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No. 21-81 ,~j{i
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
In the Estate of Bertha M. Bentz
, deceased.
To Register of Wills for the county of Cumberland, In the Commonwealth of Pennsylvania,
Petitioner(s) is (are) the executor
named In the Last Will and Testament of
Bertha M. Bentz dated April , 1960
Decedent was a citizen of the United States and a resident of Lemnyne Bnrnllgh
Township (Borough), Cumberland County, Commonwealth of Pennsylvania,
Decedent died on ~.-<IfY1Y the )q7Jk. day of .j),Ec..cv<<"'t"K A.D,19 go ,In the
County of Cumberland ,State of pennsylvanAflthe age of _78' years.
Decedent has (has not) been married and has (has not) had children born to him (her) since the ex-
ecution of the above described Will.
Decedent was possessed of personal property to the value of $ 4 . 500. 00
and of real estate to the value of $20 ,000.00
as near as can be ascertained; said real estate situated as follows 110 Bosler Avenue.
Lemoyne, Cumberland County, Pennsylvania
Therefore, your petitioner(s) respectfully apply(ies) for the probate of the said Last Will and Testa,
ment and for Letters Testamentary theron,
Dated tJ<1Jtf/ll>€Y I qt)
Name and address
of Petitioner(s)
xh~pc,A4
~ Geor~ C. Bentz
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COMMONWEALTH OF PENNSYLVANIA l
COUNTY OF CUMBERLAND l
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~pnrgp r.. Bp-ntz
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 his knowledge and belief.
.sw.orn_to and subscribed before !ll~,
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Filed: February 5, 19B1 Attorney George A, vaughn, III V
Post Office Box 332
Lemoyne, Pennsylvania 17043
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OATH OF"ERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ss:
COUNTY OF CUMBERLAND
Before me, the Register for the Probate of Wills and granting of Lellers of Administration in and for the County of
Cumberland, personally eame
(,I'eJK(,E. C U'7v'72..
who. being duly :;,..JO/J,y' , do I3S
depose and say that as
e\'eCJrv~
of the Jast wm and Testament of
;J.r;<, 71171 /11 Urv'7 2...
deceased
~ will well and truly administcr the goods and challels, rights and credits of said deceased according to law. And
also will diligently comply with the provisions of the law relating to Transfer Inheritances.s.,,ft'tV JOand subscribed before me,
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Be it remembered that on the
5th
DECREE
February
81
.A,D,,19_. there was probated and
day of
recorded the last Will and Tcstament of
Bertha M. Bentz
Lemovne
Dcceased. Lellcrs Testamentary wcre granted to
Witness my hand and official seal the day and year aforesaid.
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late of
. Cumberland County. Pennsylvania,
George C. Bentz
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tf7 ;;. Register'
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REV0449 EX+ (3.001
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(In.tructlons on Revo"e Side)
*
ESlole 01
Bertha M. Bentz
Dote 01 Deoth
19 December 1980
Lost Address 110 Bosler Avenue
Lemoyne,_ Pennsylvania 17043
Social Security No.
172-01-9311
Bureau File No.
(CITYI
(STATE:::)
(ZIPI
County File No.
21-81-86
1. Decedent died:
( ) Intestate (without a will)
(X) Testate (leaving a last will--copy attached)
2. Is the Iiling 01 a Federal Estate Tox Return required lor this estote? Yes_ No X
3. (X ) Executor/Executrix
) Administratar/Administratrix
Name
George C. Bentz
110 Bosler Avenue
Address
Lemoyne, Pennsylvania 17043
(CITY) (STATE) (ZIPI
4. All correspoadence should be mailed to (X ) Attorney
) Fiduciary.
5. If an attorney is representing the estate, indicate:
Name
Georqe A. Vauqhn, III
Address
P.O. Box 332
Lemoyne, pennsylvania 17043
(CITY) (STATE) (ZIP)
List all safe deposit boxes registered in the decedent's individual name, or jointly with, or as an agent ar deputy
01 another, or in decedent's individual name with right al access by another as agent or deputy. Include the name
and address of the bank ar other institution where the sole deposit bax is located, the name (s) in which the bax
is registered and the relationship of the joint holders to the decedent.
NAME AND ADDRESS OF BANK OR OTHER INSTITUTIDN
IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
E
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and
statements, and to the best 01 my knowl~dge and belief it is true, correct and complete.
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. SIGNA RE OF FIDUCIARY I
l' - II. <PI
DATE
REV.451 EX+ 13.80)
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONALPROPERTV
*'
"
(Instructions on Reverse Sidel
Estate of
Bertha M. Bentz
,
ESTIMATED DEPARTMENT ,
ITEM DESCRIPTION UNIT MARKET VALUATION
NO. VALUE VALUE (OFFICIAL USE ONL YI
"
MiscellaneouS personal property, house- i
1- 300.00
hold effects, clothing, and jewelry
2. Harris savings Association Account
# 1-7712 $4,001.84
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TOTAL THIS PAGE 4,301.84 i )~/ '11 ,~
I"tf#'7
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".) No.
2. Did decedent, within two years of death, transfer property from himself! herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) .IiCL-
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transfer.
b. Copy of death certi Ii cate.
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 wit/lOut 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".) 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.
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 bll1elicial 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".) Nn .
3. 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".)
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OF rlCf 5
fJOWNlmVN. COUJNfAf.PAIIK. (.'1,MPII/l.1. . I.EBI\fHJN. UNIONDEPOSfT
(:lIfllrAt C/r\' . NEWCUMflfRLANn . ~"QRK . SUMMERDALE
February 9, 1981
Mr. George A. Vaughn, III
Andes and Vaughn
26 South 8th St.
Lemoyne, PA 17043
The information which you requested on the account(s) of
Estate of Bertha M. Bentz (Social Security # ~0-36-8003
is as follows:
)
Account Number(s) 1-7712
Class of Account Optional
Date Opened 10-25-57
Principal Balance j2,900.05
Accrued Interest 101.79
Balance at
Date of Death $4,001.84
Account
Ownership Individual
Name of Joint
O;mer, if any NONE
Date O.Tlership
was Established
Additional Infor-
mation requested
G/t~~,
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Margar E. Rehman
Saving,iCounselor - Main Office
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LAST WILL AND TESTAMENT
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Ii Dauphin County, Pennsylvania, being of sound mind, memory and
!: understanding, do make and publish this, my Last Will and
II
~ Testament, hereby revoking and making void all former Wills and
Ii Codicils thereto by me at any time heretofore made.
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il manner corresponding with my estate and situation h life and
II that all my just debts and funeral expenses be fully paid and
\1 satisfied as soon as conveniently may be after my decease.
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1\ residue and remainder of my estate, of whatsoever nature and
Ii wheresoever situate, whether real, personal or mixed, unto my
I
I children, George C. Bentz, Mary R. Thompson, Ruth A. Buehler,
\ and Donald J. Bentz, share and share alike, providing, howeve~,
that they survive me by at least thirty days.
\
II mentioned in the proceeding paragraph, fail to survive me as
,
OF
BERTHA M. BENTZ
I, BERTHA M. BENTZ, of the City of Harrisburg,
ITEM 1.
I direct that my funeral be conducted in a
ITEM II.
I give, devise and bequeath all of the rest,
ITEM III.
In the event that any of my children,
aforesaid, I hereby give, devise and bequeath unto his or her
child, unto the respective child or children of the said
i\ deceased child and in the event of more than one child, that
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they share and share alike.
ITEM N.
I hereby nominate, constitute and appoint
George C. Bentz estate executive of this my Last Will and
Testament and in the event he fails to survive or qualify, then
I hereby nominate, constitute and appoint the next oldest of
"
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" my children the living estate executive of this my Last Will
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REV-"S" EX+ (eo-eol
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-81-0086
Eslate Name
_.______.____.__.____n..~._'____~_______
m Original
o Supplemental
o Remainder
File Number
Bartha M. Bentz
December 19, 1980
Date of Death
Social Securi ly Number
172-01-9311
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser In and for the County of Cumberland
Pennsylvania, do respectfully report thot I have appraised the real and pe"onal property as reported In the loregolng
retum at the values set forth opposite each Item In the last column to he right in S~ules "A", "B", "C", and "E"
Dated: October 16, 1981 ,." e' /{,~ ,.-1,..
INti ITANCE TAX APr;J' ISER
INVENTORY
VALUE AS APPRAISED
ADJUSTMENTS
COOE (HARRISBURG USE ONLY) REMAINaER APPRAISEMENT CODE
Real Property (Schedule A)
Personal Property (Schodul. 8)
Joint-Hold Property (Schedule E)
Tron.'e,. (Schedule C)
$
1l0NE 00+
1+,301 B1+ 10+
20,000 00 2lH
1l00lE 30+
21+,301 B1+
40-
92+
TOT AL GROSS ASSETS
6
93-
Leu Dllbts ond Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
~
FACTOR
PRINCI PLE
VALUE
CODE
FOR USE OF REGISTER ONLY
T ax on $
CODE
COMPUTATION OF TAX
S
$
$
$
$
6%
T ox on $
15%
Tox on $
Tox on $
Tox on $
Exemptions
T otol Estate
TOT AI. TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
S__ + $
S
=
$
=
+
INTEREST FROM --
BALANCE DUE
BALANCE
TO
S
$
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~ REV.1l62EX
~ " COMMONWEALTH OF PENNSYLVANIA
4 NO, K' 29775 DEPARTMENT OF REVENUE
" OFFICIAL RECEIPT' PENNSYLVANIA INHERITANCE AND ESTATE TAX
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~I RECEIVED
JJ FROM
~ ADDRESS
George A. Vaughn, III Esq.
26 S. 8th st., Box 332
Lemoyne, PA 17043
'--ESTATE~FORMAT~N~--------------------------
DA IE OF DEATH December 19, 1980
FILE NUMBER 21-81-86
DATE OF PAYMENT September 15, 1981
NAME OF DECEDENT Bertha M. Bent
COUNTY Cumber land
POSTMARK DATE
REMARKS
Q
"PAID ON ACCOUNT"
SEAL
TAX AT 6%
TAX AT 15%
TAX AT
ESTATE TAX
m
m
RECEIVED BY
f\EGIS1[f\ or WII.I.S
~...~..... -
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%
TOTAL TAX CREDIT
LESS DISCOUNT
PLUS % INTEREST
(FROM TO_I
TOTAL AMOUNT PAID
~49.47
$49.47
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. /SIGNATURE /
,/
.....455 (1.80)
,OMMONWEAL TH OF PENNS...LVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
Estate of Bertha M. Bentz Date of Death 19 December 1980
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
Claimant
George C. Bentz
Relationship to Decedent Son
Claimant'sAddress 110 Bosler Avenue, Lemoyne, Pennsylvania 17043
ITEM DATE NAME OF PA VEE REMARKS AMOUNT
NO.
,1. Gear e C. Bentz Famil $2,000.00
2. 1/7/81 M ers-Hall Funeral Home 2,842.00
3. 3/9/81 Holy Spirit Hospital Final Illness 5.10
4. C.Z. Ritzman Associates, I c. Final Bill 50.00
5. De artment of Public Welfa e Public Assistance Lie 216.72
6. West Shore Times Advertising Expense 17.75
7. Cumberland Law Journel Advertising Expense 18.00
8. 2 5 81 Re ister of Wills Probate Ex ense & Short Cer . 32.00
& Vau n es 7 O.
Final illness 2.00
TOTAL THIS PAGE $5,933.57
hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts. funeral
xperlses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
5 DNA E o~ ATT R F.... FIDUC ARV
OFFICIAL USE ONLY
EeTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ ~1--?'5 ')' '7 ;) (:AT ~,').
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PERCENT.
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REV.455 (1.00)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
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ESlaleof Bertha M. Bentz Dote 01 DUillh 19 December 1980
WHEN CLAIMING THE FAMILY EXEMPTION, COMPLETE THE FOLLOWING:
File No.
Claimant
George C. Bentz
Relationship to Decedent Son
Claimant's Address 110 Bosler Avenue, Lemoyne, Pennsylvania 17043
ITEM OATE
NO.
1.
.2. 1/7/81
3. 3/9/81
4.
5.
6.
7.
8.
NAME OF PAYEE
REMARKS
AMOUNT
George C. Bentz Family Exemption
M ers-Hall Funeral Home Funeral Ex ense
Holy Spirit Hospital Final Illness
C.Z. Ritzman Associates, I c. Final Bill
De artment of Public Welfa e
West Shore Times
Cumberland Law Journel
Public Assistance
Advertising Expense
Advertising Expense
Lie
$2,000.00
2,842.00
5.10
50.00
216.72
17.75
18.00
32.00
750.00
2.00
wills
Andes & Vau hn
Probate Ex ense & Short Cer .
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Att rne s fees
Final illness
TOTAL THIS PAGE $5,933.57
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.
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SIGNA ~E OF AT'- HNEV/FIDUC ARY
OFFICIAL USE ONLY
9-//. :P/
DATE
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF S
AT
PERCENT.
REGISH:H OF WILLS
DATE
GENERAL INHERITANCE TAX INFORMATION
Unsatisfieo liabilities incurred by tile decedent prior to ilis/her death me 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, luneral and burial expenses including the cost of a burial lot, tombstone or grave marker.
All debts being ciaimed 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 sclledule,
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 responsibiiity for paying the debts,
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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IS:
c'Eok'v('. (... .6Gt-Ir 2-
being duly S _,J J.<!.N eccording to low, doposes and ..ys thet he ) 'S '.,.,NE
13' K t:. ",; JDA!.. of the estate of .coo,,;! ?J.I,4 "'. .~z..
late of 1!3<?!'<JUG":!. U'" .!./.C M ,,.,...~_ , Cumberland County, Po., deceesed and that the
within Is on inventory medo by /-t I Y't , the ..id ;.= >Lc-v,J7)A:'.
of the entire estate of said decedent, consisting of all the personel property and real estate, except real estate outside
the Commonwoelth of Pennsylvania, and that the figures opposite each item of the Inventory represent It's fair value
os of the dote of decedent's death.
.1lu'fr:L!L
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and subscribed before me,
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x/te::;p-'" c 'A?~~
. , Eneutor . Adminhtor
110 Bosler Avenue
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Lemoyne, Pennsylvania 17043
Addren
Dote of Death
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INSTRUCTIONS
I. An inventory must be filed wit"in three months after appointment of personal representetive.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached os to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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