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21.80
393
No.
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
Priscilla G. Bailey <viii. ;1:'Ti/4 ;:r 6c'/(',nry ,deceased.
I
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania.
In the Estate of
PetitionerlS) is (K~j{the executor named In the Last Will and Testament of
~r.',
. . P Ii J,,-,,,,O.."I"(
Pr~sc~lla G. Bailey q/(r; IfilLl/q dated I JulY 20. 1977
Decedent was a citizen of the United States and a resident of Camp Hi 11
~~ (Borough), Cumberland County, Commonwealth of Pennsylvania.
Decedent died on Thursday
the 5th day of June
A.D. 19~,lnthe
County of Cumber land , State of Penna. at the age of 1ilL- years.
Decedent has~ been married and ,,-,,<It=~had children born to:!lirrx(her) since the ex.
ecution of the above described Will. h4S nor .~
Decedent was possessed of personal property to the value of /'0/ CiM
and of real estate to the value OfA/5',{)(It', . .
. ,
as near as can be ascertained; said real estate situated as follows
1908 Columbia Avenue, Camp Hill, pennsylvania
Therefore, your pelltioner~) respectfully appPj(ies) for the probate of the said Last Will and Testa.
ment and for Letters Testamentary theron.
fifdLf /0, /1J'0
{/ ,
Dated
Name and address ~~ ~ \(-^-'<-~
of Pell tioner(s)
Karl R. Krouch
322 West Allen Street
Mechanicsburg, Penna. 17055
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF CUMBERLAND
ss
Karl R. Krouch, Executor
named in above application. being duly sworn
statements set forth in this petition are true to the best of
~ccording to law say(s) that the
h~s knowledge and belief.
.sworn_ and subscribed before
me" JUne 10 19BO
._qlla~&-"- ~ 'xd./ _
f 6/~ster
~14~ ,(.., 'k~cL.
f/gWcti.rY D. -M/Or;- 171t (IJ.ffOIl,lT;Y
Attorney f/6;. tf2.-. /1IO~
~
Filed:
11,
1980
June
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: c5)(-tfo- 3 f3
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JAMES J. BAILEY, CONSTANCE J. BAILEY, MARK E. BAILEY,
MARY E. KROUCH, JUDSON E. BAILEY, ELIZABETH A. BAILEY.
Distribution upon termination of this trust is to be made
without regard to distributions made under paragraph A of this
ITEM II. It is my intent to create a class gift among the members
of the aforementioned group, and in the event one or more of
the group shall not survive me, the share of that member shall
be added equally to the other shares provided for in this paragraph.
ITEM III: I have expressly omitted leaving anything to
WESLEY BAILEY, on the grounds that our marital difficulties and
his conduct make him no longer deserving of any gifts whatsoever,
morally or legally.
ITEM IV: My executors and trustees and their successors
shall have the following powers in addition to those vested in
them by law and by other provision of my Will, applicable to
all property, whether principal or income, including property
held for minors, exercisable without court approval, and effective
until actual distribution of all property:
A. To borrow money from any person or institution including
my corporate fiduciary and to mortgage or pledge any or all
real or personal property as it in its sole discretion shall
choose, without regard for the dispositive provisions of this
instrument except that no property passing to the marital deduc-
tion share in ITEM I shall be so mortgaged or pledged.
B. To carryon any business owned or controlled by me at
my death for whatever period of time they shall think proper,
I and they shall have the power to do any and all things they deem
I . . 1 d' h t'
\ necessary or appropr~ate, ~nc u ~ng t e power 0 ~ncorporate
I the business, the power to borrow and to pledge assets contained
I
in my estate as security for such borrowing, the power to
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claims of the creditors of said beneficiaries or any of them.
ITEM VI: I appoint DAUPHIN DEPOSIT BANK AND TRUST
\ COMPANY, of Harrisburg, Pennsylvania, Trustee of the trusts
II created by this my last ~lill.
ITEM VII: The compensation of the corporate fiduciary
i
I shall be in accord with its established schedule of fees in
I
effect from time to time as its services are rendered.
ITEM VIII: I appoint KARL R. KROUCH, my son-in-law, as
Executor of this my Last Will. Should the said KARL R. KROUCH
\ fail
MARY
to qualify or cease to act as Executor, I appoint
E. KROUCH,
to serve as Executrix of this my Last Will.
ITEM IX: I appoint WESLEY BAILEY as Guardian of the
persons' of
my minor children. In the event the said WESLEY
BAILEY should fail to qualify or cease to act as guardian of
the persons of my minor children, I appoint MR. AND MRS. KARL
R. KROUCH, of Mechanicsburg, Pennsylvania as guardians of the
I persons of my minor children. I further appoint MR. AND MRS.
I KARL R. KROUCH Of Mechanicsburg, Pennsylvania as co-guardians
I the estates of my minor children.
I
ITEM X: I direct that my executors, trustees and their
successors shall not be required to give bond for the faithful
I performance of their duties in any jurisdiction.
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I in consequence of my death, of whatever nature and by whateyer
II jurisdiction imposed, shall be paid from my residuary estate
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II as a part of the expense of the administration of my estate.
This shall include any interest or penalty imposed in connection
II .
Iw~th any such taxes or debts.
I
ITEM XI:
I direct that all taxes that may be assessed
4 -
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~IEV;"'&z'EX"'"'' ',,",,>,' ,> ,,' " '
I " ~ifi,~)~i:.,ri',:';'/:"" ,COMMONWEALTH OF PENNSYLV~NIA ',' ','
4 JO:~O'O'04:110 'I,' :, ' DEPARTMENT OF REVENUE: " '"
~~~(,", ,; ,,', " ,,:' 'OFFICIAL'RECEIPT . PENNSYLVANIA INHERITANCE :AND ESTATE TAX
\"'"'''''' ", .
e
II
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i I RECEIVED
II FROM
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TAX AT 6%
TAXAT1S%
ADDRESS
Howard. B. Krug, .sq.
1719 H. Front Stt..t
ESTATE TAX
TAXAT_%
earri.buxv. ra. 17102
'--ESTATEINFORMAT~~u~~--5--itl80-------------
DA TE OF DEATH '
3,353.92
TOTAL TAX CREDIT
FILE NUMBER
21-80-393
January 26, 1930
LESS DISCOUNT
% INTEREST
TO_J
DATE OF PAYMENT
NAMEOFDECEDENT PRISCILLA G. BAILBY, Ai
PLUS
(FROM
.
, ,COUNTY
Caberland
m
TOTAL AMOUNT PAID
3,353.92
---.-- - - --- ------- ------- --- -- - - - -----.., ----
\
"OSTMARK DATE
',,~MARKS .PAID IN FULL.
SEAL
RECEIVED BY
//luu C:', 1,-1(_'7_2.'/
i1ary.~~Gt~(~
R89l'ter of Wille
t
REGISTER OF WILLS
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IN RE:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-80-393 TERM 1980
ESTATE OF PRISCILLA G. BAILEY
a/k/a PRISCILLA J. GARNSEY
Deceased
PET I T ION
COMES NOW, Petitioners, Karl Krouch and Mary E. Krouch,
his wife by their attorneys, purcell, Nissley, Krug and Haller,
and requests that this Court hand down an Order granting them formal
guardianship over the persons and the estates of Constance J. Bailey
and James J. Bailey on the following grounds:
1. Petitioners are Karl Krouch and Mary E. Krouch
his wife, adult married individuals residing at 322 W. Allen St.,
Mechanicsburg, PA.
2. Constance J. Bailey is a minor individual of 14 years of age,
presently residing with the Petitioners.
3. James J. Bailey is a minor individual of 11 years of age
presently residing with the Petitioners.
4. The two minor children are products of the marriage between
Wesley Bailey and priscilla G. Bailey, deceased.
5. The said Priscilla G. Bailey a/k/a Priscilla J. Garnsey
was divorced from Wesley Bailey on November 25, 1977,
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by virtue of a Decree of the Court of Common Pleas of Dauphin
County entered to No. 2545 S 1977.
6. After the divorce and up to the time of her death,
priscilla G. Bailey a/k/a Priscilla J. Garnsey had custody over
the persons and the estates of the two minor children.
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.J^Vl';~, ,J. l~i\ll,;,:Y, (,Ol;.(:'~'^';(';', ,I. :;^l;',!,:V, r1^HI\ r:. Bl\IL?Y,
Hl\RY ~-. KROlJeli, .TllU~;Oil I';. i1Ali,::Y, i:r.-l~^:~]':'l'I: ^. B^ILi';Y.
DU;tribul"illl1 upon [",.11';11.11 ion 01' ['hi!; [T\I!,t i" to be milde
\Vithout rCCJ,lrd t.O di:-;tr,ibul' inn:: P\;](!l' llndc~l~ !)ilr.l'Jl~.J.ph l\ of this
T'fEr1 I I.
Il: in my intc~nl' LCI cn',lt(., ;1 cl<-I~;:; qift aHlong the members
of the .Jforemcntio:1c'{: q!'()~IP, dnd i!l 11](' ('vr.'nt:. OIH~ or more of
Ult~ qrollp !i;l;lll 1\(11 :;lll....'1 \:,'
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"II':, ()j I II.-ll PH'j',i~.)('r :dldll
be udd(~c1 c'qu~llJy hJ LIH~ ot-ill'l' :iili\rl'~: pl:-()vjd(~c1 [or in this pnl:.:1qr.lph.
IT2M ITI: T have CX)lIo",;,; 'I \' OIllI l:lecl l"avin'f anything to
~mSLr:Y BAILEY, on the (J!:ouncl,; t11"[, our J1lilrital difficulties and
his conduct make him no lOl1qer de~;('rvinq of any gifts \oJhatsocvcr,
morally or legally.
I'm!" IV!
My executors iln~ trustecs QIld t!lcir successors
shall have the following powers in addition to those vested in
them by la\< and by otl1"r pnwi:;ion of I'll' \Vill, ap[llicablc to
.111 property, \'1!lctllC'r princil:dl OJ' jnC()I1I(~, lncludinq property
held for minors, excrci:;<Ible Vii thout C(llll~t. LlPprovul, anu cff0ctivc
until actual distribution of all property:
A. To borrow money frulIl any I~rson or institution including
my cor[lorate fiduciary and hl III0rt<j"'!" 01: pl'"I<)e ilny or all
real or personal l)rOporty an it i.Jl j_ts sol.c discretion shall
choose, '..Jithout rcgat-c1 for tile c1i.f;POfd,tivc provisions of this
instrument except tl1,lt no ,,,OOP,'I"ty p,l::,;i n'l to the mZ1rital deduc-
tion share in J'rEi'i r ~';;la L! he ,-in J!1()I~t'(J~HIC~(1 01" pledqcll.
.13. Iro curry on ilny bu:; i n1."~;:; o\,-nc:ll or controllcll by me nt
r.1y cieath for \Jl1atoV('1" period of 1.1"',' l:l:c'y ,;hall think proper,
;'or
and they shall helVe, tho pm'ler to do ,iny .w,l all things they deem
nCCCSS.:lry or uppl~opri.:1t0., incluc1inq the: poucr to incorporate
UH.~ bUf~inQss, Ul(~ p(n.It!). Iu })orro\'J <l1Ie! to p.l ..'dqc! 11!-;~;c~tr; contai np-:l
ill my estate as ~;t'cur i ty I' 01. .;l1r.h ~)orn)\'l i nq, t'hc~ pOHcr to
"
REV.449 EX+ (3.801
'cOMMJNWEALVH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Rovorso Sid.)
'"
Estate 01 Priscilla G. Baile.Y....hl1SLA
Pr~scITTa~-~rnsey
Lost Address ~9.0jLColumbia_AY..enue
Dote 01 Deo '"
June 5, 1980
Social Security No, 129-22-3289
Camp Hill n'
_____..".__~I:l..__
tel TVI
(STATE)
17011
(ZIPI
Bureau File No,
County File No,
"/ ~;'" - "~: C',' ~
X '."(, '~c-L
(
1, Decedent died:
( ) Intestate (without a will)
( X ) Testate (leaving a lost will --copy attached)
2, Is tlie liling 01 a Federal Estate Tax Return required lor this estate? Yes_ No X
3, (X ) Executor/Executrix
) Administratorl Administratrix
Name Karl R. Krouch
4. All correspondence should be mailed to (X) Attorney
) Fiduciary.
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Address 322 W. Allen Street
Mechanicsburq PA
ICITY) (STATE)
17055
(ZIP)
5. 1/ on attorney is representing the estate, indicate:
Name Howard B. Kruq, Esquire
Address 1719 N. Front Street
Harrisburq
(CITY)
PA
(STATEI
17102
(ZIP)
List all sole deposit boxes registered in the decedent's individual namehor jointly with,or os on agent or deputy
01 another, or in decedent's individual nome with right 01 access by onot er as agent or deputy, Include the name
and addrer.s 01 the bank or other institution where the sale deposit box is located, the name (s) in which the box
is registered and the relationship 01 the joint holders to the decedent,
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAF~ DEPOSIT BOX IS REGISTERED
RELATIONSHIP OF JOINT
HOLDERS TO OECED~NT
Dauphin Deposit Bank & Trust Co.
priscilla G. Bailey
3045 Market St., Camp Hill, PA
Under penDlties 01 perjury. I declare that I have uamined this return, including accompanying schedules and
statements, and to the best 01 my knowledge and belief it Is true, correct and complete.
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SIGNATURE OF FIOUCIARY , DATE
PENNSYLVANIA INHERITANCE TAX GENERAL INFORMA110N
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the IOllowing persons shall prepare and file
a return:
a. The personal representative of the estate III the decedent as to properly 01 the decedent mlministcmd by him
and such additional property which is or may be suhjcct to Inheritance Tax of which he/she shall have or
aCQui re knowl edge;
b. The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided 111i1t no separate return need be made by the transferee
of property included in the return of a personal representative.
2. PLACE FOR FILING
The return is to be filed In duplicate with the Register of Wills of the county wherein the decedent resided.
3. TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied for and
granted by the Secretary of Revenue within the nine.month period.
,
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4,: FAILURE TO FILE RETURN
,
i Section 791 of the 1961 Statute provides that". . .any person who willfully fails to file a return or other report
. required of him, . .shall be personally liable, . ,to a penalty of 25% of the tax ultimately found to be due or $1,000
! whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by
: law,"
.
5.' TAX RATES
Inheritance Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in-law and daugtJter-in-law and at the rate of 15% as to all others.
6. PAYMENTOFTAX
The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter unti I payment is made. All payments recei ved are fi rst appl i ed to any
interest which may be due with any remainder applied to the tax. I F TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED.
All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue.
7. FAILURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains In effect until
the taxes and interest have been paid in full. The taxes nlay be sued for against any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax.
8. FILING OF FALSE RETURN
Any person who willfully makes a false return or report required of 11illl shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or both,
RW-B
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INVENTORY OF REAL AND PERSONAL EST ATE
-- - -- ~
--
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In t~l' t1Iattl'f IIf t~l' ~stat, 1Ir..?J;J.l?9.~Uf!...9."..!-1f!,i,.+li!y...(\I.!S/.h,..J?.+.~l'iQj.l+.ii\. Garnsey
lale af ..Jil.9.+.RM9))..,9J...C,flrol?...I;l;:iJJ.............,....in the Caunty af IlUlli>Klfl, State af Penna., deceased.
Cumoer.Land
~nnpntl1ru af the real and personal eslate which were af the abave-named
.!?+J.l?9.~Uil-,..c;;.,...~fl.u..l;!Y..l\/.K/.I),..J'.r.i~dll.a..Garn.s.e.y... deceased. Taken and. appraised
the ......,....,...... day af ....................,.......19 (Date af death June...5.,...19BD..)
1 Home located at 1908 Columbia Ave., Camp Hill,
PA.
49,000 00
2 200 shares of K-Mart Stock value as of date
of death $22.00
3 1973 Opel Coupe, fair condition
4 Certificate of Deposit with First Federal
Savings & Loan Account No. 216-421225.
4,400 00
2,000 00
30,492 06
5 Dauphin Deposit Bank & Trust Co. checking
account No. 13-13-5988
832 14
6 Joint Dauphin Deposit Savings Account
No. 14-7-0846-9, opened September 6, 1978.
Joint with Judson Bailey, son. Balance as of
date of death $3,096.50 - Priscilla Bailey
in good health and account not established
in contemplation of death despite 2 year
presumption - death from heart attack at age
50 unexpected.
7 Joint Dauphin Deposit Savings Account
No. 03-7-0440-8, opened October 15, 1979.
Joint with Elizabeth Ann Bailey, daughter.
Balance as of date of death $368.89 - account
not opened in contemplation of death despite
establishment of account within 2 years of
death - death from heart attack at age 50
unexpected.
8 Dauphin Deposit Bank & Trust Co. savings
account No. 13-7-1258-6.
9 Joint Dauphin Deposit Savings Account
No. 14-1-0819-4, opened February 22, 1977.
Joint with Constance Bailey, daughter. Balance
as of date of death $74.25
1,548 25
184 44
353 66
37 12
(continued on attached sheet.)
,
RECAPITULA nON
Appralsod vallie of I'ursonnl Propurly ......,.....................,....,........,......,................... $ ..,~...Q.l~A:s~
Appmlsed vallie uf roalllslaw .......................................................,....................... $ .4.9...0.Q.Q..O.o
Tolal appraised vallie ..,..............................,................,....................................... $ .?J./.9.~,)".~ji
AFFIDAVIT OF PERSONAL REPRESENTk-TiVE
CoulIty 01 ~.:
Cumberland
...............................................................................................................................................
of Ihe ""laic or.~.~~.~.~g~.!...9.~....~,~.~~.!.Y...~/~/~...~!:.~.,,!;lJ.U!?-...~.~....Garn.8y
Execut
Administrat
deceased, bein~ duly....!!~9.li.IJ.................. ............................... .ccording to law, depo,e and say that the
items appearing ill the Invenlory include all 01 the personal assets wherever situate and all 01 the
real estate in the C:ommonwcatth 01 Pennsylv.nia nf said decedent; that the v.lu'lion placed opposite
cad, item or said Inventory represenls its rair value a, of the dale 01 the decedent's death; and that
decedent owned no real estate outRide the Commonwealth of Pennsylvania except that which appears
in a n11110ranclum at the end of the Inventory.
~~f' . ......:!fY!I..~..'...I.....;;;.~nd SUbSdCdbedll ...'1..., :'....);...W~...~~~~........,....
le ore me t liS......... ..,II.................... ay 0 ~ E:r:ecutor. AdmlDl~\fator
. .~.q-:!;:':z.,t.{{~Yd.I.........., A, . 19.K.4!. 322 W. Allen St., Mechanicsburq,
....'.. ",....".Q,..6.#1..I:.~.!..<?4--:,'_... .......... ........... ....... ........,.. ........Addr.~..... ....... ........ ................,..,
~~ }/\I-'" ~ '('::"". Jb!!l
, Y .,:'. . - __, " !9'-: INSTRUCTIONS
hil.r:" '.,.. . ;:'::It''l;(',:-/
1. An Inventory muat bo ntod within three months after appointment of 'Peraooat roprOBentaUve.
2. A supplemental Invontory muat be flIed within thirty days or discovery ot additional B8BOtS.
s.. Ad'dlUonal sheeta may be attached 8S to personalty or realty.
.. See Article IV, Fiduciaries Act 01 1949.
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INVENTORY OF REAL AND PERSONAL ESTATE (cont'd.)
10 Joint Dauphin Deposit Savings Account I 54 62
,
No. 14-1-0818-6, opened February 22, 1977 . I
Joint with James J. Bailey, son. Balance i
as of date of death $109.24. \
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11 HTU #14 Federal Credit union Account I 111 27
No. 375. 1
12 Household furnishings and belongings 2,000 00
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\ 91,013 56
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REV-A50 l\-sOI
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
..~
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(Instructions on Reverse Side)
ESTATE OF Priscill~~..._~i:ltL.~~LI5LA priscil,la J. Garnsey
ITEM I ESTIMATED I DEPARTMENT
DESCRI PTION MARKET VALUATION
NO,
VALUE (OFFICIAL USE
, ONLY\
1 single family dwelling at 1908 Columbia Avenue, 49,000.00
Camp Hill, PA. See appraisal letter.
Acquired February 11, 1980 - consideration of
$45,200.00 _ cumberland County Deed Book W,
Volume 28, Page 812 - no mortgage - property
financed through borrowing against certificate
of Deposit at First Federal Savings & Loan.
Property sold September 29, 1980 for $49,000.00
,
TOTAL THIS PAGE 49.000.00 4~".rJ nMFYf
"
~/._. ._. ~.__..--_._._..-.__..__._-------_._-_...
If tht! Tmth,,,,.Lr.mling Alo" iJpplies to this tr.lfIS,ICIWfI. " T,lIth inl.f'mling n. MOnlG INS. CASE NO,
st.,tmrwII' /s attacheeJ as p.lge 3 of this fortn.
c. NOTe: "Th';; lOr;,; i;.'u;i,isheci- i;)YooP';i~',-io5cr-tIC"~C-nIt09i';;Y~U;-;1'f(~;;'-;hol;t your settlement costs, and again after
slHtlcmcn\ to show the actual costs you have paId. The prescnt copy of the fOHn is:
'-,-, ADVANCE DISCLOSURE OF COSTS, Some items arc estimated, and arc marked "(el," Some amoun" mav change if the
lj~~tlt'm.1Ilt IS held 011 a date other than the date estimated below. The prcpClrcr of this form is not responsible for errors or changes in
amounts furnished by others. Advance disclosure of proration of taxes and assessments is based upon the assumption that the taxes and
assessments pel taining to the subject property are not delinquent.
~ STATEMENT OF ACTUAL COSTS, Amounts paid to and by the settlement agent are shown, Items marked "(p.o,c.I" were paid
out!lidc the closing; they are shown here for inforrnatiolla1llulpuSCs (Hili arc not included in tOlals,
-D.-::::R~O:::::t -:~~d'-r~::L:::E-~;' P:I5~~~~~'~-~IL~: F~ LENDER Cash
\ L-- _ A_"'",:.~ h/"__________- _ J____
1 G. PROPERTY LOCATION H. SETTLEMENT AGENT _.__.. I. OATES
1908 Columbia Avanua LOAN COMMITMENT AOVANCE DISCLOSURE
Borough of Camp Hill John Glise, Inc.
Cumberland County PLACE OF SETTLEMENT
Camp Hill, PA. 17011 2505 N. Front Street
Harrisbur PA.
flt-i('
111.,,'''11
DISCLOSURE/SETTLEMENT STATEMENT
A. U.S, DEPARTMENT OF HOUSING AND UROAN DEVELOPMENl
-. ..-..---. -_.--_.......~..
J, SUMMARY OF OORROWER'S TRANSACTION
100. GROSS AMOUNT OUE FROM BORROWER:
101~ - .'co"t~'aci'~aTe7P;ic-;-----------
-1..oi,_,.~e,'.~9n2!JlrOpertv __.~._-
103. S~ttlement charges to borrower
(from line 14()(), Section L)
49,Q1I.0.OO
875.00
104,
~_......__.__..~_. -.
_,).!l!!:...,_,_.__.____.__.__.._.__
. ~djustn1t!llh f()l items paid by sellcr in advam:e:
.,_.,~.-.._.- .-," _. ... ~----_..__._--_..-._-
__l.QL_.fti~:IO":'I.'J~~~)c,-.. ___..!o_ ._.....__.,.
..1.07 _ ,_.<;'l~I!.!!~!~'!.";__ n .__.....!Q.~/lL81--_.
108. ASSCS'illlellts to
,J.9.~..:~.~EQ9T:t8X-.:._.---.I;;- 7/1iBi"
...1 H.l,,,,_ .. ..._ _.n . .,..-!!!....,..----
.U.L..... .... ___. ._u__.__ ,!Q-. ,."
112, to
49.50
369.13
120. GROSS AMOUNT OUE FROM BORROWER;
I
1.50,293.63
200. AMOUNTS PAID UV OR IN BEHALF OF UORAOWfH
201.
202,
_ .20;1
204.
_.?~.?'
Ot!PIl'.lI III P~lIlli",llllon~V .
PlIll.llp,11 d_I1,!Ul1fll lllll~~ In~I!I(~).
l'(l<:,lmq In,u~~sJ 1.1~'~:1l ~lI\*:C:~ .l~l .
," ~--.I l,UOO..OO
I
. ...,...~ J.
C,l'd,h 10 ht)lI m'Jtll Itll IlI!nlS unpaid by I),'II!!I,
2U.q~. . CltV/IOWfI 1;1~1''''
.. _~l;l~. . .C(~~mly' !~x~~s....
.208, A!i!.~~sn_l~r!~~
:JOH.
210
21 t
:.'1:.'
...._."_...!.t!__.
'.." ._19..._
to
. ~ ..-. ,---.--
~~.-
_.!.Q.
t9..
III
I
I
I
I
I 1,000.00
nu,
101M AMOUNTS PAID uv on IN
UlI1AlI or uonnOWEH
300.
CAS" AT SETTLEMENT REOUIREO fROM OR
I'AVAUL[ TO BOnROW(R:
301, (i'I's, .llIlounl dill' 110m h~lfIt1WI!f
(fwflllult'I20J
302. LC~:'J1110un1'l p.lid hy or In hehalf ot
bOl'OWI:r (frum Ime 220)
50. 293. 6~,
..1..0,0.0.._00
.----- ...-...-.. '....
30:l. CASH 'XJ REllUIREO FROM OR
"1 P'AY ARLE TO BORROWER;
I
149,293.63
D. TYPE OF LOAN
3, 0 CONV,UNINS.
1. 1:..1 HIA
4, "i VA
2. [J FMHA
5. [] CONV. INS.
6, ,ILl NUMBER
1. LOAN NUMBER
.__.__.-._---_..~--------_.
SETTLEMENT
OATE OF PRORATIONS IF
DIFFERENT FROM
SETTLEMENT
9/29/80
K. SUMMARY OF SELLER'S TRANSACTION
400, GROSS AMOUNT DUE TO SELI.ER:
'4~'Con~-;i~ prlCC-
402, Personal p~opertv
,~___..__ _, .._n.
404.
Aqustnlent5 for items paid by seller in advance:
__4.05. 6Mv1t.'L":'!'-~-+.-. to
.. _.4..Q6.._.<1Q!!!l!Y-l.!!~!l' '.n___...!!!.l/l/Al
407. Assessments to
:.. 4Q!!,,":'~~.hool tsX----1o 7/1781
409.,_._____.___ to
__11!L.-.----.- to
411. to
420, GROSS AMOUNT DUE TO SELLER
NO TE: The lollowing 5()() and 600 series section are not required
tr1 be completed when this form is used (or advance disc/osllre of
settlement costs prior to settlement.
500,
501.
:iO:?
5o:J
IlEDUCTlONS IN AMOUNT OUE TO SELLER:
~~~VI;fft;L""~i~~ort~U~ !lf~~~~~--.. .~. ~- ~ ~l'--
I.)av(~!l.~'.!. s(~!:gml.!!'~~~'~l~~ !~)~n .. . __
~i'Hllcmc"t charges to sellc.r I
,~I~"m-'!'!~.!~, Sec!!!!!'..!.L_, . .- -, -1'-~':;22,QjJ
. E\I~tll.!9 l_l'ii.~l~,!kcl1 ~~I~J!~:~ I~~ __. .___ _ ._... ... .__
1980_~ch9g:LJJ-,-f:. .ta)L ...,_,._ ,___!t!l6..,
-. . ".__.'-'--_.~-- -..----. ---.--.. -
- -.. -------.. ------- ----
_.~':-=.=:.:.~:=-=:::~-=-.~=:~:=--j==~~_.
~04.
505:
50lj.
507,
508.
.-..'....
.,~Q!!._,
Crcdits to horrower fO! Itcms unpaid hy scllm:
.----fil(). . ~';'t\1;~~;~.~~i.~=.~..~_.,..~.,q.-. -~..~...l.:~~....-=..-~.~=~
!) 11 Cou~.1.!Y I~~j ..._... __.to
512. A....c~lJinu~I1\~_ . .. J~l
~J1J. ~.
!.14. In
515. to
r.20, TOTAL REDUCTIONS IN AMOUNT DUE
... TO SELLER
60(1, . CA~H 1!l. ~Hl['-' FR~!':',SE,!_f1,EMENT.:.___ ____.__
601. Gruss \inhJUnt due to st!lIcr
!.~""!~ !~:.i?PL,,-.- _ _, _.._,__ 49 .li18. 63
4 040.92
602. LClJio; tot.ll rcductllms in .1mllullt due to
lJicllt!r .f!.!~J,!J_~.i~~~~2tll.
603. CASH TO SELLER FROM SE 1TLEMENT
4&,!0.92
45 377.?l
SALES~B_~~~~~.C:~~~~~S~~~ .b~"'d on priCl .. S. ~9,,0.og_
TOlal commission paid hy seller
DIVisiull of commis~ion as folluws:
6 %
PAID FROM
BORROWER'S
FUNDS
PAID FROM
SE LLE R'S
FUNDS
L, Sf TTLEMENT CHARGES
100.
J01.
"
2,940.00
'/O~. S 1,495..00 '0 Jphn Glise, Inc.
S ,1, 44?.(J0. .~~_,pl,!s_..A.QJEl.I:'J~. s.QI1__~ejjl.!:C!.1:'
.....,.._..._._.,.. .__0Ii~[.II[:i'.iljl~:~:j:j,,:']',II'.,:"',I'I":i'1~1-::j~~,:[,~j'I::',
704.
800
301.
, '!O?,
;'0:1
IT( ....5 PAVAALE IN CONNECTION WITH LOAN.
Le.' .n 91 j!Ji.Ili:l.tiO~l .ft;C C>{,
Ll. -II 91~c.o~!lL . _ "~.._ . _
~. JF;lI~.ill ~ll~Y~
,>. !!t Rtlp.cuUu.._. .._
Lc',.Ovr_:!i !""fI!!.~!!.~I~l.~~..
M~I til...~t!.lnsuriJ.llc.t! ~pplir.,f!tj.OI~ f.~.~_t.q
A~!tlllnpllql~~rl!fjl~!III!:.~I)g f~l!..
,50.:.
BOr,.
806.
~O'I,
808.
.!!9~,
_81,.Q,..... ...",,,
g11,
Ollll. ITEMS REOUIRED BY LENDE,R. T.O B,~.!~I,D 'r:' .A'pVANCE., m__. ___._______.____
jQ):,...,I.!'t.c.r~~'!!.~'!l..- n.__.J!)."., ...,,~'S__ , ......I~ay, .'_ .,.,.."._..,,_
~.O? .__~.9.~~g~9.~.J!.~.!.i!~c..l!..P!~~l!l!m!O.!_,__.m.{!.:.!Q._ ...____.._........ __. .._ -. .'----,. ---.-..-....
.,90.~"...HJlar!li!lS'!r~I,'fe.p~emillm.l,o.r ),.Y'~"IO "F'a~g JU.r.ec:L ".. .'..'___ _. ,'..
904, ,.... ,.._.....,"'.,.....___.....y.~'-. ,'2" ,u," ,... ....__,___,_.____. __.._______ .._ ...-___
905,
1000. RESERVES DEPOSITED WITH LENDER FOR'
100 f"'.-H~t;;;~. !1~~~I!~I.l~~~EiQ:.S~~-~~_~=.!~i.:_:.=__==__.___.._. - .-. -.-...-
1002. ~(lrI9~9~_.i~~r~_~~u. _...I))~.. @l ~ _... .. .. t~~=-. ._ ___..__..._,..._~___..__.___.
10~~:" .c!tyJ'~'?P~~\\'.li1.x!''-._,,~o'-~.?- _... ..,_.!mo"____ ..._____
1004. ,CO~lI\ly p!..'!e~!~_y ~i1.~_~~._~~o:.. ~.~._.._._ _ .j_~o... .._n"_._' .. ._._..._ __.__.___~._ ..._
100~5.- - A~n~ai.~sscs-smc~~ls mo.@ S Imo.
100G:- ... ..." ,.----'-----.-m-~:(,;;S .u '--"i"~~-""-----"--"-
1-007. .. , ,.~;,;:.@. S '.' 'h---7;;;~~"---- ------.. .. ._h__.._.
~~ ~@S ~...
1100, TITLE CHARGES:
110t. . Sc.ltil;;;;.~II~.-~J~ _~I.~!.si~,~.~_~="B=9~_~.E.~~~.-~~--.:~~~~g-,=.~~.q~J_~e"~'-'-' ------~=.~._
1102. ^1)SIIHCI_lll..~~~!E_<;~~r.~~~~_. . '. .__....
1 un. Till.! l!)(,Il11inafiClll to
.!.1.~4. lll!y 1I1~IlIJ.lll:l! hl~I~h:.II.o..
1105. Doctln\l'nll'rt'nardtion 10
.1106. N"I.HV foc, 10 Cash. .
1107 .\r:t1,n"v"Fccs I,) ,C~Ejs,. Adler & Son Resltor'
, il,,:It.IC.~c.'i P.~)()~t: ~!t.'l1!~ .f}!'!:.:'_ "
-r Itl~ llhluallC~ to
.. .~--".~--~-
illlcJlI~h's .:J~)OVt" ':tL~~.'!s.. 'Y!!:.:..
l..!llt"~I'S r.UV.~~.~91: $
(J'....,II.,'r. C:1)VUI.lgl! S
l,~ml.
1I1O,
1111.
I,ll;>
1113.
12nO.GOVUlNMrN Tftlc:uiIDINt;ANU THAN-;;Fl~I\CiiAilC.ll:S---
1201. IlI~coldlll!1 tt.c~. DI!I!lI $ 10~llO ; -MOI!U,I!Jl' $"" Rf~h'.l.,t'" s
1202:. .-ciiv/cOll;"Y' ,';x/st.;",,; 'D"I~lI S 490.00 ; M.lI'IU"U" S
.i.2c.i3.'si';'i~'i~~i;i;;r;;-p;j."~~~;i ~~~p.p.!L'~~rt~:g~T' -.. . "-.', ~~. :':::=::...:'.",:=
1204,
1300,
1301.
1302.
131l:!
.1~_1?4: ". ..' "." ... .,. ..,____._,_._____,._.n__'
1305,.._,.______._._....,..__.__._.___.__._______.,
1400
_. __. .. '_~_..._.. .~?~p'g
--..---.-.-- -_.~_._-~
... . -- - ..--- ...~
'M. ~.~. _._ _.._
.-.--- ..--.-- ---.
Deelj preparation to Howard 8. Krug, Esquire
__"____. _._35.00.
...1IJ.D.IJ. _,.______.
. _, ,!L9Jl.llil
___._____~&O,
ADDITIONAL SETTL[MENT CHARGES
- . ..-- _.'..',-,.- - ~ ..
Survey 10
p,!st In!lIJl~cti'?n_I(~
!~~0J rl LrMl N f !;ltAHliES ("II't,'fI.'tl ~!~~~~J.l ."_',1 !It)]. S.,'{'tll/n\ J ,,11,1 ~L.__ 875.00 3 552.00
Ttlt~ Ulldl:t'iIHIU'11 ^, ~1l'jwll:.ltI,,,, HI!I:I!lllllll lilt'. r)l'.dmlll'~ ~\I:IIII~nll"11 SI.III'.lll!llt ,tllll ^!J11!CS 10 tilt: ClIIlcctncss Therl'uf.
NOTE.
nd:vtq))b~/p._---,.....- ._,_",.')c~i~-.k~ C:!. . '~L.-J
BUyt!f Uf Alieni fl Seller or Agent
Undt!T certd;n circwnsta"Ct.'s tluJ borrower and seller may be ptmnitted to wJive tho 12.day pcriod whi h must normally occur
tJetween Mlvance disclosurf! iJncl settlc/mmt. In the event such a waiver is miK1e, copies of the statcments of waiver, executed as
pfoviclt!d in the regulations of chI;' Department of Housing and Urban D(.\Ielopmcnr, shall be .lttachcd to and made a part of tllis
lal/" when tht! form is used as d scttlt'mtmt statement.
h...ll,l l~ I~J
2, CJ FMHA
S, [] CONV, INS.
.. n." ~.__.
I 'OISCLOSUREISETTLEMENT STATEMENT 6 HLL NUMIl[fl 7, LOAN NUMBER
~il'lh'; T:;tI~,,~;::~:,:;M;:; :,~~;i:~~~~~~.;;~;:~:~;;~-:;L;';':~;'7.";,;t,~J~" ;-;O~;;;~N~~;;o~-"---'--"
statemf!nt is attiJclwtl as piJge 3 of this form.
--... ., .. ....-.-.. ....,.__.~-_.,_._..,---_.-,...-..._--_._----~_._., -.-----
C. NOTE: ThiS form is futllishecl It) you priol to settlement to giv!'! you information ahout your settlement costs, and again after
, scttlem~l1t to show the actual costs you hal/c (Jilld. The present copy of Iht! form is:
:::-: ADYANCE DISCLOSURE OF COSTS, Some items arc eslimated. and arc marked "(c)," Some amounts may change if the
s~~tlt'm~...t IS held 011 a date other thi:n the date estimated below. The preparer of this form is not responsible for errors or changes in
amounts furnished by others. Advance disclosure of proration of taxes and assessments is based upon the assumption that the taxes and
assessments pertaining to the subject property arc not delinquent.
[l(] STATEMENT OF ACTUAL COSTS, Amounts paid to and bV the settlement agent arc shown, Items marked "(p,o,c.i" were paid
, out!lide the closing; they am shown here for infotmational purposes ;Jl1(1 me not included in totals.
f-D~::::::~O:R::::t':-:~'d'-r~::~;:E- ~;. P:~S~~::: 8ArLE~1 F, LENDER Cash
Regana 5., h/w
f
'.
.
-.,. . ..._. .....,..__ .___.___~__h'_'.-~'
fi~~('
L.....-.. .. -..--..-.---'
! 0, PROPERTY LOCATION
..--.---.. ...-.-...----.
B. TYPE OF LOAN
..-' . ......
1. U fHA
4, 1'1 VA
3. 0 CONV. UNINS.
-.-----,--.----..----.-.
H. SETTLEMENT AOENT
1908 Columbia Avanue
Borough of Camp Hill
. Cumberland County
Cemp Hill, PA. 17011
I, DATES
LOAN COMMITMENT ADVANCE DISCLOSURE
John Glise, Inc.
PLACE OF SETTLEMENT
2505 N. Front Street
Harrisbur PA.
DATE OF PRORATIONS IF
DIFFERENT FROM
SETTLEMENT
J, SUMMARY OF BORROWER'S TRANSACTION
SETTLEMENT
9/29/80
K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
1oi:'-Col't;act-..iOs"price .---
102.__~~~~~I'.!'~P!Opertv ~__.___
103. Settlement charges to borrower
(from line 1400. Section LJ
400, GROSS AMOUNT DUE TO SELLER:
42." 000.00 401. Conlract sales price
402. Person.1 prop~.ty
403,
-------.'.--.-
875.00 404.
104,
------- ,.,---..,------.
,).!l~_._,_,.u ----.--..-.
Adjustnll!1l1!t for items pllid by seller in ac'yance:
_._.__....._~ -.. -... ~----_.._,_._-_._--_._-_.
_10~~__G.~.".:'lo~~t.fl~~~~ __ __..ill.....__. ..__ -- -----
..107...._l:;.qu!.!!1'. !oxes___ ___._!QJ./l/81 49.50
lOB. Asses'irnen1S to
l.Q~,=-~fiioo). .tax-.----'-j;;-.7"/iTai- '-359:1
....LHL_........,.._..__.., .....__..J!!.._..,'___._ --"
_!J..L._, ,.,_, ..' __._. ._" __... .19_. ,." ._ ____. ,u,,__ ---
112, 10
120. GROSS AMOUNT OUE FROM BORROWER,
50 293.53
AMOUNTS rAID BY OR IN BEHALF OF BORROWER,
OI:PO,.I~ n~ ~'l~ 1lI'~t I;H~I.)~.Y --~- _U~ ---:'''-.~1- 1.,000. DO
PII'\_llp.11 ~!I~lOlll..1 ~111I'-:.~ 1l!~!I{!"). . __ . -
CXI'i11l1q Itl,1I1~sll.I~I'1l suhi,-:l.:! .'~) . u .__ "
____.L .. ".., .. -_..-
200,
201.
~02.
.?!l3
.~04,
..~Q!>" ,.
C!.:-dits to hOrlWNCI lor Illmh unpaid by .it'II!~I.
~l:~~~~;~'" ~-~j!~ :--~.F--.-..
"i:~ ,,~~~:" I
712 10 I
no ICITAl AMOUNTS rAID BY on IN I
UlHAU or UOItIlOWEH !. 000._.00
300.
, 301.
CASH AT SETTLEMENT REOUIRED FROM OR
f'AYABLE TO BORROWER:
Ci"}l,i\ .lmoun1 lIu!' from hlluuwcr
((rum IIIit' 120J
-... .... -.....-.- -.-.... .-......
L~!.) .J11l0unlS pdid hy or in behalf of
bnrrowcr I(ramlille 2201
302.
-1'''-'' ....._-
50.293.63
, . J. .ooo..J1Q
i
'49,293.63
...- . ..- .-.- _._-- .'-_...-.-- ,...---.,.....
303,
CASH 'XJ REOUIRED FROM OR
: -:1 PAYAIILE TO BORROWER,
A~ustments for i1ems paid by seller in i1dvance:
._405, Gity!t.oWIl taxe,-}_..--!.'L-.
__.4.l!.l!,-, Coun\YJ~.xes. to 1/1/81
407, Assessments 10
_...1Q!!:J~ghooi: tax---.to 7/1781
409, 10
_...1J!L..-----,-- 10
411. to
420. GROSS AMOUNT DUE TO S~LlER
NO TE: The (ollowing 500 .nd 600 Silries section .re not required
/0 bl! completed when this (orm is used (or .dv.nce disclosure o(
settlement costs prior to settJement.
369.13
500, REDUCTIONS IN AMOUNT DUE TOSELLER,
-.-..-.' _...-.. .....--.---,-,.,-..-----.--- -. ..--...... .---
__~Ql,.., ':'ay~f12f..~!l!.!,,_ortgage !~~!~ .. ' .. . ,__ __
..._59? .!'~.y.(!!!.!!! Sl!~~ntl~~9~.!.,!~II.!... _._._. ..__ ..-_.._.'...._._
503 SlH1lcmell1 charges to sc-llc.r
. ""_' ...!!~(!r!'.I!~'!..!401}. Section ~!__..... _.. ___ ,__~, ~.52. 0
._ ~O,~.~ _ ~ "'.~~t_l!.!9 ~~~n(s) !.~ken ~!::J!)i~~~.!~___.. _ ____._. __...... ____
50S. ..1.2~'O.Jic~llQLfl....J:...!..J;,PLh.._.. _.~.~~..22
SOli, ... __ ______ ...._ ._. .' _..___ ___. ."U_
507, '.u... "..,_.,___"U_'_____'_
,..,508,___,_ .__._ ,.._._.___,..".___. __......___
509,
-.-.-.--.'... ---.--..--------- ---.---- ----
.--. Credits to houower fOI items ullpaid by sellcr:
_..._- .--.--... ,.. ---_.._---._~.-'-- -.-- .--..-.-
~!O_" c;ll'i!l.t!~1) ~_~~..s__.. ._._, to ._. __.'... __.
5.L1.:,_ ..C(~u!.'..!y~~~~___.__. ___~(~,_.._ __,_.
51'}. ~....c~~m~...l.t~. .. Jl1
~13. tu
514_ ~n
515. to
TOTAL REOUCTlONS IN AMOUNT DUE
520. TO SELLER
600. CASH Tl~ ~(Ll(~ F.R~!':'.~E,!!L,E~~N!:..__
601. Gross ...muunt due 10 ~t~lIer
!~r~(!~!i!!e_~?~L_. _,_,__..._
602. less 101011 rcductuJIls in amollnt dUI! to
__". ,.cl1el (!!"mJit1,.?20J.
,. 040.92
49.418.53
4 .1l.L!0. 92
45 377.71
603,
CASH roSELLER FROMSlllLEMENl
.1,
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any nwterial pmt of his estate without receiving
valuable and ade~lJale consideration? (Answer "Yes" or "No",) llO
2. Did decedent, within two years of death, transfer property (rom himself! herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) ~
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
;nformation:
a. Ageofdecedentattimeoftransfer, !tom 1 - she WAS 48, Item 2 - she was 49
b. Copy of death certificate.
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer.
d, All other information supporting nontaxability of transfer.
4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No".) NO
a, Was there any possibility that the property transferred might return to transferor or hiS/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No".)
b, What was the transferee's age at time of decedent's death?
5. Did decedent in his/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before his/her
death:
a, The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".) ~
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No",) NO
6. If the answer to five b, above is "Yes," state whether the right was reserved in decedent alone or others. MIA
7. Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".) NO
8. Did decedent, at any time, transfer property, the booeficlal enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".) NO
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No",) N/A
COMMONWEALTH OF PENNSYLVANIA: SS:
COUNTY OF DAUPHIN
CO~ES NOW, Karl R. Krouch, who being duly swo~n accordi~g
to law, states as follows:
1. That he is the son-in-law of Priscilla G. Bailey a/k/a
priscilla J. Garnsey.
,
2. That prior to her death he was very familiar with the
state of health of the aforesaid Priscilla G. Bailey a/k/a
priscilla J. Garnsey.
3. That during the time the affiant knew the deceased,
she contemplated marriage, and the plans were to become final
upon her fiance' securing a divorce, which did not become final
until the day after her death.
4. That the decedent did not even find it necessary to
consult a physician within three (3) years of her death owing
to the good state of her health.
5. That the decedent never complained of any pain or
distress prior to her death.
6. That the funds were a result of direct deposit from the
united States Army made on behalf of Judson Bailey and Elizabeth
Bailey, and decedent contributed no funds toward those accounts.
At the time contribution, the decedent's children were serving in
the united States Army and needed some kind of depository for their
,
paychecks, and these accounts served as such.
Swo~n and subscri~~ to
before me thi.5 IJ' - ,\
day ofr.1 ((1,",.,,'.0.1.(...- ' 1980.1
, I
..'r {::, .
(>:~,<"f.,I'L--
,
WARNING: It is Illegal 10 altar this copy or to duplicClltt by pholoslCiI or photograph.
Hl05 ;12 soaM REV 1.7f1
(100 e",t, per hook)
(FE[ fOR THIS
C[RllIICA1E $2,00)
COMMONWEALTH or PENr'lS'ILVANIA
DEPARTMENT or ilEAL TH,VIT AL SlATlSTICS
N9 1'714959
LOCAL RU;ISJlC\\t'S CFllTIFIC\TIO'S OF 1lE.\1I1
, ) J./
Full Num. J./ ' . ) '0 /U
of l)Cl'Cllscd ___ _ __-L~c".{.../!...f-CLJ _.- __d ... .--- - -' "Y~fviLt..~J-- --- -------.--- - ---
filiI M,dtll...,j f la" -"')
lIestd,u,. .1- Ja J __c!"..il.U.K.-ita.--tlw!.,. n' t'a;>vJ- ____JM- -- a "t-.lut.-.Q."..,,C__.6:_-
NlImber Stre~l '" City (I' Tow,n ;' J rou"'y '"Ji~lfJ
Pt".or C ;j //,? c,~./ / 1/ I ~
Denth _____ __ _~'IUu..1-I:::,..,(,,~- _ ____ ~ tf",~ _ _ L..- ...t..t..~",,-,,,- U~ /. .1/:LtL7" J g - I'ennsyIvanla
) (OUl'!y Cily. BorOl/ijh or Town\lll[l
Sex .___2'_-<<n/J,,,i!.'-".--.-. ' ' __ nal' tof Ucn'h __ ,l~ __:,~ ./ 7 L <1..__ _.~__ ,--- II"" ,jLt.-ti~_
Dat. of IlIrt" .,,'J~g,,';'J...Lf-3,,;.) llirlhpt"" _:)'l.u.(.L__W'~L-j / .. Marital Status f) .L<.-<-~~e.,
I U
Social S"urit~' Nto,(~j~),;)_...-~..lJ':!O"UP'IIO~,,;t'IM;).~~.ctcrun's Serial No,
MEmCAJ. CEIlTlFlCo\T1\
I)art I. DCllth wns c:tu!:icd b)-':
Hq:I<,fI'fl'tl Nfl, _ -
-..-.._-----~-
Jntcrvlll nclwecn
Onset aDd Death
, '. i ()/'-:/'
Im,",d13te Cause (,) .d..uU-<..-Ll?J.~,U-~.:?.z--"
/7< L !l..l; II I! I"
Due To (b) _(..,t~-uL(..U'.Lu-L-&l.durz/.u-~~--"
Due 1'0 (c) .---.-------.-
rart II. OTHER SIGNIFICANT CONnITIONS: conlribntiu& to dl.':.ttb hut 110t rcl:ltcd to tbe immediate cause given in
I'ar! I (a)
(, ;)-;1 --,) ol.<J.,
~~_dl/kt~
Accident, Suicide or Homicide How did injuT)' uccur
\ Name nnd Title of Person . /J /l ! II
Who Certified Cmlse of Deilth (MJ?., )).0., ~!J.llcrl 1\-t.E.) _':/[)!::.Ut..? (,/",-_i
I Address -#6-y;L,&. JJ. (Lfh..L"-..,..Jl '
. Slroel /
. This is to ccrtif)' Ihrtl Ibe information here ,~i\-'Cn
I
I me as Local Itcgistrllf. The oriI:inal certificate wiU be
,
)L!L(i7d" ./
Clly
l'i curreeH)' coph'd from nn original certificate of death dnJ)' filed with
forward'~d to the Stolte Vital SIll" ICS Office for I>crmnnent filing.
.i!~LL~- ,toL."-J Od.i>,x .),-.J I ~
Locol 1I~~~'tfor of Vilal Statisticl ~):. -fiI51r1C~NO'
9).< ("[II-d..&"'~ j,' J J ., 0;-"
Sir"" AddreH "Cily, Borough. To n5 p
--ld"" n 1...Li- ,p.;
'.'{;~ReCeiVlldbYLOCaIRegi~tfar
, .'~.:,:~,t2~1i~~C'~:::~i;;1~;:':':::i:,'::::::}-.f:,,/'ii' "~~?![:~;',.."::i,:'.: :'~~:":~~:,:7'.:~1::g"t.~"."Y'H;:
,,',
,
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.,.. ..,'.'
LETTERS TESTAMENTARY
COMMONWEALTH OF PENNSYLVANIA \ 5S:
COUNTY OF CUMBERLAND
BY THE TENOR OF TIIESF. PRESBN1'S
I, .....................,.,~i~~~tK:~~t~~~r.~.......................... Esq.,
Register for the Probate of Wills and Granting Letters
of Administration in and for the County of Cumberland,
in the Commonwealth of Pennsylvania, do make known
unto all men that on the ..................J,~~g...................... day
of ................,.......~!:!!!:.................,......,.... up-g...., at Carlisle,
before me was proved, appeared and insinuated, THE
LAST WILL AND TESTAMENT OF
PRISCXLLA G. BAILEY, A/K/A PRISCILLA J. GARNSEY, LATE OF
................ ......... .............. ................ ......... ....... .... ...
" ,~~~~~~ ,~~ .~~~, ,~~~~~., ~,~~~~ ,~9~~~'.. .~~~~~.~'{~~~!. DECEASED,
(a tl'ue copy whereof is to these presents annexed), having whilst . ,~~. . lived at the time
of , ~~eath divers goods and chattels, rights and credits within the Commonwealth, by
reason whereof the approbation and insinuation of the said Last Will and Testament, and
the committing the Administration of all and singular, the goods and chattels, rights
and credits, which were of the said deceased, also the Auditing the Accounts, and Calcu-
lation and Reckoning of the said Administration to me are manifestly known to belong.
And that Administration of all and singular, the goods and chattels, rights and credits of
the said deceased, and way concerning ,~~. . Last Will and Testament, was committed to
, ~~ . ~ ~ . ~~t!~I,i.. . .. .. " , " .. .. .. . . " .. .. . . . . .. ... in the said Testament named
, ~,~~~?~. . . , , . , , , , , . . . . , . , , . , , , . , . . . , , . . , . . , , . . , . having first been duly qualified
well and t1111)' to administer the goods and chattels, right and credits of the deceased,
and make a true and perfect Inventory thereof, and exhibit the same into the Register's
office, in the borough of Carlisle, within thirty days from this date, and also file a just and
true account, calculation and reckoning of ,. , .~~~ , . . , . . .. administration when lawfully
required. and diligently and faithfully to regard, and well and truly comply with the pro-
visions of the law relating to Collateral and Direct Inheritances. Decedent died on the
, , , ,!?~f:l: , . . . clay of . . . . . . ~,~. , , , , , ".. 19!3P. . ., according to affidavit properly filed,
In Testimony Whereof, I have hereunto set my hand and caused the seal of said office to
be hCl'eunto affixcd, dated at Carlisle aforesaid, the .".".""" ~.l.'X:~ . , , , , , , , , , , , . , .
day of , , , . . . . . , . . , -?V~. , , , . , . . . , , , , , . , , . . . , , in the )'car of our Lord One Thousand
NI' Hl d' 1 d EIGHTY ,) . ;,(/.
ne 111 I e< an , , . , . . , , , . , , . . . . , , . , . . l../' (.'; ,
t(...- t. 0, .. _' I."t,. < C. t.-~'l:O..'
.............,... .............'1.......... ..................,....,..............
Rithars E. f.RdtfMsn. Register
per
,_/J/ I
,,-/':/ ~<.. ,,;/. ,,0 Depul~' R g'ster
" . .. , " .. ';.-" . .. Y" . .. .. . C I
" 1.
-..-..-.....----.-.---
delegate all or nny pnrl', of the nllpcr vLr;ion, fc1nnuCjerncnt nnd
opet"ation of the businefls to such person or persons as they
may select, and the pOl/cr to close out, liquidate, or sell the
business at such time and upon f)\lch terms as to them shall seeM
best. My exccutors anCi trusteeH shnll not bc helo to personal
liability for shrinkage of income or loss of capital value that
may be incurred in the course of their operation of the business,
except loss thnt may res~] t fror.' their ,,,ill ful misconduct.
C. To compromise clil.iPls asserted by or against my estate.
D. General powers to file joint returns.
E. To retain any or all or the assets of my estate,
real or personal, without regard to any principal or diversifi-
cation or risk.
F. To sell at public sale, to exchange, or to lease for
any period of time, any real or personal property and to give
option for sales, exchanges, or leases, for such prices and upon
such terms or conditions as they deem proper.
G. TO accept hold or invest in those investments, securities',
or obligations as more particularly set forth in the Fiduciaries
Investment Act of 1949, Section 3, entitled "Government Obligat-
ions"; section 4 entitled "Obligations of Federal Organizations";
Section 5 entitled "Obligations of pennsylvania Governmental
organizations"; Sections 12 entitled "Interest Bearing Deposit".
other than the above powers, ~t is my distinct direction
that no other fiduciary powers be exercised as it relates to
the investment program of the trustee in the administration of
the trusts created by this instrument.
ITE;'l V: All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obligation
of the beneficiaries and any of the, and shall not be subject
to any execution, attachment, levy or sequestration or other
"'~"""~'''-'''-''''.'.
.__---r-.--;,..--~-.---,....~--.......~.-....---..-"...'-... ... ..~...- ..~.>- ,,,.- .
,..',,"-"
fl."
I
REV.454 (1-80)
COMM()NWEACTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL V OWNED PROPERTY
(Instructions on Reverse Sidu)
Estate of pri sci lla G. ~aj ley A/K/A priscilla J. Garnsey
ITEM
NO.
DESCRIPTION
1
Joint Dauphin Deposit Savings Account
No. 14-7-0846-9, opened Sept. 6, 1978.
Joint with Judson Bailey, son,
PFC Judson Bailey, Battery D, 3 BN 71st
ADA, APO, New York, 09154
2
Joint Dauphin Deposit Savings Account
No. 03-7-0440-8, opened Oct. 15, 1979.
Joint with Elizabeth A. Bailey,daughter
Medical Co., USA Meddac, Ft. Monmouth,
NJ 07703
Joint Dauphin Deposit Savings Account
No. 14-1-0819-4, opened Feb. 22, 1977.
Joint with Constance Bailey, daughter,
26 w. Simpson St., Mechanicsburg, PA
3
4
Joint Dauphin Deposit Savings Account
No. 14-1-0818-6, opened Feb. 22, 1977.
Joint with James J. Bailey, son,
26 w. Simpson st., Mechanicsburg, PA
.
TOTAL PE VALUE OF DEPARTMENT
A
MARKET c DECEDENT'S VALUATION ,
VALUE E INTEREST (Officia' Use Dilly)
~
3,096.50 50% 1,548.25
368.89 5,0%
184.44
74.25 50%
37,12
109.24 50%
54.62
,
-
TOTAL THIS PAGE 1,824.43 Jf),4,1/-.3
iI1[JIf
,I
I
I
,.,Ii
,J
INSTRUCTIONS FOR COMPLETING SCHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointiy with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included, List real estate first.
1. Describe all real property as indicated in the Instructions for Schedule "A", Describe ail personal property
as indicated In the instructions for Schedule "B". I nciude the narne, address and relationship to the
decedent of the co-owner (s) and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of tile decedent's interest.
4. Indicate the market value of the decedent's interest.
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A report is required on:
SECTION 742 OF THE IMHERITANCE
AND ESTATE TAX ACT OF 1961,
1) Joint Saving. Accounto
2) Joint Checking Accounto
3) Tru.t Account.
4) Joint investment accounts, such as
certificates of deposit, share accounts,
and '0 lorth.
S) Accounto held by hu.bond and wile
and third partie.,
"When money is deposited or invested in a financial
Institution located in Pennsylvania in the names 01 two or
more penon. other thon h..band and wile or In the name 01 a
p':erson or persons in trust for another or others and one of the
parties to the dopo.lt or Investment .hall die, it .hall be the
duty of the Ilnanclalln.titutlon withi" t.n (10) daYI alter
knowledge 01 the death to notify the Dopartment 01 Revenue
thereol giving the name 01 the deceaoed penon, the date of
the creation 01 the joint or trult depollt or Inveltment, the
amount invelted or an dopa lit at the date 01 death with the
Iinancial institution and the name and address 01 the
survivor or survivors to the account. No notification 5hall
be required in regard to luch account when the deposit at
the time 01 death doel not exceed three hundred dollars
($3>0)." (Emphosil added),
No report is required on:
1) Husband and wile accounts.
2) Joint accounts with 0 balance under $3>0,00
3) Accountl held by the decedent Individually.
,
INHERITANCE TAX SUMMARY SHEET
. REV".' EX' 13-801 (BUREAU USE ONLY)
File Number 21-80-0393
Estate Name J?risci 11[\ G.0Jai!~.___,
Date of Death 6- 5-80
Social Security Number 129 22 3289
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appoin'ed 'nherllance Tax Appraiser in and lor the County 0/ Cumberland
Pennsylvania, do respectfully reporl thot I have appraised Ihe real and personal property as reporled in the /oregaing
return at the values set forth opposite each item in the last column to the right in Schedules "A", lIBIl, "C", and flE"
Dated:
January 22, 1981
J1h":d/ -If'f,A,,,j)
INHERITANCE TAX APPRAISER
IHVEHTORY
ADJUSTMENTS
VALUE AS APPRAISED CODE (HARRISBURG USE OHLYI
S 49,000 00+
1,0 189 '0+
1 824 2lH
-0- 30+
91,013 56
40-
REMAINDER APPRAISEMENT CODE
92+
Real Property (Schedule A)
Personal Property (Schedule B)
Jolnt.Held Proporty (Schedule E)
Transfers (Schedule C)
TOTAL GROSS ASSETS
93-
Less D.bt. and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of IIf. estates or
annuities. . t . . I . I . . . . . .
M!E
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
Tox on $
CODE
COMPUT A TION OF TAX
S
S
S
S
$
6%
Tax on $
15%
Tox on $
T 0)( on $
Tax on $
Exemptlons
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
s
s
Leu Credits
DATE OF PAYMENT
AMOUNT PAlO
DISCOUNT
INTEREST
TAX CREDIT
s
+ S
s
=
s
+
=
INTEREST FROM
BALANCE DUE
BALANCE
TO
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01"
pRISCII,I,/\ G. DAII,;;:Y
I, PRISCILLA G. BAILCY, of Camp Jiill, Cumberland County,
pennsylvania, declare this to be my Last ~lill and Testament
and revoke any and all \':il1~; and Codic:il,; pr.eviously made by me.
ITE/l I: I direct that all my ju!;L debts and funeral expenses
shall be paid from the assets of my estate as soon as practicable
after my decease.
ITEM II: I devise and bequeath the rest, residue and
remainder of my estate of every nature and wheresoever situate
to the trustee hereinafter named, IN TRUST, for the following
uses and purposes:
a) to accumulate the net income and to expend and apply
so much of the net income, accu~ulatecl i.nco~c, and principal
of this trust as trustee in its sole and absolute discretion
deems advisable for the support and education (including
college education, both graduate and undergraG.uate)of my two
minor children, CONSTlU1C3 J. BAILEY and JI\tOES J. BAILEY.
Trustee is not limited to making equal distributions and s~ch
distributions may be made \,i thout regard to the ability of
the surviving parent of any such issue to so provide;
b) \'lhen neither CO::STAilCE .1. BAILEY nor .JM1ES J. BAILEY
is living ?1undcr the age of eighteen (18) " and attending either,
a college or a postgraduate school, then this trust shall
terminate and the then remainiilg balance of the principal and
accumulated or undistribatecl income shall be distributed equally
among the then-surviving members of the follo~ling named group
of children:
JAll;ES J. BAILEY, Cor;STANCB J, BAILEY, I1J\IlK E. BAILEY,
~Il\RY E. KIlOUC!i, JUDSOn g. IlllIT.CY, ELI Z1\3EU: 1\. BAII.EY.
Distribution upon termin~tion o[ this trust is to be made
\d thout regard to distributions made under paragraph A of this
ITEM II. It is my intent to create a class gift among. the members
of the aforementione~ group, un(~ in the event one or more of
the group shall /lot sllrvivu i;:u, tilL! C;;l':lJ:c' of that mer"ber shall
be added equally to the other sharcs provided for in this paragraph,'.
ITEM III: I have expressly omitted leaving anything to
WESLEY BAILEY, on the grounds that our marital difficulties and
his conduct make him no longer deserving of any gifts whatsoever,
'morally or legally.
'ITEI~ IV: My executors and trustees and their successors
shall have the ,follO\~ing powers in addition to those vested in
them by law and by other provision of my Hill, applicable to
all property, \.'!1Cther principal or income, including property
held for minors, exercisable.;i thout court approval, and effective
u~til actual distribution of all property:
A. To borrow money from any person or institution inoluding
my corporate fiduciary and to mortgage or pledge any or all
real or personal property as it in its sole discretion shall
choose, without regard for the dispositive provisions of this
instrwaent except that no property passing to the marital deduc-
tion share in ITEM I shall be so mortgaqed or pledged.
B. To carryon any business o\med or controlled by me at
my death for whatever period of time they shall think proper,
and they shall have the pO\~er to do. any and all things they deem
necessary or appropriate, including the pO\'ler to incorporate
the business, the power to borrow and to pledge assets contained
in mY"1state as security for such borrowing, the po\~er to
..
delegate all or any part of tho super. vi!;ion, management and
ope~ation of the business to,such.person or persons as they
may select, and the pOl/er to close out, liquidate, or sell the
business at such time and upon such terms as to thcm shall seem
best. My executors anci trustees shall not be hclu to personal
liability for shrinkage of income or loss of capital value that
may be incurred in the course of their operation of the business,
except loss that may result from their willful misconduct.
C. To compromise claims asserted by or against my estate.
D. General Powers to file joint returns.
E. To retain any or 'all of the assets of my estate,
real or personal, without regard to any principal or diversifi-
cation or risk.
F. To sell at public sale, to exchange, or to lease for
any period of time, any real or personal property and to give
option for sales, exchanges, or leases, for such prices and upon
,such terms or conditions as they deem proper.
G. To accept hold or invest in those investments, securities',
or obligations as more particularly set forth in the Fiduciaries
, Investment Act of 1949, Section 3, entitled "Government Obligat-
ions": Section 4 entitled "Obligations of Federal Organizations":
Section 5 entitled "Obligations of Pennsylvania Governmental
,organizations": Sections 12 entitled "Interest Bearing Deposit".
Other than the above powers, it is my distinct direction
that no other fiduciary powers be exercised as it relates to
the investment program of the trustee in the administration of
the trusts created by this instrument.
ITE~I V: All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obligation
of the beneficiaries and any of the, and shall not. be subject
to any execution, attachment, levy or sequestration or other
, claims of tha creditors of said baneficiaries or any of them.
rrEM VI: I nppoint DlIJP1;n; DEPOSI'l' Illltm lI!lD THus'r
Cm1PANY, of Harrisburg, Pennsylvania, 'l'rustee of the trusts
created by this my las t ~1i 1J.,
'ITEM VII: The compensation of the corporate fiduciary
shall be in accord \lith its established schedule of fees in
effect from time to time as its services arc ren<lcred.
ITEr;! VIII: I appoint !U\RL I\. KHOUCH, my son-in-la~l, as
Executor of this my Last ~lill. Should the said KARL R. KROUCH
fail to qualify or cease to act as Executor, I appoint
I1ARY E. KROUCH, to serve as Executrix of this my Last Wi:\.l.
ITEr1- IX: I appoint HESLEY BAILEY as Guardian of the
persons of my minor children. In the eyent the said vlESLEY
BAILEY should fail to qualify or cease to act as guardian of
the persons of my minor children, I appoint MR. AND MRS. KARL
R. KROUCH, of l~echanicsbUl'g, Pennsylvania as guardians of the
persons of my minor children. I further appoint rm. AND l-lRS.
KARL R. I<ROUCH Of l1echanicsburg, Pennsylvania as co-guardians
the estates of my mino'r children.
IT~M X: I direct that my executors, trustees and their
successors shall not be required to give bond for the faithful
performance of their duties in any :jurisdiction.
ITEM XI: I direct that all taxes that may be assessed
in consequence of my death, of l'lhatever nature and by \~hatever
jurisdiction irlposed, shall be paid from my residuary estate
as a part of the expense of the administration of my estate.
This shall include any interest or penalty imposed in connection
with any such tnxes or debts.
~
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IN THE COURT OF COMMON l'I,EAS OF CmlBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO, 21-80-0393
ESTATE OF PRISCILLA G. BAILEY
Late of Borough of Camp Hill
FIRST AND FINAL ACCOUNT OF KARL R. KROUCH, EXECUTOR
Date of Death: June 5, 1980
Letters Granted: June 11, 1980
First Complete Advertisement of Grant of Letters: July 3, 1980
Account stated to: Harch 6, 1981
SUHMARY AND INDEX
Page No.
Principal Realty
Principal Personalty
Net Loss on Conversions
2
3
4
$ 42,561.53
64.35
$ 45,377.71
42,497.18
87,874.89
34,017.96
53,856.93
2,000.00
51,856.93
1,918.58
53,775.51
Adjusted Balance
Less Disbursements
5-6
Balance before Distributions
Distributions
7
principal Balance Remaining
Income Personalty Receipts 8
Balance Remaining for Distribution
24""
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RW-8
INVENTORY OF REAL AND PERSONAl. ESTATE
- .- -=..,=---,--
31n t~r Saltrr Df t~r :S:statr Df,..?F.~,~.9J.:!:~~..~.:...?!l:g~y..!.\/.~~I.~..?it,~~9.gM?: Garnsey
1 r Borouah of Camn Hill . h C f~~'" S fP d d
ale 0 ..................,............."'...........................m l C ounly 0 r late 0 enna,. ecease.,
U er ana
)nllPntorl! of the real and personal estate which were of the above-named
..!?~A,~:~g*!'!..~,f...~~gf.1.Y..bJ.Uh..R~,.j.,~9.~;J,.li!-,..~i\j;I1I'l~y.. deceased. Taken and' appraised
the ...........,...... day of .....,......................19 (Date 01 death ..:J.\\nl'l...~"..,l~aQ.)
l' Home located at 1908 Columbia Ave., Camp Hill,
PA.
49,000 00
2 200 shares of K-Mart Stock value as of date
of death $22.00
3 1973 Opel Coupe, fair condition
4 Certificate of Deposit with First Federal
Savings & Loan Account No. 216-421225.
5 Dauphin Deposit Bank & Tru'~t Co. checl:ing
account No. 13-13-5988
4,400 00
2,000 00
30,492 06
832 '14
6 Joint Dauphin Deposit Savings Account
No. 14-7-0846-9, opened September 6, 1978.
Joint with Judson Bailey, son. Ilalance as of
date of death $3,096.50 - Priscilla Bailey
in good health and account not established
in comtemp~ation of death despite 2 year
presumption - death from heart attack; at age
.sO unexpected.
1,543 254
\" /
>-.......- --- ,
7 Joint Dauphin Deposit Savings Account '
No. 03-7-0440-8, opened October 15, 1979.
Joint with Elizabeth Ann Bailey, daughter.
Balance as of date of death $368.89 - account
not opened in contemplation of death despite
establishment of account within 2 years of
death - death from heart attack at age 50
unexpected.
Dauphin Deposit Bank & Trust Co. savings
account No. 13-7-1258-6.
tY
353 66
8
9 Joint Dauphin Deposit Savings Account
No. 14-1-0B19-4, opened February 22, 1977.
Joint with Constance Bailey, daughter. Balance
as of date of death $74.25
(continued on attached sheet.)
Page 3-A
. ..
RECAPITULATION
Appraisod value 01 Por~onaIPrull"'ly .............................................................,......, s 1~,..O.:l.~....'i.6
Appratsed vatllo 01 fIlalllslalu .............................................................................., . ~9..'O,(lQ_D,O
Totall\ppraised yaluu ...............................,..............".....,,,...,......,,...................... $ 9.J...'O~1""S.6
AFFIDAVIT OF PERSONAL REPRESENl'A-'fIVE
County of Dl~..:
Cumberland
.............................................................,'"....,.........................................................................
II;
Execut
Administrat
deceased, beill~ duly...meIO.l:n.............................,..................... according to law, depose and say that the
items appearing ill the) lIVl'ntory illclllde all 01 the personal assets wherever situ.te and all of the
real estate in the CnlOl11onwenhh of Pennsylvania 01 said decedent; th.t the valuation placed opposite
ead, item of said Inventory represenls its lair value as of the date of the decedent', death; and th.t
decedent owned no real estate oUlside the COl11mllnweallh of Pennsylvania except that which appe.rs
in. lllef'",andunI at the en.lol Ihe In\'entory.
_~1..'..-.(.1r:\..~."...."..... Rnd ~uh!lcrihed
f" ~U
before ute thifi.............,th",......",.".,dny of
~\- 0'-"',_" JU_I/ t n 19td
''''00 ,J:.{..Yo,."", "''ol''~~''''''''''A''1 . . ~".....
\ ,~} 1 'e'
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(, ,Wl:~ r.:/dfE. :~.!.,rlMIiI
i't Cll'Ii;~: .;.. i::,.i,.1 S~.,I,tJ:' 11. 19NI
'/coM"., .' "'J~Hn (0",,1'. INSTRUCTIONS
III the ESlute 1l1.r.X.;\..:I,I1~,U!.\...I1.,....~.i\j.:\-.~Y....ilLl5.I..il...Ii'.t'.j,:i\\;,j.J.l<l...J.....~arnsey
..+4Ir.e...~?..J! ,n1N.?.Q........Q~Jr.w.:::::..:........
E~utor - Aaiilhlt.trar,or ..
322 W. Allen St., Mechanicsburg,
.............."......................Addr.e~;.....................................,
PA 170:
I. An Invonlory musl bo nhul within thrOB mouths altor appolntmenl oC personal repreBentaUve.
2. A IUP1"1omenlal Invenlory mual be nled wllhln thirty da)'8 of dlllcovory of nddlUonal atiBete.
a. Additional .heel" Dlny bu nUnchod a. to perllonalt, or realty.
.. Soa Article IV, Flduclorl.. Act 01 1919.
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IN'lEN'~~~ RE~.Ai'lD PERSONAL ES'l'ATJ:: (cont'd.)
.--------
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10 1 Joint Dauph3.n Deposit <;avings Account .
I No. 14-1-09J.3-6, opened February 22, 1977.
Joint with Jrones J. Bailey, son. Balance
I as of date of death $109.24.
11 HTU '14 Federal Credit union Account
No. 375.
12 HouseholU fumi3hings and belongings
I
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1980
6/9
6/9
6/10
6/20
6/24
6/27
6/30
6/30
6/30
7/2
8/6
8/20
8/27
8/28
9/2
9/5
9/7
9/8
10/7
10/7
10/7
10/22
10/22
10/30
PRINCIPAL PERSONALTY DISBURSEr1ENTS
Giant Food Store - Funeral luncheon
Alter Boys
Register of Wills - Letters Testamentary
Register of \'lills - Certification
Notary Fees
Register of \'1ills - Short Certificates
P P & L - Elec-ric
UGI - Gas
Bell of Pa - Telephone
U. S. Post Office - Stamps
West Shore Times - Advertising Letters
Prothonotary
P P & L - Electric
Bell of PA
Notary Fee
Clerk of Orphans' Court - Petition
Heckingers - House repair
Hechanicsburg Cemtary - Cemetary lot
Cumberland Law Journal - Advertising Letters
P P & L - Final electric
UGI - Final gas
Gingrich Memorials - Harker
Riverton Water Co. - Final water
Myers Funeral Home
. .2....3
L',;." ~u I'..~t v
-5-
$ 70.00
9.00
57.00
10.00
1.00
4.00
23.05
6.96
29.87
15.00
16.75
5.00
49.55
5.78
3.00
7.00
20.16
435.00
18.00
21. 32
21.71
245.00
16.09
2,702.50
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
'*'
:JI SI) ~'9"'
COUNTY FILE NO: Go\.. - '-'
'O~~~J' G.
/7 en m ~' 0
~CI~i' PeL / '7/0",
i}..(o Iqt I
,., ,~7)o:.t, evk/a..
pn.:au'Lt-" (;,~
FILE NO. a/ - y - 3 q 3
COUNTY G..vw, ~J~t^' ) .
DATE OF DEATH~'1 5 /9.\"0
DATE
ESTATE
Appraised Value of Estate:
Real Estate
Personal Property
$ , Lf q 000,06
ljO:189,13
/
Y~L/, '-13
/
+
Jointlv Held PropertylTransfers
+
Total Gross Estate
$ 9/01.:3,!3b
,
Total Approved Deductions
:15 1t'-l-3G
,
$ .55, ~qL.i: 0
Clear Velue of Estate
Less: Approved Charitable Exemptions
----,
Amount Taxable @ 6% Rate
$ 5"5 k'l3, GO
$ 55', 'X ~ ({, .G.Q.. tax due $ 335,j. 9 J.
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE $ 33'73,9~
Clear Value of Estate Subject to Tax
Amount Taxable @ '5% Rate
'* '* '* '* lit '* A five porcent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
I-';(<:'-IJ 0
s3353.90,+
$
. L_
=
d353, 9ot.
+
=
+
=
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
sri) ~ '4-A^ ~j
-,
BALANCE OF PENNSVLVANIA INHERITANCE TAX DUE
/, "..
t' I / I .' I /(/"-'1' -- . -1 i
Assessed by: / /.. ' 1,( (,,',' ,i"li /-r ,<Z-/
See Informalion on Reverse Side Age~y~(~,~ll ~~7:nwe;lIh /1
,j t <) ,uk-t/
I /' ".,/ -."
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INFORMATION
To insure proper credit to your account, the name of tho estate and lilo numher should be clearly print-
ed on the check or money order.
This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of
1961 172 P.S. 9 2485.708),
To the extent that inheritance tax is paid within three (3) months after the death of the decedent. a
discount of five (5) percent is allowed 172 P.S, 9 2485.716),
Inheritance Tal(, other than tax on a future interest, is due at the date of the decedent's death and becomes
delinquent at the expiration of nine (9) months after the decedent's death (72 P.S. S 2485-711). Inheritance
Tax on a future interest is payable within three (3) monthS after the transfer takes effect in possession and
enjoyment and is delinquent thereafter (72 P.S. S 2485- 712). Calculate interest from the delinquent date shown
on the face of this form to the date of actual payment using the following interest table:
------------------------------- --- ------------- - - --------------- -- -- -- -_..--
1 month .005 4 months ,020 7 months ,035 10 months ,050
2 months ,010 5 months ,025 8 months ,040 11 months .055
3 months ,015 6 months .030 9 months ,045 12 months ,060
1 days ,000 17 11 days ,00186 21 days .00352
2 days .00034 12 days .00203 22 days .00369
3 days .00051 13 days .00220 23 days ,00386
4 deys ,00068 14 days ,00237 24 days ,00403
5 days .00085 15 days ,00250 25 days ,00420
6 days .00101 1/; days .00267 26 days .00437
7 days .0011 8 17 days ,00284 27 days ,00454
8 days .00135 18 days ,00301 28 davs ,00471
9 days ,00152 19 days ,00318 29 days ,00488
10 days ,00169 20 days ,00335 30 days ,00500
-- --- ---------------- --- -- -- - ---- --- - ---- -- ----,---- - - - - --------- ------
Any party in interest, including the Commonwealth and the personal representative, not satisfied with
the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section
1001 of the Inheritance and Estate Tax Act of 1961 172 P,S. 92485.1001).
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address listed below:
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable estate.
In addition to debts Incurred by the decedent or estate, other items are claimable including the cost of administration,
attorney fees, fiduciary fees, funeral and burial expenses including the cost of a burial lot, tombstone or grave marker.
GENERAL INHERITANCE TAX INFORMATION
"
All debts being claimed against an estate are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed, Evidence to support the decedent's or the estate's liabilitY for the debts being claimed
should be attached to this schedule.
A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania.
If there is no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of
the same household can claim the exemption. In the event there is no such spouse or child, the exemption can be
claimed by a parent or parents who are members of the same household as the decedent.
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1. If the family exemption is being claimed, indicate the claimant's name, address and his/her relationship to the
decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column,
2. Assign consecutive numbers to each item listed.
3. Enter the date on which each debt was incurred and/or paid,
4, Enter the names of each payee,
5. Provide a brief explanation in the remarks column for each debt claimed,
6. Enter the amount of each debt being claimed.
7. The form must be signed by the person who has assumed the responsibility for paying the debts,
INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
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Russel D. And Mark E. Gingrich. Prop..
S243 SIMPSON FERRY ROAD MECHANICSnURG, PA, 17055
S6n.SBO N. UNION STREET MIDDLETOWN, PA, 170S7
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TYPE OF MONUMENT._-:"___..._ :....__~_.L.r'.2 ..:-.----.-----.
toTERI.'!..
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DATE Of (REeller. -.
----....-.
30% DEPOSIT 15 REQUIRED DEFORE COMMENCEMENT OF W(,!fK
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LETTERING 6 DESIGN
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AMQUt-lT OF O;::OE 1 ~----
I AGREE TO PAY STATED BALANCE UPON ERECTION REGARDLESS OF LABOR TROUBLES
eR SdlPMtNTS OR ANY OTHER GOOD REASONS. THIS OROER OR CONTRACT CANNOT BE
C':'NCEU.EO BY CUSTOMER UNLESS AGREEO BY BOTH PARTIES. THE ARTICLE UEREIN
'v1ENTIONED SHAll REMAIN THE PROPERTY oFGINGRICH MEMORIALS UNTil PAID IN
FUll. AND THEY RESERVE THE RIGHT TO REMOVE THE SAME If NOT PAID AS STATED.
FOUNDA1ION (.O:.T s
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TOTAL
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CASH RECEIPT
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.;,,, : I .., l USE CUSTOMER NUMBER -..". '.-
: t _I~_. .,--:..~~.~ 1 WHEN MAKING INQUIRIES PAY~fNT!.IADJUSTMENTS
. ~ .,' 21::1 ~:2 0L...3 lATE PAYMENT CtiARGE
'H .... ~~, :~~~\s., SAlES TAX Wt~~~.u"J,.Rhy
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BASE RATE INFORMATION "'tn_ UAOIHtiS METUfO US,lCf 1
_._._..__ ___ "l~ '!.I\lNI 100 CUBIC FT +-1
EST ('1ATEO I3ASE RATE 93~O 940 . 10 I
TdTAL NET - CURR~N'
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H:=LP !'REVf:,'<' PiPELINE OAMAGE,
~CCI~~NTS A~~ SEKVICE ~ISRUP'IONS.
IF Y8U Stt Su~EONE DIGGING NEAR
YIJUR HO~"., PLi:ASE CALL UG1.
PAY THIS AI/C..t.'
AFTER DUE DATE
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THIS STATEMENT IS SENT PROMPTLY NOT AS A REQUEST FOR IMMEDIATE PAYMENT, BUT
THAT YOU MAY VERIFY THE DETAILS, SHOULD THERE BE ANYTHING NOT FULLY UNDERSTOOD,
CALL US AT YOUR EARLIEST OPPORTUNITY, 766.3421.
OUR COMPLETE COST'
VAULT
CASH ADVANCED:
CEMETERY CHARGES
MINISTER Pr2ist r. r.l' anlst
NEWS ITEM
CLOTHING
FLOWERS
CERTIFIED COPIES
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15C CO
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.
,
,
;:5 5G
1fl OD
2 ~
I ., .,U
407 e.n
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TOTAL
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'INCLUDES: CASKET & BLANKET, EMBALMING, HEARSE, SEDAN & SERVICE CARS,
FUNERAL HOME AND FACILITIES, COMPETENT STAFF, MEMORIAL FOLDERS
& OTHER PRINTED MATERIAL, AND MANY OTHER SERVICES AND FACiliTIES
TOO NUMEROUS TO MENTION,
THIS BilL IS DUE AND PAYABLE WITHIN 30 DAYS, AFTER WHICH TIME A 1% SERVICE CHARGE
WILL BE ADDED. IF DIFFICULTY IS ENCOUNTERED IN PAYMENT OF THIS BILL, FINANCING CAN
BE ~RRANGED, "
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