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IN RE:
IN THE COURT OF COMMON PLEAS
. CUMBERLAND CO" PE:NNSYIJVANIA
ORPHANS' COURT DIVISION
NO, {,)J-. Q7.. 'tLI
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ESTATE OF FAY E. 1,880
(,' FINAL DECRIIlIll
AND NOW, thiS)J!!! day of re.,LV...A.(,\...A_^(}- , 1997,
upon consideration of the Petition, and after a Hearing was h~ld
after due service of the Citation on the alleged incapacitated
person, and following due notice to her next of kin and the Manor
Care Nursing Home, IT IS HEREBY ORDERED AND DECREED that Fay E,
Lebo is adjudged an incapacitated person, and MARVA A. ZEIDERS and
RICHARD K. ZEIDERS are hereby appointed as plenary Co-Guardians of
her Estate.
BY THE COURT:
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11. Currently, both sources of monthly income are being
deposited in Mrs. Lebo's checking account. The monies will be used
to cover her expenses related to her institutionalIzation at Manor
Care.
12. Mrs. Lebo was never a member of the Armed Services of the
United States, ~or i.s she currently recei.ving any benefits from the
United States Veterans Administration or its successor,
13. Mrs. Lebo suffers from a mental impairment, such that she
is unable to receive ,and evaluate information effectively and to
communicate her decisions, Moreover, she is unable to manage her
financial resources or La meet the essential requirements for her
physical health and safety.
14. Prior to her November 22, 1996 admission to Manor Care
Nursing Home in Carlisle, she was admitted for approximately
eighteen days to the Holy Spirit Hospital by her family doctor,
John C, Schiro, M,D,
15. On or about November 3, 1996, Mrs, Lebo became lost and
disoriented when she attempted to drive by car to the Polyclinic
Medical CentE\r.
16, She intended to visit her Husband who had been admitted
to Polyclinic on the same date, owing to a fall he suffered in the
bathtub.
1.7, Mrs. Lebo became seriously confused and continued to
dri.ve from Camp Hill to Suffering, New York, where she was
eventually detained by the local police in ,New York.
:3
18, The local authorities' took MrS, Lebo to the Good
Samaritan Hospital in Suffering, where she remained until her
sister-in-law and niece could pick her up and bring her back to
Cumberland County,
19, After her return to Cumberland County, Dr. Schiro
admitted her to the Holy Spirit Hospital where she remained until
she was transferred to Manor Care,
20, Since November 3, 1996, and probably sometime prior to
that date, Mrs. Lebo has been unable to fully appreciate her
surroundings, recognize her family members, or acknowledge the fact
that her Husband has passed away,
21, petitioners 1 and 2 propose to serve as Guardians for
Mrs, Lebo and have consented to so serving in that capaci ty,
At tached hereto are true and correct copies of Consellts, signed by
both Fetitioners.
22, The proposed Guardians have no interest adverse to Mrs.
Lebo, the alleged incapacitated person.
23, Since the hospitalization and subsequent death of Mrs.
Lebo's Husband, both Petitioners have undertaken an active role in
the admittance of Mrs, Lebo to the Holy Spirit Hospital and to the
Manor Care Nursing Home, and have attempted t.o organize and manage
her financial and personal affairs,
24. No other Court has ever assumed jurisdiction in any
proceeding to determine the capacit.y or compet.ency of Mrs, Lebo,
25, Mrs, Lebo currently has no Guardian appointed.
4
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card 10 you
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I -Write 'R.tum R.Oflpt RequfUlted' on lhe mallplece below tho article number,
fi 'The Allum Reetlpt w1111how 10 whom the artICle WI' delivered and the dale
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b, Rec.lved By: (Print NalYl6)
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2, 0 R..t,let.d D.lly.ry
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21-97-44
TIM,:'r ','lILI, Aim 'l'BU'j'Al'1.f,;wr
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li'AY E. LI!:PlO
I, 1."oy .J~. l,ebo, of tho town of In:ip1botllto\'lr), D/Juphin (]ount;y,
Ponneyl vanin, beinr^of sound tnind, mOinol';; ,md urid():c~lt;on(l:Lnr':, do
n181w, pUblish ond cloclnrot;h),s t18 ond !'O); my lqHb 1'1:111 Dnel tootomont.
.J;te,!1;LJ: I cUrecl; [;1\11t Ql1 of my ;ltwtdebts D.nc1 f11n,))'n1 oxpo'hnon
be fully poid by my 'horoi.naftor nomecJ oxocul;:dx DS noon flE) con~'
vientlymoy bo after my decoaso.
~.:te}2Lg: I Vivo, cJ.ov'.iS() onel bOClllElStl1 unto my hushr-md, .rAi'mn \'1.
LEBO, (lll .of my propfJrty, ro~)l, pors9D1'.1 Dnd mixod, of whntt'Joovor
kind ond whorosoovor oHuGi;o, to hi.s 01'1Tl'l88 Dbflolutoly.
#~!;.9}.n._-,lJJ_:~ If my huobr-mc1 iG c1eeom:oc] at Sllm0 t:lmo of. my d.0lrth, I
req\lOot the follo\Vinr:
it. 'rho'!; my hunbnnd, Jmno8. W. Lobe' (1 two cJnughters j1JAHVA
A. :0EIlJEHS, 011(1 ]JINDA S'. NAGY bo mn(lo GxocU"COI"S'1 thf~t n1t, m~/ propcY."b;l,
real, personal and mixed, of vlhntooovor !dnc1. and. wberosoovor s:i.'bunte,
be solcl [ll1cl mon1.os be d:i.vidocl on foHol'm:
:fl. One,-thirc1 of lily ostato bo been,tenth '\:;0 my hutibr:mCi.' s
daughtor \'ijARVA A. Z};lD:EH8 .or 1'101' beirs.
O. One-tl1i.rd. of my oo'l;oto 'be bonu0fltl' to my husbnncl's
Dm.i["hter IJINDA S. NAGY or her' he:i.rs.
D. . One-tbir'd,o:f rn;!est,~d;o 'be bOQuoflth to my mothel', SARA
J. S\'IARTIJ~Y, 0); j.t dooeasod, this Ono-;thj,rd be d:i.vi<;1.ocl.oCl\18J.ly 'between
, .
my nieces and nephel'ls Cllil follows: Doni.dcJ I,. ]if(,aU$, Tjoy6l'fl .J. ~Provlos,
L;ynotte D. Palmor, Paul E. Heed ,Tr, TamiaL. Heeel, 'rim R. Oobaur:h,
and Nan A. Oobour;b.
...~~~~.J;~L..*:R:":f~.___C$2-"'1J.L.__~
8),[\ned, sealed, publ'ishecl and declared., by tbo EJo:l.c1 Tray ]!l. T~ebo
as and for her H\st \'1:1..11 and tes.tamE)\1'c, in tbo -presonc(, of us, who
at her request, and in her presenco, and :In the presence ofeech
other, have s\\bsc:d.bed our l:1ames llS witnesses thereto.
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Mldrll~:OWii, li,j,L nil!
ll\ycommisilon [xpiros J~.n~.~ 191f?
Decedent's Complete Address:
1m'" ^"'""'" 4.- NO t. ClTlZ: IJ7il:'!' !^Ji~71(V)) i -l
~" ~(}/t/tt, /3e>m~ I: (l --1''''~ I'P--- I~//~
Tax Payments and Credits: I)'
1 TAX Due (PAge 1 line 10) (1) . l
2. Credlls/PAYOlenls
A Spousal Poverly Credll
B. Prior PaYOle,'ls
C. DlScounl
o
j5
Tolal Credils ( A + B + C I
(2)
....-..-..-..Q".-.-----.
3
InleresVPenally if applicable
D.lnleresl
E. Penally
4.
TOlellnleresVPenalty ( D + E )
II line 2 is grealer Ihan line 1 + Line 3, enler Iho differ.nce. This is the OVERPAYMENT,
Check box on Page 1 Llna 20 to raquost a refund
"jL_.
__..i2 _.._
(3) _..____f1~_..____
(4) __~___""_.______u
(5) _....________________
(5A)
5.
If line 1 + Line 3 is 9,aalor Ihan Line 2, enler the difference This Is the TAX DUE,
A Enle,lhe Inleresl on the lax due.
B Enl8llho lolal of Line 5 + 5A. This is Iho BALANCE DUE.
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
,';-'~-'{'~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
I2\j'
rxt
I2if
IX!'
PG
i>(l
[1 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Did decedonl Olako a Iransler And
a relaln the use or income of the properly lransferred;..
b. relaln the righl to designate who shBII use the properly transferred or ils income;" .
c. retain a reversionary Inlerest; or." .
d. receive Ihe proOl1S0 for liIe 01 eilher pnYl1lenls, benefils or care?.
2. If dealh occurred after December 12,1982. did decedenllransfer p,operly wilhin one year 01 de.lh
wilhout receiving AdequClte consideralion?.. .. '''''',..' _,...""..."....
3. Did dece""nl own an "In I,usllor" or payable upon dealh bank accounl or security al his or her de'lh?
4. Did decedenl own an Individual Rellremenl Accounl, annuity, or olher non.p,obAle properly which
contains a beneficiary designalion?
Yes
.. ........1]
............................. [J
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Under penaltlns 01 pOllllr" 1 dflClillllIllnl1 hiM) f!~olll1jf]od Ihl5 rotolll, ir1c!t1l11119 ,lCCOlllrilllyiltg hO;';;dlllw, ilnd Sliliorl1nnl), ilnd to tIle best of my knllwlf!llgu ilnd llollOf, it is IlIle, cOIme! ard "onlpleltl
Oeclaralion of pleparer othor Ihan Iho rorsonal rUpresol1t,lllVtl is biIS{)CJ Oil alllllfurnlill{'1l of willet. l)fe~'il!UI ~IJS ill1, knowlodgfJ
ADDI'~.S
jU S(p LMi O-<..-,.1J{-..1lI2l:A
SIGNATURE OF PREPARER OTHER THAN REPRESENTAI'lVE f
t/JiJL>.I;>JAb~J h)...
r 'pATE
tJ/ /5/ (J:S
/7//1
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rale imposed on the net vCllue of transfers to or for the use of the surviving spouse is 3%
[72 PS 99116(,) (11) (III.
For dAles 01 d"lh on or aller JanUArY I. 1995, Iho lax rale Imposed un Ihe nel VAlue ollrAnslers 10 or 10'Ihe llSe ollhe su,vivlng spouse is 0% 172 PS 99116 I') (11) (1111
The statute QQQ.illill..~KQ[l)Ql a translor to (1 surviving spouse Irom tAX, and the SIEllutory requirements for disclosure af assets Elnd filing a lax return are still Elppiic~ble even if
the sUl\'iving spollse is the only beneficiary,
Fo, dAles 01 death on or aller July 1, 2000
T1w la~ fille imposed on the nol vaiue of trill1sfors from a decease,! child twenty-one YfJClrS of ago or YOllngfH fI( deatllto or for Ihs lJse of fI natural parent, an adoptive p,lrer,l.
or a sloppereol ollhe cliild is 0% 172 PS 9\1116(81(1.2)1.
Thn IflX rille Imposo(j on the net valllo of lranslflrs 10 or for tlw use of 111[1 Of'codf'lJilr, Ilnf'!:ll bonefh';irHles IS 4.5':;" flxcf;Jpl ElS noted in 72 P.S, S9116(12) [72 r,s S9116(il)( 1)]
The ti-lx rille Imposod on lho nut .'allle of tr;lIl~fers 10 or for Ihellse of HlP. (lec(JdHnl's siblings is 12"/, [72 PS s911G(nl(1JJ] A sibling is defined, \lnoer Serlion 9\02 as ,lll
individual who hfls at Inm;( one pawnl in common With the decedont. whe!hor by blood or MopHDIl
07-07-2003
LEBO
04-17-2001
21 97-004'.
CUMBERLAND
101
E:~::::~i R~~~~~d ~~J
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 ~
R 'EV: iSCii" i:i{" Ai: p""foY.- oj Y -NoT" icr OF - "iN"Hi:iii;: Ai,fcE - T"i. X - ;iP"ii R'A- is i:i.fENT -, - -A i.l"li"wAN"C E- ciR' --- - - - - - - -.. - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
FAY E FILE NO. 21 97-0044 ACN 101
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF 1'AX:
15. AllOunt of Line 14 at Spousal rs"te
16. Allount I)f 1.1ne 14 taxable at lineal/Class A. rate
17. A~ount of lins 14 at Sibling rate
16. Allouot of Line 14 taKable .t Collateral/Class B rate
19. Principal Tax D~.
~~
/$= /6)/. Cl
8UREAU OF INDIVIDUAC TAXES
IHIIEIHl'^NCE: TAX DIVISION
OErT. 2801101
HARRISBURG, PA I71ZB-Oblll
COMMONWEALTH OF PENNSYLVAN1A
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
MARVA ZEIDERS
APT 2
5056 LANCASTER
HBG
'0;
i. : 1 (I
DATE
ESTATE OF
DATE OF DEATH
FILE NUMlJER
COUNTY
ACN
..I
ST I
PA(~ 7111
ESTATE OF LEBO
TAX RETURN WAS: I X) ACCEPTED AS FILED
CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Ryal Estate (Schedule AJ
2. Stock$ and Bonds (Schedule 8)
3. ClosAly Held stock/Partnol'ship Interest (Schedule C)
4. Mortgagos/Notes Race1veble {Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
b. Jointly Owned Prop81'ty (Schedule F)
7. Transfers tSchedulo G)
8. Total Assets
III
121__
131
(4)
(5)
(6)
(7)
.00
.00
,00
.00
1.918.30
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, funeral Expenses/Adm. Costs/Misc. Expenses (Schedule tll
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. To'tal Dllductions
12. Net Value of T~x Return
1::5. Chari table/Gov81'n1llental Bequests; Non-elected 9113 Trusts (Schedule J)
14. N.t Value of Estate Suhject to Tax
(9)
110 )
.00
15,673.00
III)
1)21
(13)
(14)
NOTE:
DATE
RECEIPT
NUM8ER
116 ) ,00 X
(16) .00 X
117 ) ,00 X
118 ) .00 X
AMOUNT PI,ID
DISCOUN I "TO
INTEREST/PEN PAID 1-)
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
------ ----. ----- ----
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIDNAL INTEREST.
'*
UV-I~ll n UP (~I.OII
FAY
E
DATE 07-07-2003
NOTE: To insure proper
credit to your account,
S1ubll! t the upper portion
of this form with your
tax pay.,ent.
1,918.30
15.673 00
13,754.70-
.00
13,754,70-
00 0. .00
0450. ,00
12 = .00
15 = ,00
1191;;-----:00
'O~
----~-- .-
.00
---- -
.00
- -- -------------
.00
--------- - --.
IF TOTAL OUE IS LESS THAN $1, NO PAYMENT IS REQUIREO.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU MAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)