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21.80
No.
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
531
In the Estate of
ANDREW JACKSON CLARK, a/k/a A. J. C1arkr,deceased.
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania.
Petltloner(s) Is~1lI) the execut r;.".
named In the Last Will and Testament of Andrp.w ,Tackson
Clark. a/k/a A. J. Clark. dated August 17 r 1961
Oecedent was a citizen of the United States and a resident of Newvi 1 1 '"
xllmI:lIlStllIx(Borough), Cumberland County, Commonwealth of Pennsylvania.
Oecedent died on
Wednesday
the 30th day of ,Tilly
A.D. 19....8..0..-, In the
County of Cumber land , State of .....ElI.. at the age of --B.ll- years.
Oecedent has (has notl been married and has (has not) had children born to him (!lIlT) since the ex.
ecutlon of the above described Will,
Oecedent was possessed of personal property to the value of Ilnilf>t:p.rmi npn
and of real estate to the value of none
as near as can be ascertained; said real estate situated as follows
Therefore, your petltloner(sl respectfully apply(ies) for the probate of the said Last Will and Testa-
ment and for Letters Testamentary theron.
Dated
August 14
, 1980.
I
Name and address
of Petitioner(5j
a tf1J/~ d~ti., ';;(:/ddJ.II) (!IAAJP)
Charlotte Mil er Clark
32 Fairfield St.
Newville, PA. 17241
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF CUMBERLAND
Charlotte Miller
ss
Clark
named in above application, being duly sworn according to law say(s) that the
statements set forth in this petition are true to the best of her knowledge and belief.
Sworn and subscribed before ~#a~f!(tttr,,{;J::J t&.:f (l J AA.R ~
me, August 14 1980.
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Filed:
August 14, 19BO
Attorney
Tom H. Sietsch, Esq.~
Bietsch & Morgentha1 ~ ~
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.
1, Andrew Jackson Clark of 32 Fairfield Street, Newville, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding do make, publish and declare
this is as and for my last will and testament.
1. 1 direct that rrr:J wife, Charlotte Hiller C1arll, be named Executrix of this will and to
LAST WILL AND TESTAME~~ ON AUGUST 17, 1961
pay all rrr:J just debts as soon after my decease as may be found convenient to do so.
2. I give and bequeath all my real estate and personal property unto rrr:J wife, Charlotte
M iller Clark.
,. In case of simultaneous deaths of myself and my wife, Charlotte Miller Clark, I direct
that the proceeds from sale or sales of my personal and real estate property shall be div-
ided into three equal parts. One part of which 1 give and bequeath unto my daughter, Julie
Agnes Oiler; one part unto my son, Andrew SCott Clark; one part unto my step-son, Robert
Wayne Miller.
4. In Case of simultaneous deaths of myself and my wife, Charlotte Miller Clark, I name
my daughter, Julie Agnes Oiler as executrix of this will.
In witness wherof, I have hereunto set my hand and seal this 17th day of August 1961.
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Signed, sealed, published, and declared by the above named, Andrew Jackson Clark, as and for
his last Will and Testament, in the presence of us, who, in his presence and in the presence
of each other, have hereunto subscribed our names as witnesses thereto.
WITNESSES:
~r~'~j
"
. .
OATil m' SUDSCRIJIING WITNESS
COMMONWEALTH OF PENNSYLVANIA I ss:
COUNTY OF CUMBERLAND f
This 14th day of August A.D.,19 80 ,
before me, Rcgister for Ihe Probatc of Wills and granting Ictters of Administration in and for said County of Cumberland, in
thc Commonwealth of Pennsylvania, pcrsonallycame GF>r,,' n K. Wol t7. "nn F.dwi n Rowm"n
Ihe subscribing witncsscs 10 thc foregoing instrument of writir,g purporting to bc th, la;t Will and T~sl.mcnl of
J. Clark,
Andrew Jackson Clark, a/k/a A. / Dated_ August 17, 1961
late of the Borouqh of Newville.
Cumberland County Pa" deceased who being duly
sworn acearding to law, depose and say, that thev were
present, and saw and heard the testa tor ,
Andrew Jackson Clark. a/k/a A. J. Clark.
sign, seal, publish, pronounce and declare the said
instrumentof writing as and for h is
Testament and Last Will, and at :he timc of so doin~ he
was of sound and disposing mind memory and understanding, to the best of their
AM.! J( ",)4
Gerald K. Woltz
~.:~ ((}.J~"~--1__
Edwin Bowman
knowledge, observation and belief.
Sworn
and subscribed before
t!;1dAl" a, ~~
Register
AFFIDAVIT OF DEATH
COMMONWEALTH OF PENNSYLVANIA t 55:
COUNTY OF CUMBERLAND ~
Charlotte Miller Clark,
being duly
sworn
says that as nearly as can be ascertainerl the said decedent
Andrew Jackson Clark, a/k/a A. J. Clark,
died on
Wednesdav the 30th day of
II.' ,r-,.., /1
at or about __ U u o'clock, ~.
July
A,D.,19 80 ,
Sworn
and subscribed this
14th
a ~ orI.1'/.d4. _ YIA I ~ /J .u
Charlotte Miller Clark
().PAAP~
day of
August
80 .
19._, before ~
a, ,~ ~
.Ill/{ 1 e. (' ~~
Register
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t'.~
Wll~(.I",>"",....
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA ss:
COUNTY OF CUMBERLAND
Before me, the Regisler for the Probate of Wills and granting of tellers of Administration in and for the County of
Cumberland, personally came
Charlotte Miller Clark
who, being duly sworn
,does
depose and say that as
Executrix
of the last Will and Testamenl of Andrew Jackson Clark, a/k/a A. J. Clark,
deceased
she will well and truly administer the goods and chattels, rights and credits of said deceased according to law. And
also will diligently comply with the provisions of the law relating to Transfer Inheritances. Sworn and subscribed before me.
August 14 A.D., 19~ -eJ{,aAJ.dtiJ '1'1A.I~.1(::k. (J~AA.P/
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Be it remembered that on the 14th day of
DECREE
August
,A.D.,19~, there was probated and
recorded the last Will and Testament of Andrew Jackson Clark, a/k/a A. J. Clark,
the Borouqh of Newville
late of
Deceased. Lellers Testamentary were granled to
Witness my hand and official seal the day and year aforesaid.
, Cumberland County, Pennsylvania,
Charlotte Miller Clark.
". 'r
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~egist
7PO.
Jointly Held Prope,'ty
Real and Personal Property owned by decedent and
his surviving wife as tenants by the entireties.
Tl"an.Cel~ within TWO YEARS Prior to Death
NONE
E.timated
Value
'-.
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That at the time of death there was no safe deposit box registered ih decedent's individual name, or jointly with, or as agent or deputy of
another, or in decedent'. individual name, with right of access by another as agent or deputy, with the exception oC the Collowing:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
Farmers National B n
Big Spring Avenue
Newv~lle, PA. 17241
BENEFICIARIES AND ADDRESSES
(State Cull namea of an and their addre.... who hav
an interest, vested, contingent or otherwise, in estate.)
Charlotte Miller Clark
32 Fairfield St.
Newville, PA. 17241
BENEFICIARIES
RELATIONSHIP
(I( step.c::hildren or
illegitimate children
are involved, set
Corth this Cact,)
Wife
~
r=---
THIS SAt"E DEPOSIT BOX RENTED
IN NAME OR NAMES OF
Miller Clark
SURVIVED
DECEDENT
STATE YES
OR NO
Yes
AGE OF LIFE
TENANTS OR
ANNUITANTS
AT DEATH OF
DECEDENT
NONE
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RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
wife
INTEREST OF
BENEFICIARY
IN ESTATE
Entire Estate
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REV0484 EX'" (3-80)
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONL Yl
File Number
21-80-0531
Estate Name
Andrel'1 J. Clark
Dote of Death
7 -30-80
Social Security Numb~r
REPORT OF INHERITANCE TAX APPRAISER
I, Ihe undersigned duly appoinled Inheritonce Tax Appraiser in and lor the County 01 Cumberland
Pennsylvania, da respectfully report that I have appraised Ihe real and personol property as reported In the loregoing
retum at the values set forth opposite each Item in the last column to the right in Schedules IIAIt, 118", "e", and liE"
Dated: January 22, 1981
P/~.-'f /d)'1fI'~hJfJ)
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
CODE
ADJUSTMENTS
(HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
Real Property (Schedule A)
Personal Property (Schedul. B)
Jolnt.Hold Properly (Schodulo E)
Tran,fers (Schedule C)
$
-0- 00+
5,198 23 10+
-0- 2lH
-0- 30+
5,198 2::
40-
92+
TOT AL GROSS ASSETS
93-
Leu D.bts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of Itfe estates or
annultl.s. . . . . . . . . . . . . .
~
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
T ox on $
CODE
COMPUTATION OF TAX
S
S
S
S
S
6%
T ox on S
15~G
T ox on $
Tox an $
Tax on $
Exemptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
TO
s
s
s
Less Credits
DATE OF PAYMENT..
AMOUNT PAID
TAX CREDIT
s
S
INTEREST FROM
BALANCE DUE
REV.518 FO (7.80)
~~
....~,.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
NOTICE OF FILING OF APPRAISEMENT
Charlotte Itlller Clark
32 Fairfield Street
Newville, Pa. 17241
RE:
AndreI" J. Clark
Cumberland .
21-80-0531
Estate of
County of
File No.
Dear Hrs. Clark:
You are hereby notified that the origiIl31
appraisement in the estate of AndreI" J. Clark
has been filed in the office of the Register of Wills of Cumberland
County on January 22 , 19 81. Said appraisement reflects the following voluations:
Real Estate
Personal Property
Jointly Owned
Transfers
Total
-0-
5,198.23
-0-
-0-
5,198.23
As to such tax that is paid within three months from dote of death, 0 five (5%) percent
discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months when
death occurred prior to December 22, 1965) from dote of death, interest at the rote of six (6%) percent
per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty days
after receipt of said notice os provided by Section 1001 of the Inheritance and Estate Tax Act of
1961,72 P.S. 2485-1001, P.L. 373.
Dote January 22, 1981
Signed --Pi!"""!} )'1'f'/~Jl'2Jfj)
Title Chief Appraiser
NOTE: This is not 0 bill.
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
55:
,.---.----
being duly SJiQ.rn----- according to law, deposes and says that she ~s the Executr!~___
_---------.---- of the Estate of Andrew Jackson Clark
late of the Borough of Newville . Cumberland County, Pa., deceased and that the
within is an inventory made by _______.___. her_ .-_ . the said Executrix
of the entire estate 01 said decedent, consisting of all the personal prop.rly and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
Charlotte Miller Clark
- -------..---.---------
Sworn
..d "b.,,<bod bol... m., \
0~0(".(J,.JL ,^A~(JOr.\ fO..IIAJ?
E.ecutor . ~D(COXUr
1980
~ GJ--:u_ G. N~-jJ.^.
.1/ !,nr;. r.. 11P'TZLFR. l'-!OT t\RY PUBLIC
r, ,~-I..~,I".d ("0unly Ccrlislc. PA
My Commission Expires Jonuary 27, 1983
32 Fairfield St.
Newville, FA. 17241
Addreu
Date of Death
30th
Day
July
Month
1980
Year
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days 01 discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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Inventory of the reo I and personol estote of
ANDREW JACKSON CLARK
doceaud.
l. Checking Accountr Farmers National Bank of Newville, 2,945 83 I
Newville, PA. ,
!.
i'
2. 1973 Plymouth Coup Automobile. 750 00 ,
,
3. 1975 Dodge Coup Automobile. 1,200 00
4. Miscellaneous Barber Shop Equipment. 302 40
TOTAL 5,198 23
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
'*
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
V(-fo-lJ3/
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COUNTY FILE NO:
, (,:412/
FILE NO,
"
COUNTY (.I
DATE OF DEATH ~
( \
"
Appraised Value of Estate:
Real Estate
$
+ t? /98 ,) ~
/
Personal Property
Jointly Held PropertylTranslers
+ -.-
Total Gross Estate
$ 5/(,y J..:j
5 OLI a 3oz.
$ 155.9(
Total Approved Deductions
Clear Value 01 Estale
Less: Approved Charitable Exemptions
Clear Valua of Estale Subject to Tax
$ J t:;P; q /
$ / f).1) q / lax due $ 9 3C,
lax due -----.
TOTAL PENNSYLVANIA INHERITANCE TAX DUE $ g .~ ~
,
Amount Taxabla @ 6% Rate
Amount Taxable @ 15% Rate
'* .. '* .. * '* A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
less Credits:
DATE OF PAYMENT
DISCOUNT
INTEREST
TAX CREDIT
AMOUNT PAID
ltr.::?J
= s 9, 3 C;
Yn s 9,3.1;
+ $
$
+
=
+
=
Interest accrues at the rBte of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
s (;?J ~ \-1. t Jj
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is
Assessed by: '. /" ;' / " (i;,
See Informalion on Reverse Sida Ag.ntfo~thl Cdm~r'~'h ~.,
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REV.455 (l.eO)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
SCHEDULE "F"
ST A TEMENT OF DEBTS
AND DEDUCTIONS
*
.,
.'
. . \
. ~
File No.' {J /.. 8(" .,~:31
-_.-- ------- ~'--~ --.-.
Estate of ANDREW JACKSON CLARK Date of Death July 30 r 1980
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant Charlotte Miller Clark
Relationship to Decedent survivinq wife
Claimant's Address
32 Fairfield St'r Newville. PA. 17241
ITEM .. ..
NO. OATE NAME OF PAYEE REMARKS AMOUNT
Reaister of wills Letters Testamentarv $ 17.00
Reaister of wills Short Certificates 3.00
Enner Funeral Home Funeral Exnenses 1.773.00
Charlotte Miller Clark Reserve for Grave Marker 750.00
Belvedere Medical Coro. Statement 154.40
Carlisle Hosoita1 Statement 14.40
Carlisle Radio1oay Associa es - Statement 45.52
Charlotte Miller Clark Family Exemption 2,000.00
Charlotte Miller Clark Reserve for C10sina Exoenses 35.00
Beitsch & Morgentha1 Attorney Fee 250.00
TOTAL THIS PAGE I <:c: 042.32
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
(.,{. (I.~O.dl. ,\"" ('LGUt ) (iiC(1,~)? ~JI \ '1~
SIGNATURE OF ATTORNEY/FIDUCIARY ~-
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S .5 (~ 4-a,. 3~)
AT
GiJ (
PERCENT.
/-;?,?'_ J/
DATE
GENERAL INHERITANCE TAX INFORMATION
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.
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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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
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.
: I