HomeMy WebLinkAbout04-30-07
'.-J
15056051058
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes '
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 07
00397
Date of Birth
209-20-0540
07/12/1999
12/12/1925
Decedent's Last Name
Suffix
Decedent's First Name
MI
Holmes
George
c
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Holmes
Alice
L
spou.~e'sSociGlI Secu.rity~,u.rnbe.r
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~. 1. Original Return
2, Supplemental Retum
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
'--. 4a. Future Interest Compromise (date of
death after 12-12-82)
,"_,.! 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
J"~., 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch, 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name PGlytirnEl!el~ph<:>ne Number
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Stephanie Kleinfelter
(717) 901-7786
REGISTER OF WILLS USE ONLY
Wood Alle.n & Rahal, LLP
First line of address
PA
17043
635 N. 12th Street
Second line of
Suite 400
~ity,,()~.F'()st Office
Lemoyne
State
ZIP Code
_J
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
''I"Y\ ~ PfWo~
ADDRESS
5223 Meadowbrook Drive, PA 17050
SIGNATURE OF PAR R OTHER AN REPRESENTATIVE
DATE
CfIJ,.~(CJ7
ood Allen & Rahal, LLP, 635 N, 12th Street, Suite 400, Lemoyne, PA 17043
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051058
15056051058
--.J
\
~
.....I
15056052059
REV-1500 EX
Decedent's Name:
George
C Holmes
RECAPITULATION
1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 Q... 141,852.26
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
209-20-0540
Decedent's Social Security Number
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059
Side 2
L
138,741.44
3,452.82
142,194.26
342.00
141,852.26
141,852.26
0.00
15056052059
--.J
REV-1SpO EX Page 3
Decedent's Complete Address:
File Number
21
07 00397
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
George C Holmes 209-20-0540
STREET ADDRESS
15 South 27th Street
CITY I STATE I ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
Total Credits (A + B + C ) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
0.00
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~
c. retain a reversionary interest; or.......................................................................................................................... D ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1504 EX+ (6-98)
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM NUMBER
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. $140,000 Promissory Note From Allen K. Holmes, Dated December 31,1998,
Secured By Mortgage Of The Same Date
Principal $138,159.05; Accrued Interest $582.39
138,741.44
See Attached Copies of Note And Mortgage
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
138,741.44
JAM\dlb\re\holmes.not
'Jov"modr 12,1998
NOTE
December 31, 1998
CAMP HILL, PENNSYLVANIA
2139 MARKET STREET, CAMP HIU", PENNSYLVANIA 17011
(Property Address)
1. BORROWER'S PROMISE TO PAY
In return for a loan that I have received, I promise to pay U.S. $140,000.00 (this amount is called "principal"), plus
interest, to the order of the Lender. The Lender is GEORGE C. HOLMES. I understand that the Lender may transfer this
Note. The Lender or anyone who takes this Note by transfer and who is entitled to receive payments under this Note is called
the "Note Holder."
2. INfEREST
Interest will be charged on unpaid principal until the full amount of principal has been paid. I will pay interest at
a yearly rate of 6.0%.
The interest rate required by this Section 2 is the rate I will pay both before and after any default described in Section
6(B) of this Note.
3. PAYMENTS
(A) Time and Place of Payments
I will pay principal and interest by making payments every month.
I will make my monthly payments on the 1st day of each month beginning on February 1, 1999. I will make
these payments every month until I have paid all of the principal and interest and any other charges described below that I
may owe under this Note. My monthly payments will be applied to interest before principal. On February 1,2019, I will
pay the outstanding amount of principal and interest in full on that date, which is called the "maturity date."
I will make my monthly payments at 15 South 27th Street, Camp Hill, PA 17011, or at a different place
if required by the Note Holder.
At the option of the Holder, the principal and interest outstanding on January 1, 2009, and January 1 of each
succeeding year, may be declared due and payable by written notice to Borrower.
(B) Amount of Monthly Payments
My monthly payment will be in the amount of U.S. $1,003.01.
4. BORROWER'S RIGHT TO PREPAY
I have the right to make payments of principal at any time before they are due. A payment of principal only is known
as a "prepayment." When I make a prepayment, I will tell the Note Holder in writing that I am doing so.
I may make a full prepayment or partial prepayments without any prepayment charge. The Note Holder will use all
of my prepayments to reduce the amount of principal that I owe under this Note. If I make a partial prepayment, there will
be no changes in the due date or in the amount of my monthly payment unless the Note Holder agrees in writing to those
charges.
5. LOAN CHARGES
If a law, which applies to this loan and which sets maximum loan charges, is fmally interpreted so that the interest
or other loan charges collected or to be collected in connection with this loan exceed the permitted limits, then: (I) any such
loan charge shall be reduced by the amount necessary to reduce the charge to the permitted limit; and (ii) any sums already
collected from me which exceeded permitted limits will be refunded to me. The Note Holder may choose to make this refund
by reducing the principal I owe under this Note or by making a direct payment to me. If a refund reduces principal, the
reduction will be treated as a partial prepayment.
6. BORROWER'S FAILURE TO PAY AS REQUIRED
(A) Late Charge for Overdue Payments
If the Note Holder has not received the full amount of any monthly payment by the end of 15 calendar days
after the date it is due, I will pay a late charge to the Note Holder. The amount of the charge will be 5 % of my overdue
payment of principnl &nd interest. ! will pay this late charge promptly but only once on each late payment.
(B) Default
If I do not pay the full amount of each monthly payment on the date it is due, I will be in default.
(C) Notice of Default
If I am in default, the Note Holder may send me a written notice telling me that if I do not pay the overdue
amount by a certain date, the Note Holder may require me to pay immediately the full amount of principal which has not been
paid and all the interest that I owe on that amount. That date must be at least 30 days after the date on which the notice is
delivered or mailed to me.
(D) No Waiver By Note Holder
Even if, at a time when I am in default, the Note Holder does not require me to pay immediately in full as
described above, the Note Holder will still have the right to do so if I am in default at a later time.
Jl.M\dlb\re\i,olmes.r.ot
November 12, 1998
(E) Payment of Note Holder's Costs and Expenses
If the Note Holder has required me to pay immediately in full as described above, the Note Holder will have
the right to be paid back by me for all of its costs and expenses in enforcing Ulis Note to the extent not prohibited by applicable
law. Those expenses include, for example, reasonable attorneys' fees.
7. GIVING OF NOTICES
Unless applicable law requires a different meUlod, any notice Umt must be given to me under this Note will be given
by delivering it or by mailing it by tirst class mail to me at the Property Address above or at a different address if I give the
Note Holder a notice of my different address.
Any notice that must be given to the Note Holder under this Note will be given by mailing it by first class mail to
the Note Holder at the address stated in Section 3(A) above or at a different address if I am given a notice of that different
address.
8. OBLIGATIONS OF PERSONS UNDER THIS NOTE
If more than one person signs this Note, each person is fully and personally obligated to keep all of the promises
made in this Note, including fue promise to pay fue full amount owed. Any person who is a guarantor, surety or endorser
of this Note is also obligated to do these things. Any person who takes over these obligations, including the obligations of
a guarantor, surety or endorser of this Note, is also obligated to keep all of the promises made in this Note. The Note Holder
may enforce its rights under fuis Note against each person individually or against all of us together. This means that anyone
of us may be required to pay all of the amounts owed under this Note.
9. WAIVERS
I and any other person who has obligations under this Note waive the rights of presentment and notice of dishonor.
"Presentment" means the right to require the Note Holder to demand payment of amounts due. "Notice of dishonor" means
the right to require the Note Holder to give notice to other persons that amounts due have not been paid.
10. UNIFORM SECURED NOTE
This Note is a uniform instrument with linlited variations in some jurisdictions. In addition to the protections given
to the Note Holder under this Note, a Mortgage, Deed of Trust or Security Deed (the "Security Instrument"), dated the same
date as this Note, protects the Note Holder from possible losses which might result if I do not keep the promises which I make
in this Note. That Security Instrument describes how and under what conditions I may be required to make immediate
payment in full of all amounts I owe under this Note. Some of those conditions are described as follows:
Transfer of the Property or a Beneficial Interest in Borrower. If all or any
part of the Property or any interest in it is sold or transferred (or if a beneficial interest
in Borrower is sold or transferred and Borrower is not a natural person) without Lender's
prior written consent, Lender may, at its option, require immediate payment in full of all
sums secured by this Security Instrument. However, this option shall not be exercised by
Lender if exercise is prohibited by federal law as of the date of this Security Instrument.
If Lender exercises this option, Lender shall give Borrower notice of
acceleration. The notice shall provide a period of not less than 30 days from the date the
notice is delivered or mailed within which Borrower must pay all sums secured by this
Security Instrument. If Borrower fails to pay these sums prior to the expiration of this
period, Lender may invoke any remedies permitted by this Security Instrument without
further notice or demand on Borrower.
WITNESS THE HAND AND SEAL OF THE UNDERSIGNED.
{:'{\/,RJl
c,\
</"'. ~
f, /J.../L__' -
(l>c< l /+,,_..~
Allen K. Holmes--Borrower
(Seal)
(Sign Original Only)
2
JAM\eUbW\bOJrnn.l.ml:
NoY~r 12. .991
/o.~c; -(/
MORTGAGE
u::>
to .'
c... "~-.
1. 1 r day of ~ in the year nineteen hu~rei
r...." ~.
THIS INDENTURE, made the
ninety-eight (1998)
BETWEEN ALLEN K, HOLMES
::0 "
::3 .-
r-- .
........ .... .."
Mortgigor~.. :.:
o ,:
-J
and
GEORGE C. HOLMES
Mortgagee:
WHEREAS, the said Mortgagor, in and by certain Obligation or Writing Obligatory, under his
hand and seal, duly executed, bearing even date herewith stand bound unto the said Mortgagee in
the sum of One Hundred Forty Thousand Dollars ($140,000.00) lawful money of the United States
of America; conditioned that the said Mortgagor, his heirs, executors or administrators, shall and
do well and truly pay, or cause to be paid, unto the said Mortgagee, his certain attorneys,
executors, administrators or assigns, the sum of One Hundred Forty Thousand Dollars
($140,000.00), .' ..
/
\
AND ALSO, from time to time, and at all times, until payment of said principal sum be made as
aforesaid keep the building, erected and to be erected upon the land herein described, insured for
the benefit of the Mortgagee, in some good and reliable Stock Insurance Company or Companies
to the amount of at least One Hundred Forty Thousand Dollars ($140,000.00), and to take no
insurance out on said buildings, not marked for the benefit of the Mortgagee; the further condition
of the said Obligation is such, that if at any time default shall be made in the payment of interest
or insurance premium as aforesaid, for the space of fifteen (15) days after any payment thereof
shall fall due, or if a breach of any other of the foregoing conditions be made by the said
Mortgagor, his heirs, executors, administrators or assigns, then and in such case, the said
. principal sum shall at the option of the said Mortgagee, his executors, administrators or assigns,
become due; and payment of the same, with the interest amI costs of insurance due thereon, as
aforesaid, together with an attorney's commission of ten percent (10%) On the said principal sum,
besides costs of suit, may be enforced and recovered at once, anything therein contained to the
contrary thereof in anywise notwithstanding, as in and by the said recited Obligation and the
condition thereof (relation being thereunto had) may more fully and at large appear.
WITNESSETH that the said Mortgagor, as well for and in consideration of the said debt or sum
of dollars, and for the better securing the payment of the same with interest, as aforesaid. unto the
said Mortgagee, his executors, administrators or assigns in the discharge of the said recited
Obligation, as for and in consideration of the further sum of One Dollar, lawful money, aforesaid,
unto the said Mortgagor in hand well and truly paid by said Mortgagee, at or before sealing and
c
Bood512UGE 511
'---r
JAM\dlb\re\bolmes-2.mc
NO"~r n. ;991
delivery hereof, the receipt whereof is hereby acknowledged, granted, bargained and sold,
released, and confirmed, and by these presents. does grant, bargain and sell, release and confirm
unto the said Mortgagee, his heirs and assigns
ALL THAT CERTAIN tract or parcel of land, with the buildings and improvements thereon
erected. situate in the Borough of Camp Hill, Cumberland County, Pennsylvania, bounded and
described in accordance with a survey and plan thereof made by William B. Whittock. Registered
Professional Engineer of Harrisburg, PA. dated August 24, 1959, as follows:
BEGINNING at II point on the Southerly side of Market Street (fifty feet wide); said point being
274.15 feet East of the Southeast corner of Market and Twenty-Second Streets; thence extending
along the Southerly side of Market Street South 80 degrees 30 minutes East 82.5 feet to a point
in the center line of a fourteen feet wide alley; thence along said center line South 9 degrees, 30
minutes West 727.7 feet to a point on the Northerly side of a twelve feet wide alley; thence
extending along the Northerly side of said alley North 80 degrees 30 minutes West 82.5 feet to
a point a corner; thence North 9 degrees 30 minutes East 'll7.7 feet-to the point and place of
BEGINNING.
TOGETHER with all and singular the improvements, ways, waters, watercourses, rights,
liberties, privileges, hereditaments and appurtenances whatsoever unto the hereby granted
premises belonging, or in anywise appertaining, and the reversions and remninders, rents issues
and profits thereof;
TO HAVE AND TO HOLD the said hereditaments and premises granted. or mentioned and
intended so to be with the appurtenances, unto the said Mortgagee, his heirs and assigns, to and
for the only proper use and behoof of the said Mortgagee, his heirs and assigns. forever:
AND it is hereby expressly certified and declared that this Indenture of Mortgage is junior and
subordinate. in both lien and payment. to a certahi mortgage to secure the payment of the principal
sum of Two Hundred Five Thousand Dollars ($2b5.ooo.oo) given by Pennsylvania State Bank to
the herein Mortgagee dated December 10, 1993, and recorded December 14, 1993, in the
Cumberland County Recorder of Deeds Office in Mortgage Book 1185, Page 177; and that the lien
of said Mortgage shall not be affected or impaired by a judicial sale under a judgment recovered
upon this indenture or upon the bond secured hereby; but any such sale shall be expressly
advertised and made subject to the lien of the said Mortgage.
AND the said Mortgagor, for his heirs and assigns do hereby covenant, promise and agree to and
with the said Mortgagee, his heirs, executors, administrators and assigns, that if the said
Mortgagor, his heirs or assigns, shall neglect or refuse to keep up the aforesaid insurance, it shall
be lawful for the said Mortgagee, his heirs, executors, administrators or assigns, to insure the said
building in a sum sufficient to secure payment of the said principal debt, in case of fire, and shall
recover the costs and expenses of such insurance in a suit upon this Mortgage.
2
Bood512 rAGE. 512
--\
.:.>v
JAM\dlb\re\holmc.-l.mlJ
No'lCl1ltm' 12. \998
PROVIDED always, nevertheless, that if the said Mortgagor, his heirs, executors. administrators,
or assigns, do and shall well and truly pay, or cause to be paid unto the said Mortgagee, his
executors, administrators or assigns, the said principal sum of One Hundred Forty Thousand
Dollars ($140.000.00), lawful money, aforesaid. on the day and time hereinbefore mentioned and
appointed for payment of the same, together with interest and costs and charges of insurance. as
aforesaid, and without any deduction, defalcation or abatement to be made of anything for or in
respect of any taxes, charges or assessments whatsoever, then and from thenceforth, as well this
present Indenture and the estate hereby granted, as the said recited Obligation, shall cease,
determine and become void, anything hereinbefore contained to the contrary thereof in anywise
notwithstanding. AND PROVIDED. also, that it shall and may be lawful for the said Mortgagee,
his executors, administrators or assigns, when and as soon as the said principal sum shall, in any
event, become due and payable, as aforesaid, an Action of Mortgage Foreclosure may be properly
commenced upon this Indenture of Mortgage, and proceed thereon to judgment and execution for
the recovery of said principal sum and all interest due thereon, and the costs and expenses of
insurance. as aforesaid, together with an attorney's fee often percent (10%) on said principal sum.
besides cost of suit, without stay of or exemption from execution or other process, with a full
release of errors; any law, rule of court, or usage to the contrary notwithstanding.
IN WITNESS WHEREOF, the said party of itie first part has to these presents set his hand and
seal, the day and year first above written.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
fj)..~.A {, 47-,~
(t<< I ~
ALL N K. HOLM
CERTIFICATE OF RESIDENCE
I hereby certify that the pr.ecise address of the Mortgagee herein is as follows:
Attorney or Agent for Mortgagee
3
.Bood512 rAGE 513
JAM\dlb\re\hohnu-l.nq
~'"..~ 12. ,99'
COMMONWEALTH OF PENNSYLVANIA
coUNTY OF G-u-Jotl'" \ a...o\
58.
On this, the "3\ So}- day of ~CLv-.h...r , 1998, before me, a Notary Public, the
undersigned officer. personally appeared ALLEN K. HOLMES. known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged that
he executed the same for the purpose therein contained.
'-.
COMMONWEAL;~FPENN8YLVANIA
",
".
COUNTY OF CUMBERLANp'
RECORDED in the Recorder of Dee
. Page
WITNESS my hand and Official Seal this
/).1JJ >ttJ.. '"t'.J5AL 1< ," (.~
.Notary Public
My Commission Expires:
_1-
~",---.y-
eon.,.._ C_Cculy
My~~Juno .1.1002
_r,P~__OI_
)
: 55.
)
. 1998.
Rtt"'" of~
".
4
BooK15i2 rAGE. 514
Exhibit "A"
ALL THAT CERTAIN piece or parcel of land situate in the Borough of Camp Hill.
Cumberland County. Pennsylvania. more particularly bounded and described in accordance with
a survey and plan thereof made by William B. Whittock, Registered Professional Engineer, of
Harrisburg, PA. dated August 24, 1959, as follows, to wit:
BEGINNING at a point on the Southerly side of Market Street (fifty feet wide); said point
being 274.15 feet East of the Southeast corner of Market and Twenty-second Streets; thence
extending along the Southerly side of Market Street South 80 degrees 30 minutes East 82.5 feet
to a point in the center line of a founeen feet wide alley; thence along said center line South 9
degrees 30 minutes West 227.7 feet to a point on the Northerly side ofa twelve feet wide alley;
thence extending along the. Northerly side of said alley North 80 degrees 30 minutes West 82.5
feet to a point a comer; thence North 9 degrees 30 minutes East 227.7 feet to the point and place
of BEGINNING. .
~~ll:' .' ~"f'\"C!,,~":''''!'' .
rmlh: ~: \;;;I~:'.
:.~.., ':'~,;'~t~J.
11: .1~
~\:\~ii:, ~'I :-,:"0
..
Bood512 rAGE. 515
''-.
"
__01"'- ,,- .......- . ---
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
George C. Holmes
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Acacia Life Insurance Company Policy No. 4010262780
Insured: Allen K. Holmes, Son
Beneficiary/New Owner: Alice L. Holmes, Surviving Spouse
1,726.41
Acacia Life Insurance Company Policy No. 4030244057
Insured: Laurene L. Holmes, Daughter
Beneficiary/New Owner: Alice L. Holmes, Surviving Spouse
1,726.41
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,452.82
REV-1511 EX+ (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
George C. Holmes
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1.
DESCRIPTION
AMOUNT
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2. Attomey Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
.Zip
Relationship of Claimant to Decedent
4.
Probate Fees
260.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
8.
Cumberland County Register of Wills - Short Certificates, JCP Fee Automation Fee, Renunciation
Cumberland County Register of Wills - Filing Fees PA Inheritance Tax Return & Inventory
52.00
30.00
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
342.00
REV-1513 EX+ (9-00)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
George C. Holmes
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Alice L. Holmes Surviving Spouse 141,852.26
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)