:
H. Brockelman, the
J . ~
~ ~A.u/f
, the witnesses, who under oath do
1. The Testator signed the instrument as his will;
2. This was the Testator's free and voluntary act for the
purposes expressed in the will.
3 . Each
in his
witnesses.
witness
presence,
signed at the request of the Testator,
and in the presence of the other
Page 3 of 4
A[Y-ttO) IX .,....,
'C0'-4'-40"'WUL 'H OF P[......S...LY...kl...
I~Hr"U...~C[ ,.... n(fUA~
AUlon., D[C[DENT
SCHEDULE B
STOCKS AND BONDS
ESTATE OF
FILE NUMBER
CUrtis H. Brockelman
(All property 10lnUy-owned wttI1 RighI 01 Survlvorlhlp mUll be dllCloled on Schodul. F.)
ITEM
NO.
21-1996-1048
DESCRIPTION
VALUE AT DATE
OF DEATH
1 AT&T Gorp (001957109)
300ss of common stock
Accrued dividend arrount none
11,625.00
2 AMP Incorporated (0131897101)
400ss of common stock
Accrued dividend arrount none
15,200.00
3 Amoco Gorp (031905102)
200ss of common stock
Accrued dividend arrount none
15,125,00
4 Be11south Gorporation (079860102)
210ss of common stock
Accrued dividend arrount none
7,980.00
5 Bristol-Myers Squipp 00 (110122108)
100ss of common stock
Accrued dividend arrount none
10,844.00
6 Carolina Power & Light Go (144141108)
400ss of common stock
Accrued dividend arrount none
14,350.00
7 Cess1and Gorp Ltd (157159104)
26ss of common stock
Accrued dividend arrount none
0.00
8 Duke Power Go (264399106)
800ss of common stock
Accrued dividend arrount $424.00
Dividend on above stock declared prior to decedent's death
9 E:lcxon Gorp
400ss of common stock
Accrued dividend arrount none
35,200.00
424.00
37,600,00
10 GTE Gorp (362320103)
254ss of common stock
10,827.00
Dividend on above stock declared prior to decedent's death
11 Genuine Parts Go (372460105)
150ss of common stock
119,00
6,656.00
'lbtal fran rontinuation s
TOTAL (Also enler on line 2. R Itula1iOn)
(II more space Is needed, Insen addltlonaloheels 010.",. size.)
s
394 758.00
560 708.00
PAI5031 NTF ""
COP"I;"I Fa,,,,, Soth,lI. Only, 1114 N.lco.lnc, kI4P"'O:S1
Page 3
21-1996-1048
Estate of: curtis H. Brockelman
SCHEOOIE B - Stocks and Bonds
Value at Date
of Death
ItBll
No.
Description
-
59,029.00
23 MFS ser Tr V Total Return (552981300)
4034.824ss of cammon stock
AccrUed dividend !llTPunt none
24 Merrill Lynch Capital Fd A (590190104)
2250.777ss of cammon stock
Dividend on aboVe stock declared prior to decedent'S death
68,806.00
1,854.00
4,805.00
25 Merrill Lynch Fed sees Cl D (59019MS02)
500ss of cammon stock
AccrUed dividend !llTPunt none
31,247.00
26 $30,000 U S Treasury NT (912827R61)
DTD 10/31/94 Mat: 10/31/1999 7.50%
oencmination.........$30,000
AccrUed interest.....$267.27
267.00
Interest on above bond accrued as of decedent's death
11,165.00
27 $10,000 New HampShire St Tpk Sys ReV (644693CB7)
DTD 03/15/91 Mat: 11/01/2011 6.75%
Denamination....,....$10,000
Accrued interest.,...$78.75
Interest on aboVe bond accrued as of decedent's death
79.00
'lUrAL. (carry forward to rra.in schedule) . . . . . .
177,252.00
R(V-I'OI [If 1'-171
SCHEDULE E
CASH. BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ploaso Prlnl or T 0
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAlC REl\JRN
RESIDENT DECEDENT
ESTATE OF
CUltis H. Brockelroan
All . o/nU -ownod wt1h III. R 10lSurvlvo.ahl muat be d1acloHd on Schodul.
ITEM
NO.
21-1996-1048
DESCRIPTION
VALUE AT
DATE OF DEATH
1 Dauphin Deposit - checking
Acct # 30-58716-6
34,100.00
Interest on above item accrued as of decedent's death
2,00
2 Merrill Lynch - QolA MJney F\1nd
Acct # 822 10255 7780
0.00
Interest on above item accrued as of decedent's death
0.00
3 Centennial MJney Market Trust
A G Edwards & Sons, Inc
8,767.00
4
Bank of New Hanpshire 5.35% CD
CD-132723 Due 5/7/97
Beneficiary designation Averill B Shepps
Accrued interest of $7.23 included in the balance of $7,354.35
7,354.00
5 United Telephone - refund 12.00
6 Country Meadows - Security deposit refund 500.00
7 Country Meadows - Rental refund 1,761.00
8 Bell Atlantic - Refund 1.00
9 Holy Spirit Hasp - refund 109.00
10 Leader Nursing Hare - refund 552.00
11 SUburban Cable Co - refund 22.00
12 Cloutier & Sons I.cx}Jing 2,046.00
Sale of timber
PA15081 NTF 121$
TOTAL (Also onlOI on hno 5. Roc "ulabOn S
(Anach addllional8 1/2". II" shoots d moro spaco I. noodod.)
55 226.00
COD'tflght For,,"s Soll""'lr, Only, UIU N,lto, Int. Ni4PAOII
Estate of: CUrtis H, Brockelman
SOlEOOIE H, PARI' A - Funeral Expenses
Page 2
21-1996-1048
ItEm
No. Description lurount
1 Reese Funeral Hana - cremation/death certificate 815.00
2 Town of FranCXlnia - ElJM:lold Canetry cremation lot 200.00
3 Averill B Sh~, EKecutrix - cremation CXlntainer 117.00
4 Gary Johnson - services at EJ.nr...wd Cenetry 75.00
5 Town of FranCXlnia - grave site preparation 50.00
6 Patricia Brockelman - flowers 50.00
7 Anton Brockelman - funeral reception 125.00
8 Littleton M:tnuIrent Co - traI1IllreI1t 395.00
TOrAL. (Carry forward to main schedule) . . . . . .
1,827,00
REV- ,~'O EX ' 1~'01)
COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
TRANSFERS
PLEASE PRINT OR I'I'PE
FILE NUMBER
CUrtis H. Brockelman 21-1996-1048
THIS SCH MUST BE COMPlETED. FILED IF THE ANSWER TO ANV OF THE QUESTIONS ON THE REVERSE SIDE OF COVER SHEET 15 Vl!S.
DECO. DOLLAR VALUE
ITEM DESCRIPTION OF PROPERTY EXCLUSION TOTAL VALUE ~. OF DECEDENrs
Includo nama ollho transloroo.lhon
NO. folahonshlD to docodont. dalu 01 tJansfor. OF ASSET INT INTEREST
1 $10,000 cash gift to daughter, 3,000.00 7,000.00 100 7,000,00
Averill B Shepps, on Nov 26, 1997
:! $10,000 cash gift to son, Anton 3,000,00 7,000.00 100 7,000,00
Brockelman, on Nov 26, 1997
3 $10 cash gift to great grandson, 10.00 0.00 100 0.00
Max Dudley, on Dee 11, 1997
4 $50 cash gift to grandson, Mark 50,00 0,00 100 0.00
Brockelman, on Dee 11, 1997
5 $50 cash gift to granddaughter, 50,00 0,00 100 0,00
Wendy Brockelman, on Dee 11, 1997
6 $50 cash gift to grandson, Steven 50.00 0.00 100 0,00
Schmelz, on Dee 11, 1997
7 $50 cash gift to grandson, Mark 50,00 0.00 100 0.00
Dudley, on Dee 11, 1997
8 $50 cash gift to granddaughter, 50,00 0,00 100 0,00
Kristin Dudley, on Dee 11, 1997
9 $10 cash gift to great 10,00 0.00 100 0.00
granddaughter, Anabe11e Schmelz, on
Dee 11, 1997
10 $150 cash gift to son, Anton 0,00 150.00 100 150,00
Brockelman, on Dee 11, 1997
11 $100 cash gift to daughter-in-law, 100,00 0.00 100 0,00
patricia Brockelman, on Dee 11,
1997
12 $50 cash gift to grandson, Anton 50,00 0,00 100 0,00
Shepps, on Dee 11, 1997
13 $50 cash gift to granddaughter, 50,00 0,00 100 0,00
Heidi Schmelz, on Dee 11, 1997
14 $10 cash gift to great 10.00 0.00 100 0.00
granddaughter, Kristina Schmelz, on
Dee 11, 1997
Total from continuation oaoe(s) 300.00
TOTAL (Also onlor on Iino 7. Rocapllulalion) S 14,450,00
(II morc space is needed. insert addibonaJ shoots 01 samo size.)
PA15101 NT~ 1217A
CopyrIght ~O'ITIS Soltwa,. 0"1'1'.199. pljel(.o.l"c. pljg.PA10'
Estate of: curtis H. Brockelllan
Page 2
21-1996-1048
SCHEOOLE G - Transfers
Item
No.
Description
Total Value
Exclusion of Asset
Decedent
Percent
Interest
D:lllar Value
of Decedent's
Interest
15 $10 cash gift to great grandson, 10.00 0.00 100 0.00
Tyler Schmelz, on Dee 11, 1997
16 $10 cash gift to great grandson, 10.00 0.00 100 0.00
Anton Schmelz, on Dee 11, 1997
17 $50 cash gift to daughter-in-law, 50.00 0.00 100 0.00
Sharon Shews, on Dee 11, 1997
18 $300 cash gift to daughter, Averill 0.00 300.00 100 300.00
B Shews, on Dee 11, 1997
'l'Ol'AL. (carry forward to nain schedule) . . . . . .
300.00
REV-Uti U.j7-1I1
SCHEDULE H
FUNERAL EXPENSES.
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Plu.. Print or Typo
CO,",,",ONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIOENT OECEDENT
ESTATE OF
curtis H. BrockellTan
ITEM
NO.
A. Funeral Expon...:
FILE NUMBER
21-1996-1048
DESCRIPTION
AMOUNT
See Schedule attached
Total fran CXlntinuation pagels)
1,827.00
B. Admlnl.traUve Co.ls:
1,
P.rsonal R.pr....nt.tiv. Corm1ission.
Social Seeumy Number 01 P.rsonal R.pr....nt.tiv.: 023-24-8445
V.ar Cooy",ssion. paid 1997
Name: Averill B Sherps
10,000.00
2. Anorney Fees
0.00
3. FamilV Exemption
Claim.nt
0.00
R.I.bonshlp
Address 01 Claimant .t deced.nt's d..th
Street Address
City
Sta1.
Zip Cod.
4. Prob.te Fee.
0.00
c, Mlse.n.neou. Expon....
See Schedule attached
Total fran CXlntinuation
5 370.00
17 197.00
TOTAL Also .nt.r on line 9. Recapitul.tlOn) S
(II mora space'. n_, In.ert addlUolUll .heets of sam. .Ile.)
PA15111 NTF '211
Copyright Fa,,", So'h~'". O"ly, ';;4 N.1CO,I"C, N;4PA',1
.
~
I
,
'....
Estate of: CUrtis H. BrockelJmn
Page 2
21-1996-1048
SOlEIlUlE H, PART A - FUneral Expenses
Item
No. Description 1\nD\Ult
1 Reese FUneral !lane - cremation/death certificate 815,00
2 Town of Franconia - Elmtioold Ceretry cremation lot 200.00
3 Averill B Shews, Executrix - cremation container 117.00
4 Gary Johnson - services at ElmNood Cemetry 75.00
5 Town of Franconia - grave site preparation 50.00
6 Patricia BrockelJmn - flowers 50.00
7 Anton Brocke1m:m - f\Uleral reception 125.00
8 Littleton M:rnurrent CO - m::mument 395.00
'!OrAL. (carry forward to rrain schedule) . . . . . .
1,827.00
QEV.t!U,O'ltl'II,
COMMONW(AL fH OJ J1[NN!"'l~A"'I"
INH(R1U~C[ fAl Noun,-
"[510[~f O[C[O[,.,
SCHEDULE I
DEBTS OF DECEDENT.
MORTGAGE LIABILITIES AND LIENS
ESTATE OF
CUrtis H. BrockelJoon
ITEM
NO.
DESCRIPTION
1 Manorcare Health Service
2 CUmberland Ambulance Service
3 A Z Ritzman Assoc
4 Carlisle Digestive Disease
5 West Shore Anesthesia Assoc
6 Central Pa MRI Center
7 Carlisle Hospital
8 West Shore GMS
9 Orthpedic SUrgeons Ltd
10 United Telephone of PA
11 Holy Spirit Hospital
12 Dailey Eye Assoc
13 RM:: Emergency Physicans
14 Internal Revenue Service - 4th qtr 1040ES
15 Pa Dept of Revenue - 4th qtr PA40ES
16 Orthopedic SUrgeons Ltd
17 Masland Assoc, Inc - ERG
18 Belvedere Medical Corp
19 Carlisle Imaging Assoc
20 Carlisle Ccmmmity Ambulance
21 Hanp:len 'l\oip Ambulance
22 Mediq l-bbile X-Ray Services
23 United of PA - final bill
futal fran oontinuation
PA15121
TOTAt.IAJso enter on line lD, RecapitulabOn) $
(II mo.. space IS needed. tnson addrtJonalsheets 01 same siZe.)
NTFIUO
COPYI'IQPtI ~O""' Solh...,. On'y, tgg.. Nlt(O, t"e. ~g.PA'll
Pl.... Pnnl or T
FILE NUMBER
21-1996-1048
AMOUNT
2,852,00
61.00
11.00
34.00
40.00
86,00
118.00
81. 00
5.00
12.00
902,00
11.00
17,00
1,802,00
250,00
294,00
2,00
17,00
3,00
58.00
23.00
31. 00
3,00
5,518,00
12,231. 00
Estate of: curtis H. Brockelman
Pacp 2
21-1996-1048
SCHEOOlE I - Debts of Decedent, lobrtgBcp Liabilities and Liens
Item
No. Description
Arrount
24 'l11ree Springs Medical Practice
25 Manorcare Health Services
36.00
28.00
26 White Rose J\rrbulance
132.00
20.00
30.00
27 J\lrerican Red cross
28 'l11ree Springs Family Practice - Iredical services 10-31 to
11-20-96
29 Internal ReVenue Service - 1996 1040
4,715.00
415.00
30 PA Dept of Revenue - 1996 PA40 tax balance
31 Holy Spirit Hosp - Iredical
32 ROC E)rergancy Physicians - Iredical 12-12-96
33 Orthopedic surgeons Ltd - Iredical 10-20-96
34 'l11ree Springs Family Practice - Iredical 10-27 to 10-29-96
35 SUburban Cable Co - final bill
42.00
18.00
12.00
45.00
25.00
'!OrAL. (Cany forward to rrain schedule) . . . . . .
5,518.00
R[V~ I'I~U. 'l-Ul
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSVLVAWA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
CUrtis
ITEM
NO.
H, Brockelman
21-1996-1048
AMOUNT OR
SHARE OF ESTATE
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
A. Taxablo Boquosls:
1 Averill B. Shepps
4817 Oelbrook Road
Mechanicsburg, PA 17055
2 Anton Brockelman
PO Box 901
Franoonia, NH 03580
Daughter
304,177.00
Son
293,787,00
ITEM
NO.
AMOUNT OR
SHARE OF ESTATE
NAME AND ADDRESS OF BENEFICIARY
B. Charltablo and Govornmental Boquosts:
1 Yale university
New Haven, CT
1,000.00
2 Phillips Exeter Academy
Exeter, NH
1,000,00
3 United Church of Christ
Franoonia, NH
1,000.00
TOTAL CHARITABLE AND GOVERNMENTAL BEOUESTS (Also onlo, on Hno 13. Roc itula1JOnj
(II more space 'a needed. In..rt additional ahaole ol..me aJ..)
3 000.00
s
PA15131 NT'm"
CODY"Q"IFo,,"s 5011'0,.,. Only. '"'' Nelco.lnc. Ng4PA1]1
;
,
,
,
I
,
I
I
I
.
.
I
I
I
I
I
I
.
I
f
I
I
I
I
I
I
:- 'oto HUI
I
I
I
I
I
I
_. . --., .~._- ~._._. -'__ __ h ~. ___ _" "_..__
Ib.IW"
1851')59 COMMONWEALTH OF PENNSYLVANIA
Ci DfPARTMINT O. RIVINUI
OFFICIAL RECEIpt' · PENNSYLVANIA INHERITANCE AND ESTATE TAX
w;
DNo. AA
RECEIVED FROM:
&
ACN
ASSESSMENT ~
CONTROL iii
NUMBER
AMOUNT
AVER I LL D SHEPPS
lul
-C::ts,uvu.uu
4817 DELBROOK RD
MECHANICSBURG, PA
.
17055-3009
ESTATE INFORMATION,
~ FILE NUMBER
III C?J-1996-J048
r:t NAME OF DECEDENT (LAST)
~ BROCKEL MAN CURTIS
II DATE OF PAVMENT
a POSTMARK CATE
COUNTY
SSN
IFIRST)
H
018-01-6322
IMI)
CUMBERLAND
DATE OF DEATH
REMARKS
AVERILL B SHEPP
m TOTAL AMOUNT PAID
SEAL
CHECK" 1012
(--
RECEIVED BY 'j /'t
S28,000.00
,CW .1
I .: (. ~~ I'I,!.' 1'''./(.'1
, SfGNATURE/ ..' ~ , -TJ;'!
J '." /1" 't
MARYC. LEWIS /""'/1._.:,,:
REGISTER OF WILLS .
REGISTER OF WILLS
-- - -- - --.- --- -~ ---- --- .---- -- -.- --- --. ---
., --- --. --- - -..-.- --- --- --- - -- - --- -.., - --- ----- -~--..
. .
-- - _- -_..- - ~.'--:"..JlI.
---~
r. .,:.
- - .
is-/'N3
BUREAU DF INDIVIDUAL TAXES
INUUltAHC[ tAX DIVISION
DlPI. 180bOl
tlARAISIUNG, PA Hua-OltOl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*'
NDTlCE OF INItERITANCE TAX
APPRAISEMENT, ALLDWANCE OR DISALLDWANCE
DF DEOUCTIDNS AND ASSESSMENT DF TAX
11'.\"'" &I, .".tll
TIMOTHV C WAGGONER
WAGGONER ETAL
3310 MARKET ST
CAMP HILL PA 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02'09-98
BROCKELMAtl
12'13-96
21 96-104B
CUMBERLANO
101
CURTlS
H
AMount R."it tad
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
rfiv:isi,TEX'AFP'iii9':ij'rj'NoTiCE"oi="INHEiiiTAHCn'-"in'piiiiiiiSEHENy.;.AL.i."'owAHcE.oli..........nn...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BROCKELMAN CURTlS H FILE NO. 21 96-1048 ACN 101 DATE 02'09'98
TAX RETURN WAS' I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. A..I Est.t. (Schedule A)
2. Stacks and Bonds (Schedule B)
3. Closely Hald stock/Partnership Int.r..t (Schedule C)
4. Hortgaga./Hat.. Racaivable (Schedule 0)
5. Cash/Bank Deposits/Hisc. Parsonal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfars (Schedule G)
a. Total Assats
I I CHANGED
NOTE: To in sura proper
credit to your account,
sub..it the upper portion
of this for. with your
tax paYlla"t.
.00
560.708.00
.00
.00
55.226.00
.00
14,450.00
181
III
121
131
141
ISI
1&1
171
630,384,00
APPROVED DEDUCTIONS AND EXEMPTIONS:
17.197,00
9. Fun.~.l Exp.nl.~/Adn. Costl/Hi.c. Expanse. (Schedule H) (9)
10, D.bh/Modg.g. LhblllU.s/L1.ns ISch.duh II 1l0l 12,231.00
11, Tot.1 D.ductlons 1111
12. Hat V.lue of Tax R.turn (12)
13. Charltabla/Govarnnantal Bequests; Non-al.ctad 9113 Trusts (Schedule J) (13)
14, N.t V.lu. of Est.t. Subj.ct to T.. 1141
NOTE: If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Anount of Lin. 14 at Spousal rat. (15)
16. Anount of Lin. 14 taxable at lin..I/Cla.s A rat. (16)
17. Anount of Lin. 14 taxabl. at Collat.ral/Clasl Brat. (17)
la. PrincIpal Tax Due
?Q.4?R no
600,956,00
3.000,00
597. 956,00
,00 X .00.
597,956.00 x. 06.
.00 x ,15.
U81
,00
35,877 ,00
.00
35.877 ,00
TAX CREDITS:
PAVMEHT
DATE
03'10'97
09-12-97
DISCDUHT 1+1
INTEREST/PEN PAID I-I
1,473,68
,00
AHDUHT PAID
28,000.00
6.403,00
RECEIPT
NUMBER
AA185259
AA242232
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
35,B76,68
.32
,01
.33
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATIDH OF ADDITIDNAL INTEREST,
IF TDTAL DUE IS LESS TitAN 'I, ND PAVMEHT IS REQUIRED,
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI, VOU MAV BE DUE
A REFUND, SEE REVERSE SIDE DF THIS FORM FOR INSTRUCTIDNS.1
RESERVATIONI E.tata. 0' dacad.nt. dying on or b.for. O.c.ab.r Il, 1~82 -- I' O"Y future lnt.r..t In the ..tet. I. tran.flrr.d
In po.....lon or .nJoy..nt to Cia.. I (collet.r.l) bln.flclarl.. of th. d.c.d.nt aft.r th. ..plration 0' any ..tat. 'or
Ilf. or far y.ar., th. Ca..anwlelth h.r.by ..pr...lY r...rv.. tha right to appral.e and e...S' tran.flr Inhlrltanc. Ta..'
.t th. I.wful CI... I (coll.tar.l) r.t. on .ny such future Inter..t.
PIlR1'OSE Of
NOTICE~
To 'ulflll the r.qulr..lnt. 0' Section ll40 of the Inhlrltanc. and E.tet. T.x Act, Act 21 0' 1995. (ll P.S.
S.ctlon 914G).
PAVKENTs
D.t.ch the toP portion of thl. Hotlc. and .ubalt with your p.y..nt to the R.glst.r of will. prlntld on the r.v.r.a .Idl.
--M.k. check or .oney ord.r p.yable to: REGISTER OF MILLS, AGENT
REFUND (CR):
A r.'und of . tax credit, which w.. not reque.ted an thl Tex R.turn, ..y b. reque.t.d by ca.pl.tlng an -APpllc.tlon
'or R.'und 0' Plnn.ylvanla Inh.rltanc. and E.t.t. 'a.- (REV-ISIS). Application. .r. avall.ble at the Offlc.
of the Regl.t.r 0' Wlll., any 0' the 25 R.v.nu. DI.trlct O'flc.., or by calling th. ,plclel 24-hour
an.warlng ..rvlc. nuaber. 'or for.' ardlrlng1 In Penn.ylvanl. 1-800-562-l050, out. Ida P.nn.ylvanle and
within locel HarrisbUrg ar.e (111) 181-8094, TOOl (111) 11l-225l (H.arlng I.p.lr.d Only).
OIJECTIONS:
Any p.rty In Int.r..t not satl.fl.d with the .ppr.I....nt, allowance or dlsellowanea of deduction., or .......ant
0' tax (Including discount or Int.rest) e. .hown on thl. Hatlca au.t obJ.ct within sixty (60) dey. of rac.lpi of
this Hotlce bY1
DR
.-wrltten prota.t to the PA Oepart.ent of Rev.nu., loard of App.als, D.pt. 281021, Harrisburg, PA
.-al.ctlon to heva the .att.r d.t.r.lnld .t .udlt of the account 0' the p.rsan.l r.pr..entatlva,
--appaal to the Orphan.' Court.
11128-1021,
OR
ADMIN
IS1RATtYE
CDQREClIOHS1
Factu.1 .rror. dl.cov.r.d on this ........nt .hould b. .ddr....d In writing to: PA DIPart..nt of R.venue,
lur.au 0' Individual lax.s, A1THI po.t A.......nt R.vllw Unit, O.pt. 280601, Harrl.burg, PA 11128-0601
phon. (111) 187-6505. 5.1 page S of thl bookl.t -In.tructlon. for Inh.rltanc. Ta. R.turn for. R..ldant
o.c.d.nt- (REV-ISOl) far an ..planatlon of ad.lnl.tratlv.1Y corr.ctabl. .rror..
DISCOUNT:
I' any ta. due 1. p.ld within thr.e (5) cal.ndar .anth. .ft.r the d.c.dlnt's d.eth, . flv. p.rc.nt (SX) dl.count of
the ta. peld I. .llow.d.
PENAL TV 1
lh. ISX tax .ana.ty non-p.rtlclpatlon p.nalty I. co.put.d on the tot.l of the ta. and Intlr..t .......d, and not
paid b.far. Januery 18, 1996, thl 'lr.t day aft.r thl .nd of thl te. a~.ty p.riod. This non-p.rtlclpatlon
penalty I. appeal.bla In the .... .~r and In the the .... tl.. p.rlod .. you would app.al the ta. and lnt.r..t
that ha. b.an ..s....d a. Indicated on thl. notlc..
INTEREST:
Int.r..t I. ch.rg.d bIg Inning with flr.t day of d.llnqu.ncy, or nine (9) .onth. and on. (1) day 'roe the data 0'
d.ath, to the datI 0' pay..nt. T.... which b.ca.. d.llnqu.nt b.'or. January 1, 1982 baar Int.ra.t at thl rat. of
.1. (6X) p.rc.nt plr annua calculat.d et a d.lly rat. of .000164. All ta... which b.ca.. dallnqulnt on and aft.r
January 1. 1982 will b.er lnt.r..t at a rate which wl11 vary fro. calendar y.ar to cal~ar y.ar with that r.t.
~cld by the pA D.part.ent of R.venu.. Th. appllcabl. Int.r..t rat.. for 1982 through 1998 er.:
'!.!!! Int.rut Aat. Dally Int.rut Factor !!!! Inter.st Aat. DallY lntar..t Fector
1982 "X .000548 1987 OX .000247
1985 16X .000458 1988-1991 lIX .000501
19114 l1X .000501 1992 'X .000247
1985 13X .000556 1995-199" ]X .000192
1986 lOX .OOU7" 1995,-1998 'X .00DZ47
--Int.r..t la calculat.d a. followas
INTEREST . BALANCE Dr TAX UNPAID X NU"BER Dr DAYS DELINQUENT X DAILY INTEREST rACTDR
--Any Hotlc. I..u.d aft.r the ta. b.co.I' d.llnquent will r.fl.ct an Intar..t calculatlon to flft.an (IS) days
b.Yond thl dat. of the ........nt. If pay..nt I. .ad. aftlr tha Int.r..t coaputatlon data Ihown on the
Notlc., additional Int.r..t ~.t b. c.lculat.d.
PURPOSE Of
NOflCEl
To fulfIll the r.qulr...nt. of S.ctlon Zl~S Cb) 0' tn. Inh.rltanc. and E,t.t. r.. Act. Act 21 of 1995.
(7l P.S. S.ctlon 91~SI.
PAYMENTJ
D.t.ch the top portion of thl, Notlc. and .ub.lt with your p.y..nt to the R.ol.t.r of ~III. prlnt'd on the
revsr.. .Id..
n "ek. ch.ck or .on.y ord.r ply.bl. to: REGISTER OF HILLS I AGENT.
AEFUND (CR) I
A refund 0' a ta. cr.dlt "V bl rlqu..t.d by co.pl.tlng an RApPllc.tJon 'or R.fund of P.nn.vlvanl.
Inh.rltanc. and E.tet. T..R (REY-llIl). Application. ar. .v.llabl. at the Offlc. of the Alol.t.r of Will.,
any of tn. 23 R.v.nue DI.trlct Of' Ie., or fro. thl D.p.rt.lnt', 2~-hour an,wlrlng ..rvlc. nueb.r. for for.. ord.rlngl
In P.nn.vlvanla 1-800-)62-2050, out.ld. Penn'vlv.nll Ind within 10c.1 tlerrhbura ".. C7I7) 787-109~,
TDDI (717) 772-2252 (H..rlng t'Pllrld Only).
OBJECTIONS I
Any p.rtv In Int.r..t not ..tl.'I.d with the ........nt of t.. a. .hown on thl. notlc. .av obJ.ct within
,I.ty (60) d.y. of r.e.lpt of thl. Hotlc. bVI
--wrltt.n prot..t to the PA D,p.rt.,nt of R.v.nu., Boerd of App..ls. D.pt. 281021. Herrhburg. PA 17128-1021, OR
--.I.ctlng to h.v. the .ett.r det.r.ln'd .t ludlt of the per.onal r.pr...nt.tlv., OR
--epp.al to the Orphan.' Court.
AOtUN-
ISTRAflVE
CORRECTIONSJ F.ctu.1 .rror. dl.cov.r.d on thl, ........nt .hould b. .ddr....d In writIng tal PA Dlpert..nt of RIV'nu.,
Bur.au of Individual T..... ATTNI Po.t &""...nt R.vl.w Unit, DIPt. 210601, Harrl.burg. Pi 17121-0601.
Phon. (717) 717-6505. S.. peg. 5 0' the booklet Rln.tructlon, for Inh.rltanc. Ta. Return for. R..ldant
Dlc.d.nt- (REY-ISOl) for an ..planatlon 0' .d.lnl.tratlv.lv corr.ct.bl, .rror..
PENALTY:
Th. 15X t.x .~..ty non-p.rtlclp.tlon p.nelty I. co.put,d on the totel 0' the te. end Int.r..t .......d. end not
p.ld b.for. Janu.ry II. 1996, the flr.t d.y .'t.r the .nd 0' the t.. .en..tv p.rlod. Thl, non-p.rtlclpetlon
p.nllty I. app..labl. In the .... .enn.r and In tn. the .... tl.. p.rlod a. you would app..1 the te. and Int.r..t
th.t ha. b..n .......d a. Indlc.t.d on thl. notlc..
INTEREST:
For d.t., 0' de.th on or aft.r 10-3-91, P.nn.vlvanl. E.tat. Tex ba..d on the Fed.rel E,tat. T..
r.turn b.eo... d.llnqu.nt at the ..plratlon 0' nln. (09) .onth. frol the d.t. of d.ath.
For det.. of d.ath prior to 10-)-91, P.nn.ylvanll E.tlt. Tlx ba..d an the F.d.ral E.t.t. T.x r.turn
b.eo... d.llnqu.nt at the e.plratlon of .Ight.en (11) .onth. fro. the date of d.ath.
T.... which blc.., d.llnqulnt b.for. Jenuary I. 1912 b.ar Int.r..t at the r.t. of .1. (6Z) p.rc.nt p.r annua
calculat.d et a dally rat. 0' .00016~. All t.... which b.ce.. dellnqu.nt on or eft.r Janu.ry 1, 1912 will b..r
Int.r..t at a rat. which will vary fro. c.l.nd.r y.ar to c.l.ndar y.ar with th.t r.t. announc.d by the PA
C.p.rt..nt of R.v.nu.. The .ppllc.bl. Int.r..t r.t.. for 1912 through 1991 .r.r
Y..r Inter..t R.t. C.lly Int.r..t Flctor V..r Int.r..t R.t. Dilly lnter..t F.etor
1912 2aie .aa05~1 1917 OX .aoozu
1913 16~ .oaa~)1 1911-1991 l1ie .0oo3GI
19" 11:C .000301 1992 9~ .ooalU
1915 Uie .000356 1993-1994 n .000192
1916 1O:C .OaaZ74 1995-1991 9~ .00020
--Int.r..t I. c.leulet.d .. fallo""1
INTEREST = BALANCE DF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlc. I..u.d aft.r the t.. beCO'I' d.llnqu.nt will r.fl.ct en Int.r..t calcul.tlon to flft..n CIS) day.
b.yond the d.t. of thl ........nt. I' p.~ent I. ..d. .ft.r the Int.re.t eo.put.tlon d.t. .hown on the
Notice, .ddltlonal Int.r..t ~.t b. calcul.t'd.
~w ~ :o~
:1 ~
~. " ~~ n
. "
~
-
N
,
(; ~
L C) -
~L W v; g,
;4 -
PURPOSE OF
NOTlCEI
I. fu.fll. tho ,.qul,...nt. .f S..tlon Z"S (bl .f tho 1...,1'''.' and E.t.,. I., ..t. ..t ZI .f 1"S, (7Z P,S,
Section ,11t5).
PAYMENT I
D.t..h tho t.p p."I.n .f 'hI. H.t'., and .ub..t ."h .au' p....nt t. tho ...I.t., .f wl.l. p,lnt.d .n tho
rav.'" dds.
._ "aka chack or .onn order payable tal REGISTER OF MILLS, AGENT.
.EFUND (C.l. . ,.fund .f . t., .,.dlt ... b. ,.qu..,.d b. ...pl.tlno .n ",ppll..tl.n f.' ..fund .f p.nn.....nl.
I...,ltnne. ond E.t.t. I.," (.EV-13131, ,ppll..tlon. .,. ...II.bl. .t tho Dffl.' .f tho .....t., .f wll",
.n. .f tho Z3 ....nu. DI.t,l.t Dffl..' ., f,.' tho D'P.,t..n'" Z'-hOu' on...,ln. ..,.1.. nuob.,. f.' f.'" .,d.,ln..
In p.nn.....nl. 1_.00_3.Z_Z0S0. aut.ld. p.nn.....nl. .nd .Ithln I.." H.""OO'. .,.. 17171 7.7-.0...
TOO' (1171 712-2252 (H..tlng t~.lr.d Only),
OBJECTIONS:
An. p.,t. In Int.,..t n.' ..tl.fl.d .I'h tho .......ont .f t., ., .hO" .n thl. not I.. ... .bj..t .I'hln
sixty (60) dayS 0' r.calpt of thl. Notle. by:
__.,Itt.n p,.,.,t t. tho P' D.p.,t..nt .f ....nu.' ...,d .f 'PP..... D.pt. Z.10ZI. H.""OO'., P' 171Z.-10Z1. DR
--a.actlng to have the ..ttar d.t.r.l~d at audit of the parsona. rapr..lntatlva, OR
--appaal to the Orphans' Court
AOHIN-
ISTRATlVE
CORRECTIONS I
F..tu.' .".,. dl.....'.d .n thl, ..,.,...nt .hauld b. .dd'....d In .,Itln. t.: P' D'P.,t..nt .f ....nu..
.u,.ou .f Ind..IOo.. I.,... .IIH. P.,t .,'..'..nt ...1.. unit. D.pt. Z.O.OI. H."I.OO'.. P' 171Z.-0.01.
Phon' (7171 7.7-.S0S. 5.. p... S .f tho b..k..t "In.t,u.tlon. f.' 1...,ltnne. I., ..tu,n f.' . ...Id.nt
OacadantM tREY-ISO.) for an axplanatlon of adalnllt,atlvalv correctable .rrorl.
PENALlYl
Ih. ISX t., .on.,t. non'p.,tl.lp.tlon p.n.lt. I. .....t.d .n tho t.t.' .f tho t., .nd Int.,..t .......d. ond not
p.ld b.f." J.nu." 1.. 1.... 'h' fl,.t d.. .ft., 'h. .nd .f tho t., .on..,. p.,I.d. Ihl. non-p.,tl.lp.tlon
p.n..t. I. .pp..I.b.. In tho .... .ann.' ond 'n 'h. tho .... tl.. p.,I.d .. .au oould .pp..l tho t., and Int.,..t
that ha. baan .,.....d a. Indicated on thl. notlc..
INTEREST I
.ddltl.n.l p.nn..I..nl. E.t.t. I., ..,....d ., . ,..ult .f . .h.... .n tho F.d.,.. E.t.t. I.' ....Ino
..tt., b...... d.llnqu.nt .t 'h. .,pl,.tl.n .f .n. III ..nth f,.' tho d.t. tho fln.l n.t'.' .f tho In.'....
In fade,a. Eltata Tax I. racelved.
I.'" .hl.h b..... d.l'nqu.nt b.f." Jonu'" 1, 1'.Z bo., Int.,.,t .t 'h. ,.t. .f .1. (.Xl p.,..nt p., onnuo
..I.u..t.d .t . d.ll. ,.t. .f .0001", "1 t.,.. ..I.h b..... d.'lnqu.nt on ., .ft.' Jonu'" 1. 1..Z .11' b..,
Int.,..t .t . ,.t...hl.h .111 ..,. f,.' ..I.nd., ..., t. ....nd., ..., .,th 'h.t ,.t. announ..d b. tho P'
Oapart..nt of Rav.nue. The applicable lntere.t rate. far 198Z through 1998 aret
~ tnten.t Rat. Dally tnter..t Factor ~ tnter.st Rat. DailY tntere.t Factor
1982 ZOiC .DDa!ifta 1987 'X .aaU47
1985 I'X .aaa4SB 1988-l'JtJl 11:C .aaalD1
1984 11X .aaUSal 19tJZ 'X .aDDZ47
198!i U:C .aDDn' 1995.1'J94 7X .aOO19Z
1986 lOX .000Z74 199!i.1'JtJB 'X .OOUU
.-lnter..t is calculated ., fallOW.t
INTEREST = BALANCE DF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTDR
,-'n. N.tl.. I..u.d .ft., tho ,., b...... d..I....nt .11' ,.f'..' on In,.,.,t ....u..tl.n t. f,ft.on (IS) d...
b...nd tho d.t. .f tho ........nt. If p....nt I. ..d. .ft., tho Int.,..t ...put.tl.n d.t. .h." .n tho
Notlc., additional lntare.t eu.t b. calculated.