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No. 21-81
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
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In the Estate of 011 mE" !-I 1= III /oly p., 0 R.rI m 1/# :;z:. , deceased,
To Register of Wills for the County of Cumberland, In the Commonwealth of Pennsylvania,
Petltloner(s).lll.(are) the executP,;;( named In the Last Will and Testament of Jllm.t"1
!..JF.#KIA "RI"IR}/k! IftJ..zJ:" dated
Decede~ a citizen of the United States and a resident of c:.'h~ () .fJ: 1/
Township (Borough), Cumberland County, Commonwealth of Pennsylvania,
Decedent died on ~J.\ fIlII. D tJ ~ the ~~ day of mil 'I A,D, 19h.-, In the
County of C. .IJ n. ~ F R } It N , State of J A at the age of ~ years,
Decedent.. (has notl been married and '- (has not) had children born to him (.l since the ex.
ecution of the above described Will,
Decedent was possessed of personal property to the value of ~ ~,<}'OO
and of real estate to the value of
"7 d<t!J 060
,
as near as can be ascertained; said real estate situated as follows ;Is /).Ife,e E5r //oJ
.s:5 ~'l> "'- 16Jl.tl
Therefore, your petltioner(s) respectfully apply(le ) for the ptobate of the said Last Will and Testa.
ment and for Letters Testamentary theron,
Dated 3"" U I,) !' 16
''181
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llH~boMMONw..~LTH OF PENNSYLVANIA )
-w 0::';'" t
~ncOU~rv O~iGUMBERLAND j
Gayle B. Larson
Name and address x
of Petitloner(s)
U I 11<; i DE..
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,
(;:
ss
named In above application, being duly sworn
statements set forth in this petilion are true to the best of
according to law say(s) that the
her knowledge and belief,
sworn
and subscribed before
jS'I1/1J
m~June 16 19 91.
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eglster
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Flied: June 16. 1981
,<<(.,AE/TT ~p" f7.ER
Attoa'fYrl~ ...g~.
~A""I":>-t;14M!5i. A.
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LAST WILL AND TESTAMENT
Of
JAMES HENRY BORN~IAN, I I
I, JAME~ HENRY BORN~~N, II, being of sound and disposing
mind, memory and understanding, do make, publish and declare
this to be my Last Will and Testament, hereby revoking and
making null and void any and all former Wills made by me at
any time before this Will.
FIRST: I direct my Executor, herein-
after named, to pay all my legal debts and funeral expenses
as soon after my decease as conveniently may be done; how"
ever, my Executor may, in my Executor's discretion, negotiate
for the continuation of financing arrangements existing at
the date of my death.
SECOND: All the rest, residue and
remainder of my estate, of ,,,hatsoever nature and wheresoever
situate, I give, devise and bequeath to my sister, GAYLE B.
LARSON, if she survives me by thirty (30) days. If my
sister does not survive me by thirty (30) days, then I give,
devise and bequeath my estate to BRUCE A. LARSON, the husband
of my sister,
8[)8
THIRD: I direct my Executor to pay
all inheritance, estate, succession and legacy taxes of
whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise
passing by reason of my death may be subject,
FOURTH: My Executor is hereby author-
ized and empowered, in addition to such powers granted
executors by law, all exercisable without court order: (a)
to sell securities or other property, real or personal or
both; (b) to borrow money from such persons as it may de-
sire, including the power to bcrrow from itself as an in-
dividual or as a fiduciary under any Trust Agreement for any
purpose necessary or desirable in connection with the payment
of taxes or other matters incidental to the settlement or
administration of my Estate, or for investment purposes,
either secured or unsecured, at such rate of interest as may
be necessary and to sign notes and to pledge the assets of
my Estate as security therefor; (c) to make distribution in
kind or partly in kind or partly in cash; (d) to retain all
or any part of my property, real or personal, constituting
my Estate for such time as it deems best or to invest or
reinvest the same without being restricted to "legal"
investments; (e) to compromise claims, against or in favor
of the Estate, with or without Court approval on such terms
-2-
8D9
and conditions as Executor deems appropriate, in its sole
discretion; (f) to elect to pre-pay and to pre-pay inheritance
taxes on remainders or other interests at the sole and
exclusive discretion of my Executor, and such election shall
be binding upon all beneficiaries, recognizing that there
are or could be conflicts between the beneficial interests
by reason of any election made; (g) if the Estate includes
any interest which I had in a business at the time of my
death, whether the same is a sole proprietorship, a partner-
ship, or a corporation in which I owned all or a substantial
portion of the stock, to continue said business, until such
time as it deems it advisable to sell, liquidate or distribute
the same in kind. Executor shall have all rights and powers
in connection with said business as I had when living,
including by way of example and not limitation the powers to
operate or join in the operation thereof as a going concern,
to form or re-form a general or limited partnership, to
incorporate or re-incorporate and to liquidate or sell the
same or any part thereof, all as it deems advisable for the
best interests of the Estate and of the beneficiaries thereof;
without any liability for loss resulting from the operation
of said business except where such loss is the result of
gross negligence or fraud on the part of the Executor; (h)
to receive, for its services in connection with any said
-3-
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C.I":"
OATH OF SUlISCRllllNG WITNESS
MMONWEALTH OF PENNSYLVANIA i ss:
COU OF CUMBERLAND
(
/)
/
/
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This day of /A.D,,19 ,
before me, Register for the obate of Wills and granting letters of Administration in and for said coUnty of Cumberland, in
the Commonwealth of Pennsy ia, personally came . //
/
"-.
the subscribing witnesses to the foregoing instru
nt of writir.g purporting ~~st Will and T ~stam~nt of
Dated /
late of
/
according to law, depose and say, that/ pr~nd saw and heard the testa
/ sign, seal~lish, pronounce and declare the said
l,,~~", .f wri<l" " ". f'',;(.; ~.~.'""". L... Will. ,rnf " ,h. ,;= ,f ;;;a.."
was of sound and disposing mi d memory and understanding, to the best of ~
knowledge, observatio~d belief. """-."
/ .. and subscribed before "
// ~.
berland County Pa" deceased who being duly
Register
AFFIDAVIT OF DEATH
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COMMONWEALTH OF PENNSYLVANIA t ss:
COUNTY OF CUMBERLAND \
Gayle B. Larson
sworn
says that as nearly as can be ascertainerl the said decedent
James HenryBornmanII
died on
S/v)' Ti ho1
at or about
the
.:J. ~ day of
//J 1 C/
I
A.D,,19U,
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_o'clock, ..1:3.-M,
sworn
and subscribed this
16th
day of
June
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. Registcr (315
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I
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H:
GAYLE LARSON
. -.--.-- -... -"-'.--.-.--.---..- -._-- ....---...------
being duly -. ___sworn..._.H__..__ occording 10 I.w, dopo,., ond ..y. thot sho,..__..______.______._.
--,_ti?_.J;;.l<:~9.U.tJ:'.i.x_...... ..... of Iho Elhto of..~amei?_Henry"_Bornman, II
lot. of ..... Camp Hill _'" Cumbo'/ond Counly, Po" d.c.o.od ond thot tho
within i. on invenlory modo by Gayl_E! Larson _ _.__, the .oid_..~x.<<>:<::~tri~
of Iho ontiro estoto of ,oid decadent, con,i,ting of .11 tho porsono/ property ond roo/ e,lolo, .xcopt roo/ o.hto outsido
tho Commonweoith of Penn'y/vonid, dnd thol tho figuro, oppo,it. odch itom of the Invontory ropro.ont it'. foir vo/uo
d' of tho d.to of ducedonl', do.th,
~~!!....-._-- ond ,ub,cribod bofor. mo,
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,..,' ..... DIANE M. rECK, NOTARY rUAlIC
srm TON AORO, OAUPIIIN COUNTY
\lY "OM MISSION [XPIII[S ore. j I :IIi]
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executor. Adminidr.tor
Hillside Road
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Dauphin, Pennsylvani.a
Addr...
-.---------.-
Ooto of Dooth
May
23, 1981
D,y
.....__._.-- ------_..__..__._-~---
Month
Vea,
INSTRUCTIONS
I, An inventory mu,t bo filed within threo month, .fter oppointment of porsonol roprOlenhtivo,
2, A ,upploment invontory must bo filed within thirty doy' of dilcovory of odditionol o..ots,
], Additiono/ .heots moy bo ottoched 0' to personolty or roolty
4, Seo Articlo/V, Fiduciarie, Act of 1949,
.
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Inventory of tho rool ond personol estote of
JAMES HENRY BORNMAN, II
doceosed.
REAL
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PROPER'l'Y
One-third interest in property located at 3434 Trindle
Road, C3mp Hill, pennsylvania
pERSONAL PROPERTY
1. 1970 Chevrolet pick-up Truck
$ 1,650,00
2. 1953 Ford automobile
2rOOO.00
3. Clothing, sports equipment and books
4. 1972 snowmobile
165.50
310.00
5. Tools
292.33
6. State Capital savings Association
Account No, 002-00-00552r
Balance $ 78.57
Interest $ 1.72
80.29
7. Trail Bike (Inoperable)
75.00
TOTAL PERSONAL PROPERTY
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$4r833 34
$4,573 12
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AMENDED INVENTORY OF REAL AND PERSONAL ESTATE
In Slor.aUrr IIr Slo, i.tall IIr..........x~~,~..TI~~'~'Y1"'J?~~~,t.l"",;J;1..,..","'.."'..
'I .'1. \,;ullUJer anu .
late of ..,~R!:R!:l,C],l:..,~L~,'!-!J1.P.J!~,tL..............in thc County oIt~, State of Penna" deceased,
Jnll,nlDrll of the real and personal estate which were of the above-named
..,......;ri\IIll;lJ>...ll...,aor.wna.n....Il...,......,..,........,....,....,..,....".. deceased, Taken and appraised
the .................. day of ............................19 (Date o( death ....!;i,/,/\:lI.Il.1,........,)
REAL PROPERTY
One-third interest in property located at
3434 Trindle Road, Camp Hill, PA 20,689 74 20,689 74
PERSONAL PROPERTY
1. 1970 Chevrolet Pick-up Truck 1,650 00
2. 1953 Ford automobile 2,000 00
3. Clothing, sports equipment. and books 165 50
4. 1972 snowmobile 310 00
5. Tools 292 33
6. State Capital savings Association
Account No. 002-00-00552
Balance $ 78.57
Interest 1.72 80 29
7. Trail Bike ( Inoperable) 75 00 4,573 12
MISCELLANEOUS:
Interest in Estate of .James Henry Bornman
(Adjudicated January 12, 1982) Cash
4,244 49
33 shares of P.R.R. stock (valued as of
May 26, 1981)
1,521 96
5,766
45
IJEV.150ttEX + (9-Bl) ::L
BUREAU OF EXAMINATION INHERITANCE TAX RETURN
PENNSYLVANIA DEPARTMENT OF REVENUE RESIDENT DECEDENT
P.O. BOX 8327
HARRISBURG. PA 17105 II - ,;) ~ -
o ,dent's Nama (Lest, First, an Middl, Initial) Dec,dent's Add,,,s
DECEASED . Dr~ H, 2>1.\34 --rn'I'~le ROIld.
Soc181 Secunty Numb, Oat. of Death
Ca.!I-I Hillj PA 1101/
05-(l., .
FiI. Numher
a\.~I- 03toLt
CHECK
1. O,iginal R'turn rn
2, Supplemental Return 0
3. Remainder Raturn D
APPRO.
PRIA TE
4. Lif, Estate D 5. F,deral Estat, Tax 0
R'turn Required,
6. D,cedent died testate m 7, Decedent maintained a living D B. Numher of safe d,posit D
(Attach c,py of Will) W trust (Attach copy of trust! boxes inventoried
All corresp,ndence and confidential tax information should be directed to:
BLOCKS
Es
Recapitulation
1. Real Estate (Schedule A) ( 11
2, Stocks and Bonds (Schedul, B) ( 21
3. Closely H,ld Stock/Partnership Interest (Schedule C) ( 31
4. Mortgages and Notes (Schedule D) ( 4)
5. Cash & Miseellanaous Personal Property (Schedule E) ( 5)
RECAPIT. 6. Jointly Owned Property (Schedule F) ( 6)
ULATIDN 7. Transfers (Schedule G) ( 7)
B. Total Gross Assets lIotal lines 1.7)
AND 9. Funeral Expenses Administrative Costs/Miseellaneous
Expenses (Schedule HI ( 9)
TAX 10. Debts/Mortgages/Liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10)
12. Net Value ,f Estate (line B minus line III
CALCU. 13, Charitable B,quests (Schedule J)
LATION 14. Net Value subject to tax (line 12 minus line 13)
State
Zip
~Dl~~
IOI~o'l,07
(B) '?l\IO~Ct~\
(Ill 'i?,lDlD6.103
(121 a~, 2> ~3.14'i\'
(131 a~, 2>u~.l.lR
(141
x.06=
x,15= 0, ~5l.\.'55
(17) 3, '35'\,55
Computati,n of Tax
15. Amount of line 14 taxableat 6% rate (151
(inciude values from Schedule KI
16, Amount ,f line 14 taxableat 15% rate (16) d~ I :.ID 3. 4> <6
linclude values from Schedule K)
17, Principal tax due (add tax from line 15 plus tax from line 16)
lB. T'tal Prier payments:
(a) Amount Paid
(b) Plus Discount
(c) Minus Interest (IBI
19, Balance Due lline 17 minus line lB) (19)
Make Check Peyable te: Register ,f Wills, Agent
... PLEASE RECHECK MATH'"
Under penalties of perjury, I declare that I have examined this raturn, including accompanying sehedules and statements, and to the best of my knowledge
and belief, it is true, carre end complete. Declaration ,f preparer other than the personal representative is based on all information of which preperer has
any knowledge, ..; II / iJ....
ADDRESS . 1 DATE
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COMMOMWEAL TH OF PEMMSYLVAMIA
DEPARTMEMT DF REVEMUE
TRAMSFER IMHERITAMCE TAX
RESIDEMT DECEDEMT
AFFIDAVIT OF
FIDUCIARY
(In.tru:tion. on Reverse Side)
Estate of
James Henry Bornman, II
Do te of Dea th
MaV 23. 1981
,;lD,') - 3(", '7\/1( I
Lost Address 3434 Trindle Road
Social Security No.
Camp Hill, PA
17011
Bureau File Ho.
County FHe No.
,-2 /-%/-S b4
{CITYI
{STATEI
(ZIPI
1. Decedent died:
( ) Intestate (without a will)
( X) Testate (leaving 0 last will--copy attached)
2. Is the filing of a Federal Estate Tax Return required for this estate? Yes_ No X
3. ( ~ Executor/Executrix ) Administrator/ Administratrix
Name Mrs. Gayle B. Larson
Address Hillside Road
Dauphin, Pennsylvania
17018
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4. All correspondence should be moiled to (X) Attorney
) Fiduciary.
5. If an attorney is representing the estate, indicate:
Name Robert C. Spitzer, Esquire
Campbell, Spitzer, Davis & Turgeon
Address 130 State Street, Post Office Box 1000
Harrifihnrg. ppnn!=:y'vAni;::l 1710R
(CITY) (!:TATE) (ZIP)
List all safe deposit boxes registered in the decedent's individual namer or jointly with, or as an agent or deputy
of another, or in decedent's individual name with right of access by another as egent or deputy. Include the name
and address of the bank or other institution where the safe deposit box is located, the name (s) in whir.~ the box
is registered and the relationship of the joint holders to the decedent.
MAME AMD ADDRESS OF BAMK OR OTHER IMSTITUTIOM
1M WHICH DECEDEMT MAIMTAIMED A SAFE DEPOSIT BOX
MAME OR MAMES 1M WHiCH
SAFE DEPOSIT BOX IS REGISTERED
RELATIOMSHIP OF JOIMT
HOLDERS TO DECEDEMT
Under penalties of perjury, t declare that I have examined thi. return, including accompanying schedules and
statements, and to the best of my knowledge and belief it is true, correct and complete.
,xl~'l A.J/
DATE
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Djd decedent, within two years of death, make any transfer of any material part of his estatr. without receivjng
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 (jncluding a spouse) in joint ownership? (Answer "Yes" or "No",) ~
3. If the answer to one or two above js "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 fi cate,
c, Affidavit by the attending physician indicating the state of decedent's health at time of transfer,
d, All other information supporting l10ntaxability or 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 th~ property transferred might return to transferor or his/her estate or be subject
to hjs/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 "Ves" or "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 consideratjon for which was transferee's promiseto 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 beneficial 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 ~IYes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Ves" or "No".)
".'"
THIRD: I dir.ct my Ex.cutor to pay
all inheritance, estat., succes.ion and l.gacy tax.. of
whatso.v.r nature and kind, to which .y ..tate or the
transfer of any prop.rty paning her.under or oth.rwh~
passing by reason of .y death may be ,ubj.ct. '
FOURTH: My Ex.cutor ls hereby author.
11.d and ..pow.r.d, in addition to .uch pow.r.' grant.d
.X'Cutor. by law, all .x.rei.abl. without court ord.r: Ca)
to ..11 .ecuritie. or oth.r property, r.al or p.r.onal or
both; Cb) to borrow mon.y fros .uch per.on. a. it m.y de.
.ir., lncludins the pow.r to borrow fro. it..lf a. an In.
dividu.l or .. a fiduciary under any Tru.t Agreement for .ny
purpo..'n.c....ry or d..irabl. in connection with the p.,..nt
of tax.. or other ..tt.rs incident.l to the settlement or
adaini.tration of my B.t.t., or for investm.nt purpo....
.ith.r ..cur.d or unsecur.d, at such rat. of int.re.t as ..y
b. n.e....ry .nd to sign not.. and to pl.dge the ....t. of
sy B.t.t. .. ..curity ther.foTi Cc) to .ak. dl.tribution In
kind or p.rtly in kind or partly 1n cash; Cd) to r.tain all
or .ny part of my prop.rty, r..l or per.onal, con.tituting
ay E.t.t. for .uch tiae .. it d...s be.t or to inv.st or
reiny..t the ..... wi thout being reltrictid to "l.gal"
,
inv..ta.nts: Ce) to comproml.. clai.s, agaiD.t or in favor
of the Estat., with or without Court approval on .uch t.ra.
-2.
and conditions al Executor deems appropriate, in it. .01.
discretion; (f) to elect to pre-pay and to pre-pay inheritance . '
tax.s on remainders or other inter..t. at the .01. and'
exclusive discretion of my Executor, and .uch election .ha11
be binding upon all beneficiarie., recogniling that there
are or could be conflict. betw.en the beneficial intere.t.
by reason of any election made; (.) if the Estat. include.
any inter..t which I had in a bu.ine.s at the time of my
death, whether the la.e i. a 101. proprietor.hip, a partner-
.hip, or a.corporation in which I owned all or I .ubstantia1
portion of the Itock, to continue .aid bu.in..., until .uch
time as it deems it advilab1. to .e11, liquidate or distribute
the I'" in kind. Bxecutor shall have all rightl and pow.rs
in conn.ction with laid bUlinesl a. I had when liVing,
inCluding by way of examp1. and not limitation the pow.rl to
operate or-join in the operation thoreof as a going concern,
tu form or re-form a general or limited partnership, to
incorporat. or l.-incorporate and to liquidate or ..11 the
laa. or any part thereof, all as it dee.1 advi.ab1e for the
belt int.rest. of the Eltate and of the bGneficiaril1 thereof;
without any liability for 10ls resulting from the operation
of .aid business except where luch loss il the result of
groll negligence or fraud on the part of the Executor; (h)
to r.ceive, for its services in connection with Iny said
.,
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lJ
COMMom~EALTH OF PENNSYLVANIA
581
COUNTY OF DAUPHIN:
, ,
I, JAMES HBNRY BORNMAN, II, Tes ta to~, who.. name 11
signed to the attached OT fOTegoing instrument, having been
duly qualified accoTd,ing t,o law, do heT.by &cknowledg.e that
I signed and executed the in.tru.ent a. my Last Will; that I
signed it willingly; and that I signed it al my free and
voluntary act for the purposes therein expresled.
If, le'fl'XI:.')" ~/e'Jl/Lt iy)D'I,tJ/llldA, 7Z
. ('. -
Sworn or affiTmed to and
acknowledged, before me,
this II! /t day. of
7....-
, 1980.
I
My Commislion Expires:
t.::.;-II
RI!V0453 EX"C3.DOI
COMMONWEAL nt OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEOULE "0"
BENEFICIARiES
*~
, ,
, . '
(Instructions 0" Roverse Side)
Estate of
.J^~IES IIENRY BOJ@IAN, TT
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BEtlEFICIAR'
DECEDENT BIRTH
Mrs. Gayle B. Larson
HIllSIde Road
Sister Yes Of Age Entire Estate
The above beneficiaries are living at this time except for the following:
_I
NAME
DATE O~ DEATH
REV.A54l1.8QI
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL V OWNED PROPERTY
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(Instructions on Reverse Sic/aJ
Estate of JAMES HENRY BORNMAN , II
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ITEM R
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INFORMATION
This document is the Notice required to be given under Section 709 of the Inheritance and Estate Tax Act
of 1961 (72 P.S. seelion 2485).
If the tax is paid within three (3) months after the decedent's death. a discount of 5% of the tax paid is allowed.
InheritJnce Tax becomes delinquent nine (9) months after the decedent's death. Interest is charged at the
rate of six (6) percent per annum on the amount of unpaid tax. (SEE EXAMPLE 8ELOW)
EXAMPLE: If a balance of tax due of $2.000.00 is in a delinquent status from ~. and payment is made
on 5-23-80. the interest is calculated as indicated below:
STEP 1
Determine the rate of
interest from the table below.
STEP 2
Multiply the balance of
tax due by the rate of
interest.
STEP 3
Add the interest
to the balance of
tax due.
Interest from 3-03-80
Results in:
2 Months =
20 Days =
Rate of interest =
la 5-23-80
.010
+ .00335
.01335
Balance of tax due
Rate of interest
INTEREST
$2.000.00
x .01335
$ 26.70
Balance of tax due
Plus Interest to
Date of Payment (+)
TOTAL tax and
interest to Date
of Payment
$2,000.00
$ 26.70
$2,026.70
---------------------------------------------------------------------
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 day .00017 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 days .00068 14 days .00237 24 days .00403
5 days .00085 15 days .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 days .00284 27 days .00454
8 days .00135 18 days .00301 28 days ,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
appraisement and assessment may object within sixty (60l days after receipt of this Notice as prolJided by
Section 1001 of the Inheritance and Estale Tax Act of 1961 (72 P.S. sec. 2485 - 1001).
MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WI~~S, AGENT"
DETACH THE TOP PORTION OF THIS FORM AND SUBMiT WITH VOUR PAVMENT TO THE REGISTER OF WI~LS FOR
THE COUNTV SHOWN ON THE REVERSE. SEE THE INHERIT ANCE TAX INSTRUCTION BOOK FOR ADDRESS.
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
File No. 21-81-364
IN THE MATTER OF THE
ESTATE OF JAMES H.
BORNMAN, II, DECEASED
CERTIFICATION
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF DAUPHIN:
SS:
I, GAYLE LARSON, being duly sworn according to law, depose
and say that on ~. to _ , 1982, there was mailed
to Gayle Larson, Hillside Road, Dauphin, Pennsylvania, a copy
of the attached Notice indicating the time and place of the Audit
of the Account filed in this matter.
~J
~,~.~W
Galle Lars n
before me, this
Sworn to and subscribed
&~
r2R~
Q.Jmd
Public
, 1982.
.' day of
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.... , '. IMtS, NOTARY PlIBlIC
'"1 CommISSIon h .
p.res Selltem"cr 3. J935
Hartltburc. PA 0 h'
aup tn Cau""
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COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
File No. 21-81-364
Estate of James H. Bornman, II, Deceased
Late of Camp Hill, Pennsylvania
FIRST AND FINAL ACCOUNT OF
GAYLE LARSON, EXECUTRIX
Date of Death: May 23, 1981
Letters Granted: June 16, 1981
First Complete Advertisement of Grant
of Letters: July 10, 17 and 24, 1981
SUMMARY
PRINCIPAL
Receipts
Net Gain or (Loss) on Conversions
Adjusted Balance
Less Disbursements
Balance Before Distribution
Distribution to Beneficiary
Investments
Capi tal Changes
Principal Balance Remaining
INCOME
Receipts
Less Disbursements
Balance Before Distribution
Distributions to Beneficiary
Income Balance Remaining
COMBINED BALANCE REMAINING
$ 31,029,31
-00-
$ 31,029.31
-12,788.52
$ 18,240.79
-12,371.29
(15,000.00)
-00-
$ 5,869.50
$ 5,869.50
$ 1,052.24
-00-
$ 1,052.24
-00-
$ 1,052.24 $ 1,052,24
$ 6,921.74
COMPOSITION OF NET BALANCES
PRINCIPAL
Dauphin National Bank, Certificate
of Deposit
State Capital Savings and Loan
Association, Savings Account
P.R.R. Stock
Trail Bike
One-third interest in tools and
car in Father's Estate
Cash
TOTAL PRINCIPAL
INCOME
Interest on Dauphin National Bank
Certificate of Deposit
Interest on State Capital
Savings and Loan Association,
Savings Account
TOTAL INCOME
TOTAL PRINCIPAL AND INCOME
$ 15,000.00
78,57
1,521.96
75.00
431.66
6,148.34
$ 23,255.53
$ 1,050.49
$ 1.75
$ 1,052.24
$23,255.53
1,052.24
$24,307.77
kCS:jai 1/13/tiL
PRINCIPAL DISBURSEMENTS
6/16/81 Register of Wills, Short Certificates $ 9.00
6/16/81 Register of Wills, Probate Will 37.00
7/08/81 Myers Funeral Home, funeral expenses 2,525.00
7/22/81 The Evening Sentinel, advertisement
of letters 23.50
9/08/81 Cumberland County Law Journal,
advertisement of letters 18.00
10/30/81 Gayle B. Larson, reimbursement for
expenditures for 3434 Trind1e Road,
Camp Hill, PA 3,812.83
10/9/81 Auctioneer's Commission 661. 43
10/9/81 Auctioneer's advertising 196.75
1/04/82 . Holy Spirit Hospital, services at
time of death 490.30
5/07/82 Inheritance Taxes 3,364.71
7/13/82 Gayle B. Larson, Executrix fee 900.00
7/13/81 Campbell, Spitzer, Davis & Turgeon 750.00
TOTAL PRINCIPAL DISBURSEMENTS $12,788.52 $12,788.52
PRINCIPAL INVESTMENTS
Dauphin National Bank, Certificate
of Deposit
TOTAL PRINCIPAL INVESTMENT
PRINCIPAL CAPITAL CHANGES
None
$ 15,000.00
$ 15,000.00 $15,000.'00
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COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
File No. 21-81-364
Estate of James H. Bornman, II, Deceased
Late of Camp Hill, Pennsylvania
FIRST AND FINAL ACCOUNT OF
GAYLE LARSON, EXECUTRIX
Date of Death: May 23, 1981
Letters Granted: June 16, 1981
First Complete Advertisement of Grant
of Letters: July 10, 17 and 24, 1981
SUMMARY
PRINCIPAL
Receipts
Net Gain or (Loss) on Conversions
Adjusted Balance
Less Disbursements
Balance Before Distribution
Distribution to Beneficiary
Investments
Capital Changes
Principal Balance Remaining
INCOME
Receipts
Less Disbursements
Balance Before Distribution
Distributions to Beneficiary
Income Balance Remaining
COMBINED BALANCE REMAINING
S 31,029.31
-DO-
S 31,029.31
-12,788.52
S 18,240.79
-12,371.29
(15,000.00)
-00-
S 5,869.50
$ 5,869.50
S 1,052.24
-00-
S 1,052.24
-00-
S 1,052.24 $ 1,052.24
$ 6,921. 74
BCr,~: i",) Pi,Gi Gb3
COMPOSITION OF NET BALANCES
PRINCIPAL
Dauphin National Bank, Certificate
of Deposit
State Capital Savings and Loan
Association, Savings Account
P. R. R. Stock
Trail Bike
One-third interest in tools and
car in Father's Estate
Cash
TOTAL PRINCIPAL
INCOME
Interest on Dauphin National Bank
Certificate of Deposit
Interest on State Capital
Savings and Loan Association,
Savings Account
TOTAL INCOME
TOTAL PRINCIPAL AND INCOME
$ 15,000.00
78,57
1,521.96
75,00
431. 66
6,148.34
$ 23,255.53
$ 1,050.49
$ 1. 75
$ 1,052,24
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tl,:;f, J.1..') .'.'..L ',h'':I
$23,255.53
1,052.24
$24,307.77
RCS:jai 7/13/82
PRINCIPAL RECEIPTS
Per Amended Inventory, copy attached
hereto:
Real Property
Personal Property
Miscellaneous
$ 20,689.74
4,573.12
5,766.45
TOTAL PRINCIPAL RECEIPTS
$ 31,029.31
PRINCIPAL CONVERSIONS INTO CASH
1970 Chevrolet Pick-up Truck
Inventoried at $1,650.00
Carried at 1,650.00
1953 Ford automobile
Inventoried at $2,000.00
Carried at 2,000.00
Clothing, sports
Inventoried
Carried at
equipment and books
at $165.50
165.50
1972 Snowmobile
Inventoried at $310.00
Carried at 310.00
Tools
Inventoried at $292.33
Carried at 292.33
Trail Bike
Inventoried at $75.00
Carried at 75.00
TOTAL
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$
-00-
-00-
-00-
-00-
-00-
$
-00-
-00-
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF DAUPHIN:
I, GAYL~ LARSON, Executrix of the Estate of James Henry
Bornman, II, deceased, being duly sworn according to law, de-
pose and say that the foregoing Account is true and correct
to the best of my knowledge and belief.
C L _~~~~~tu ;(tlA4c-rJ
Gayle Larson
Sworn to and subscribed
,. ~1d
before me, this ><
....... ^~ay of CL/'j' /. , 1982.
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".'....:\..I.~'
5UDY It IMES, NOTARY PUBLIC
My Commi"ion Expl,es September 3. J 9SS
~"rlsburi, PA Dauphin Counly
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AEV.ll02 EX
COMMONWEALTH OF PENNSYLVANIA
NO L' 04987. ':l DEPARTMENT OF REVENUE
. O'F'FICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
m
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Assessment Control No.
.CEIVED FROM:
I ~~be:u.J!pit.~t!'!=:.Q~Yil!._li!..':J:'~.rgicln
_.--L30.Uate.Str..t,_BOX.,,1000,
_.H.~r1""p~1:q ,lla. .". 17108
Probate
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ESTATE INFORMATION:
FILE NUMBER
NAME OF DECEDENT
21-81-364
. DATE OF PAYMENT
lAST FIRST
MI
~OSTMARK DATE
COUNTY
DATE OF DEATH
Oatober 8 1982
Cumberland
May 23. 1981
REMARKS
@TOTALAMOUNT PAID
SEAL
RECEIVED BY
///'(" (<
:. SIGNATURE
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G AMOUNT
30.77
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30.117
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n_ _.... _....._. .____ ..._~_..___ '_n_ ___. _~_.__ __'
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Discount:
Interest:
n:r'., '
'0';
(1- ,i:.; it'"
{,: '
If any tax due is paid within three (3) months after the decedent's death. a discount of
five percent 15%) of the tax paid is allowed,
, the discount period is calculated in calendar months. Example: date of death 1- 15-82,
discount period expires 4-15-82,
Except for tax on a future interest. inheritance tax becomes delinquent at the expiration of
nine (9) months from the date of death.
. Inheritance tax on a future interest becomes delinquent at the expiration of three months
from:
- the date of election to prepay or
- the date of death of the life tenant or annuitant
Interest is calculated on a daily basis from
- delinquent date to date of payment on any tax unpaid on delinquent date
- date of last delinquent payment to date of payment on any unpaid balance.
Interest is charged at the following rates:
Delinquent Date
Annual Interest Rate
Daily Interest Factor
5/27/43 to and including 12/31/81
1/1/82 to and including, 12/31/82
1/1/83 to and including 12/31/83
6%
20%
16%
.000 I 64
.000548
,000438
. Those estates that become delinquent on or before December 31. 1981 will maintain
a constant interest rate. The rate in effect when the tax first becomes delinquent will
remain constant until the delinquent' tax balance is paid in full.
. Those estates that become delinqusnt on or after January 1, 1982 will contain a variable
interest rate. Thus, taxes that remain outstanding from calendar year to calendar year will
be SUbject to the different rates in effect on each January 1,
. Interest is calculated as follows:
INTEREST = BALANCE OF UNPAID TAX X NUMBER OF DAYS X
DAILY INTEREST FACTOR,
If a tax balance remains outstanding for more than one calendar year, a separate interest
determination must be made for each year at the applicable rate, (Only one calculation
is necessary if the estate maintains the constant interest rate.)
Any Notice issued after the tax becomes delinquent will reflect an interest calculation to
fifteen (15) days beyond the date of the notice, If payment is made after the
interest computation date shown on the Notice, additional interest must be calculated.
To Remit Payment Detach the toP portion of this Notice and submit with your payment to the Register of Wills
of the county shown on the Notice.
. Address information is listed on page 13 of the booklet. "Instructions for Inheritance Tax
Return for a Resident Decedent."
. Make check or money order payable to: Register of Wills, Agent.