The URL can be used to link to this page

Home My WebLink About01-0843 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Doris Mae Stiverson also known as No. To: O)l-D\- bL+3 Deceased. Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 179-20-9510 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl ies for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at Chapel Pointe at Carlisle, Cumb. Co., Pa (list street, number and municipality) Decendent, then 79 years of age, died at Chapel Pointe at Carlisle September 1 fCk4j( 2001 , Decendent at death owned property with estimated values as folllows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: None $10,000 00 $ $ $ Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence s,PA 17324 THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. 13 rj)~~-Ut~ CU'" l:~q~ ].g m-'::: 3& cu "- BO cIS s:: I:ll) Vi ll-ta-G} OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. affirmed and lOtn (]JJr~/a~~ Cl) .... ~ ... ~ s:: l:lO .... U) No. 21 - 01 - 843 Estate of DORIS MAE STIVERSON , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW September '1 ~ P9 2001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Carole A. Brunner is/ are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Carole A. Brunner in the estate of Doris Mae Stiverson ~(}~~flOtv4d. MARY CLEWIS George F. Douglas, III, Esquire FEES Letters of Administration Short Certificates( ~ . . . . . . . . . . Renunciation ................ JCP $ 40.00 $ 1? nn $ $ r:; 00 TOTAL _ $ S7.00 Filed .~~Pr....1 ?,. . .. . . . . .. A.D. ~9 2001 e U~g€i ATTORNEY (Sup. Ct. J.D. No.) 27 W. High St., Carlisle, PA 17013 ADDRESS 717-243-1790 PHONE Called attorney on 9-12-01 WARNING: IT IS IllEGAL TO ALTER THIS COpy OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEAi_'n-! OF PENNSYLVANIA DEPAIlTMENT OF HEALTH VITAL RECORDS LO( );1. F-1EGISTBAR'S CERTIFICATION OF DEATH CERT. NO. T 4 9 3 9 3 3 5 ~11,;il'l'n..;;;- Ali[~~ \ ~__QF_ p[;;:~);, /\"'-~\../ -', "/I, -.\ /,\~~""/ '-''.rJ::-.:, /t..' ~,/ , "';.I?,:':..\ /l~! .~\~\\ if ~,.' ::~ \~~, l:<--, ""',' 'b.') \*~<*f \":. ~, ,~,/l \:;--:.'*.1> '",' , / k~i/ :?('-, 'MENT ~\ ~ "", '-;~~2_('!!!/!!!JJ!!!.!!J - September 4, 2001 Date of Issue of This Certification Name of Decedent ____ Doris Mae Stiverson Fire::( 'AldrJ( UiS' Sex ____ Fema~:-..___ Social Security No, 179-20-9510 _ Date of Death September 1, 2001 Date of Birth __ 4-22-1922 Birthplace Chapel Pointe at Carlisle, Latimore Township, Adams County, Pennsylvania Place of Deatll Cumberland County, Carlisle ra,,",'y Name i'OUjih Cily Borough 01 Township Pennsylvania VVlllte , Race______________ Occupation D. ed Decedent's S lvorc M '1' Add Mantal tatus ____M________ allng ress Carole Brunner Laborer No Armed Forces? (Yes or No) 35 Georgetown Road, Gardners, P A 17324 ~Jr.l'n~;e' Street CilV or Town State Informant Name and Address of Funeral Establishment __ Funeral Director M. Lee Dugan Dugan Funeral Home, Inc., Benrlersville, P A 17306 (a) Interval Between I Onset and Death 1 Week Part I: Immediate Cause Pontine stroke. (b) ___ I I I r------- I I I I I I (c) ______ Part II: ( d) Other Significant Conditions Manner of Death Natural ~ Accident Describe how injury occurred: Suicide Homicide Pending Investigation Could not be Determined o o o Name and Title of Certfier M n~tnip.IQ M n , (M.D., 0..0., Coroner, M.E.) Address 301 North Baltimore Avenue. Mt Holly Springs, PA 17065 _ This is to certify that the information here given is correctly copied from an original certificate of dGath duly filed with me as Local Reglstr~r. Th riginal certificate will be forwarded to the State Vital Records Office for permanent flli /. j) /l IItlLUn 01-010 L I PIC:, IlL r Of V tal Records D'strlct No September 4,2001 __ L24 Rice Avenue, -,.---~-'_:r:-:-~:~~~-----~-- C:!tv BI)"O~JlJh T();NnS~'lp 'E .. NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA In re Estate of Doris Mae Stiverson , deceased, No. 21-01-0843 of TO: Carole A. Brunner (beneficiary) 35 Georgetown Rd.. Gardners.PA 17324 (address) Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: Daughter under the Intestate Laws of the Commonwealth of Pennsylvania (if additional space is needed, use back of page) Name of decedent Doris Mae Stiverson Last known address Chanel Pointe at Carlisle. PA of decedent Date of death Sent. 1. 2001 Place of death Chanel Pointe at Carlisle. PA County of grant of original letters Cumberland Decedent died testate x intestate. A copy of the will is -1L- is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone Carole A. Brunner, 35 Georgetown Rd., Gardners. PA 17324 NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYL VANIA IN RE: ESTATE OF DORIS MAE STIVERSON, DECEASED NO. 21-01-0843 TO: Carole A. Brunner 35 Georgetown Rd. Gardners, PA 17324 Please take notice of the death of decedent and the grant of letters to the personal representative named below. You may have a beneficial interest in the estate under the Intestate laws of the Commonwealth of Pennsylvania. Name of decedent: Doris Mae Stiverson Last known address of decedent: Chapel Pointe at Carlisle, P A Date of Death: September 1,2001 Place of Death: Carlisle, Pa. County of Grant of Original Letters: Cumberland Decedent died Intestate Name, address and phone number of all personal representatives: Carole A. Brunner 35 Georgetown Road Gardners, P A 17324 Name, address and phone number of counsel: George F. Douglas, ill, Esquire 27 W. High St. Carlisle, Pa. 17013 Phone: 717-243-1790 Additional information may be obtained from the undersigned: Do las, Douglas & ,Douglas By George F. ouglas, III, E quire 27 W. High St. Carlisle, Pa. 17013 717-243-1790 Dated: September 13, 2001 I .. ~... " . . ~ CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: 1::>0('1 ~ ~ <;t\\I~ Date of Death: 1- I - 2..00' ooltf.3 Will No.: Admin No.: 2..00 I To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6( a) o~e "rph~' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 3 0 / : I ~ Name /) Address ~ A.I3~ClI'1Il~& ~ ~ ~-,L- I' Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ~_. r~ r Date:~/DI ~ .~ F. ~~ 1!r SIgnature ;/~ ..-- ~ :.1 ~J Name DOUGLAS, DOUGLAS & DOU.2LAS P.O. BOX 261 CARLISLE, PA 17013 Address '0 ("'t"\ R ".-.:: :"" ~ ...- ,.l f"""': ~3~: ......-. 001 0(1.) <Pa: a: 1(7- 2,Cf3 '''''''0 Telephone u c:::I ,-;,.:.,. p '.. ci) ,;, ..0 "t::S:: cu= 00 Capacity: D Personal Representative J(J. Counsel for personal representative .' NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA IN RE: ESTATE OF DORIS MAE STIVERSON, DECEASED NO. 21-01-0843 TO: Carole A. Brunner 35 Georgetown Rd. Gardners, P A 17324 Please take notice of the death of decedent and the grant of letters to the personal representative named below. You may have a beneficial interest in the estate under the Intestate laws of the Commonwealth of Pennsylvania. Name of decedent: Doris Mae Stiverson Last known address of decedent: Chapel Pointe at Carlisle, P A Date of Death: September 1,2001 Place of Death: Carlisle, Pa. County of Grant of Original Letters: Cumberland Decedent died Intestate Name, address and phone number of all personal representatives: Carole A. Brunner 35 Georgetown Road Gardners, P A 17324 Name, address and phone number of counsel: George F. Douglas, III, Esquire 27 W. High St. Carlisle, Pa. 17013 Phone: 717-243-1790 Additional information may be obtained from the undersigned: Dated: September 13,2001 o v.J 2 .C C"'J --" .s:::.. ;e --.. ,---- t:: - JJ'i (t)() (Co ""~'l"" -~ t(.~ a Jr ~: ~~ ,if 0 - INRE: ESTATEOF DORIS MAE STIVERSON : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY,PENNA. : ORPHANS' COURT DIVISION : NO. 2001-0843 AND NOW, this ttt,RDER day of _~ , 2002, the Petition to Settle this Small Estate is approved, and Carole A. Brunner is hereby discharged From her duties as Administratrix of this Estate. J. 4\\~ lo- ~-O:2J IN RE: ESTATE OF DORIS MAE STIVERSON : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY, PENNA. : ORPHANS' COURT DIVISION : NO. 2001-0843 PETITION FOR THE SETTLEMENT OF A SMALL ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: CAROLE A. BRUNNER, Administratrix of the Estate of Doris Mae Stiverson, through her attorneys, Douglas, Douglas & Douglas, respectfully represents: 1. Doris Mae Stiverson, mother of Carole A. Brunner, who resided at 35 Georgetown Road, Gardners, Cumberland County, P A , died intestate on September 1, 2001. 2. Letters of Administration were granted to Petitioner on September 13, 2001. 3. The only assets in the estate were as follows: 1. 2. 3. 4. 1991 Pontiac Sunbird, 4 door sedan M&T Bank, checking account Erie Insurance Refund PSECU, regular shares and checking account V2 value joint with daughter, Carole TOTAL ASSETS 4. Expenditures in the amount of $11,501.10 have been made on behalf of the said Estate: 5. No inheritance tax was due on this estate because it was insolvent. A ('''Py of the Appraisement of Deductions from the Department of Revenue is attached'" 's Exhibit A. 6. The said Doris Mae Stiverson left her entire estate to her Carole A. Brunner, under the Intestate laws of the Commo'" ~ ~ ~ RECAPITULA TION Total Assets: Total Credits Insolvent Balance $ 6, 7 O. 11.501. -$4,793... E. 1,725.00 1,064.10 311.00 3.607.68 $6,707.78 WHEREFORE, your Petitioner prays that Your Honorable Court approve this estate as set forth herein, and that the said Administratrix, Carole A. Brunner, be discharged from the duties of her appointment. Douglas, Douglas, & Douglas BY~C.~ ~ Attorney for Petitioner Dated: April 18, 2002 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Carole A. Brunner, Administratrix, being duly sworn according to law, deposes and says that the averments of the within Petition are true and correct to the best of affiant's know ledge, information and belief. (I~{i~ Carole A. Brunner - -- - Sworn to anf subscribed before me this '2.--rJ - day of ~ ' 2002. k~~~ NotarIal Sell George F. Douglas, III, NotIfy PtNo C8rIIsIe Boro. CuIT1tJeMIId CcuIty My Cornmlellon Expires.... 28, 200S COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR~ OF INDIVIDUAL TAXES lNHERITANCE TAX DIVISION ; -IlEPT. 280601 HARRISBURG, PA 17128-0601 ~dAN 2210* NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX GEORGE F DOUGLAS III ESQ DOUGLAS ETAL 27 W HIGH ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2002 STIVERSON 09-01-2001 21 01-0843 CUMBERLAND 101 REY-1547 EX AFP 112-00) DORIS M Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y-=is4-j-ix--AFP--ri'2-:o0.r-NOY-ici--OF-.rtiHiififANCE-YAX-APPRjrisii.fENi'~--ALt-owAircE-cfR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STIVERSON DORIS M FILE NO. 21 01-0843 ACN 101 DATE 01-21-2002 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 3,100.10 3,607.68 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subiect to Tax (9) (10) 11,501.10 .00 NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 6,707.78 (11) (12) (13) (14) 11.1i0l 10 4,793.32- .00 4,793.32- 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045= .00 x 12 = .00 X 15 = (19)= .00 .00 .00 .00 .00 TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) REV.1470 EX (~'18) ... . INHERITANCE TAX EXPLANA TION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME STIVERSON, DOIS FILE NUMBER LARRY SZOLLOSY ACN 2101-0843 101 REVIEWED BY ITEM SCHEDULE NO. H B-2 EXPLANATION OF CHANGES Reduced to $3,100.00. Family exemption can only be claimed against assets subject to will or intestacy. ORIGINAL Page 1 /1-0-9 ~ R~'~ei'('~. CO PYREV-1500 r'.c.c._,.c_....~."............"'''......._.oFFlCiAl USEONly_.~.,_..~'-~w_-.'._.l , I --- _.-1 CQMMOOWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN 10 DEPARTMENT OF REVENUE 0 1 DEPT. 280601 RESIDENT DECEDENT , HARRISBURG PA 17128-0601 DECEDENTS fWAE 1lAST. FIRST AND MIDDlE INITIAl) use I blank bIoc:k to seoarale words T1 J0- In 10 Ir Ii IS I Mia Ie I Is It Ii Iv e r s 10 In I I I I I i I I I z ! 1 W socw.. secURI1Y NIAeER DATE OF DEATH DATE OF BIRTH 0 11 17 19 12 10 19 15 \110 9 10 1 12 o 10 11 4 12 12 11 12 12 I W 0 0 9 0 W (IF APPlICABlE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDlE INITIAl) SOClAI. SECURITY NlMIER W THIS RETURN WST BE FLBlIN IlUPlJCATE WITH THE 0 I J.I ! I I REGISTER OF WillS III 00 1. Original Return o 2. St.ppIemental Return o 3. Remainder Return (date of deaIh prior 10 12-13-82) r ~ iI( W) o 4. Umited Estate o 48. Future Interest Compromise (date of death Iller 12-12-82) o 5. Federal Estate Tax Return Required oi:~ ... D. 8 o 6. Decedent Died Testate (AIlachcopyofWl) o 7. Decedent Maintained a living Trust (AltaehcopyofTrust) _ 8. Total Number of Safe Deposit Boxes x ~..J o D. a:l a. o 9. Utigation Proceeds Received o 10. Spousal Poverty Creat (date of deaIh between 12-31-91 n 1-1-95) o 11. Election to tax under Sec. 9113(A) (AIlach Sch 0) c( .... ~ . z NME COMPlETE MAtING AOORESS III a Geor~e F. nouJrlas. lli. Esquire 27 W. High 8t. z ~ FIRM NAME (I AppIcabB) i DouMls, Doudas & Douglas TB.EPHONE NlM3ER 0 (717 243-1790 Carlisle PA 17013 0 1. Real Estate {Schedule A} (1) ..I OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 9 :o'i :3 ~r ('!)(") 3. Closely Held Corporation, Partnership or ~rq>rietorship (3) cn 0 r.r:,' ~ "'~. ""'-.: wQ 4. Mortgages & Notes Receivable (ScheWle D) (4) e> c:;;; ;~ fRo -'i r',: W 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3 1 0 0 1 <!':,J 0 z (ScheOOIe E) ~~~ 0 6. Jointly ONned Property {Schedule F} (6) 3 6 0 7 6 L ?3 i= ...... Wo :5 7. Inter-VIVOS Transfers & Miscellaneous Non-PrOOate Property (7) ~> N - {Schedule G or L} - ::J .... 8. Total Gross Assets (total lines 1-7) (8) I I 6 17 0 7 17 8 I ii: ct 9. Funeral Expenses & Administrative Costs {SchedJle H} (9) 1 1 9 0 1 0 0 0 W ." a:: 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10) 11. Total Deductions (total lines 9 & 10) (11) 1 1 9 0 1 0 0 12. Net Value of Estate {Une 8 minus line 11} (12) - 5 1 9 3 2 2 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) (14) - 5 1 9 3 2 2 15. Amount of line 14 taxable I I 1 I IxI:J z at the spousal tax rate (15)~ 0 See instructions on reyerse side for . . centaae ~ 16. Amount of ~ne 14 taxable ~~ at 6% rate X .00 (16) -c.. 17. Amount of fine 14 taxable X .15 (17) -H :E at 15% rate 0 0 18. Tax Due (18) \ 19. . . . . . . . . . . . . ..0 - .klder penaIies of petjt.Iy, I declin flat I haIIe examined I1is return, R:Uding lIXOOlp8Ilying schedul!s and stalements, and b the best of my knowedge lrld beIef. it is true, correct iI1d oornpete. DecB'alion of preparer other han the persooaI representaliYe is based on II information of v4lich prepaer has lIlY knowhdge. )fGNA TURE OF PERSON RESPONSiBlE FOR FlUNG RETURN ADDRESS DATE ADDRESS 27 W. High St. Carlisle PA 17013 DATE Nov. 29,2001 o ~d t' C I t Add ece en s ample e ress: STREET ADDRESS 35 Georgetown Road aTY I STATE PA I ~p Gardners, 17324-9657 Tax Payments and Credits: 1. Tax Due (page 1 Line 18) 2. Creci1slPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 3. InterestJPenalty if applicable D. Interest E. Penalty TotallnterestJPenalty (D + E) (3) 4. If line 2 is geater than line 1 + line 3, enter the dfference. This is the OVERPAYMENT. Check box on Page 1 line 19 to request a refund (4) 5. If line 1 + line 3 is geater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT $0.00 $0.00 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; ...........................................................0 00 b. retain the right to designate who shall use the property transferred or its income; ...............0 00 c. retain a reversionary interest; or .............. ..... ..................................................... ................. 0 00 d. receive the promise for life of either payments, benefrts or care? ........................................ 0 00 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982. did decedent transfer property within one year of death without receiving adequate consideration? .......... ..... .................. ....................... ....................................0 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............. ..... ................................ ................................... ........... ..... .............0 00 4. -Oid decedent own an individual retirement account, annuity, or other non-probate property? ....0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 72 P.S. ~9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995. 72 P.S. ~9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use ofthe surviving spouse from 3% to 0% for dates of death on or after January 1. 1995. The statute does not exemot 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 JANUARY 1,1995 - Please answer the following question by placing an "x' in the appropriate space. Did the decedent create a trust or similar arrangement which is soley for the surviving spouse's benefit for his or her entire lifetime? Yes 0 No 00 If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second spouse, at which time it wfll be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule 0 in order to make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate, and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must attach Schedule 0 to a timely-filed tax return, along with Schedule( s) K and/or M in order to show the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). 1lEV-1S01 EX .(1-'1) SCHEDULE E CASH. BANK DEPOSITS. & MISC. PERSONAL PROPERTY CO~TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF FilE NUMBER Doris Mae Stiverson 21-01-0843 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VAlUE AT DATE OF DEATH $1,725.00 1991 Pontiac Sun bird - 4 door sedan 2. see attached appraisal M & T Bank, checking account #2679028239 see attached bank statement $1,064.10 3. Erie Insurance refund $311.00 TOTAl (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3.100.10 REV-1509 EX + (1-11) COMMONWEAL. TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Doris Mae Stiverson If an asset was made joint within one year of the decedenfs date of death, it must be reponed on Schedule G. FilE NUMBER 21-01-0843 SURVIVING JOINT TENANT(S) NME RElATIONSHIP TO DECEDENT ADDRESS A. Carol S. Brunner B c 35 Georgetown Road Gardners, P A 17234 daughter JOINTLY-OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY "OF DATE OF DEATH ITEM FOR JOINT MADE kdJde name fi fiNn:iaI institution Md bank lKXlOUIlt oomber or similll' identifying number. Atta:h DATE OF DEATH DEro's VAlUE OF Nut.I3ER TENANT JOINT deed b" joint,~ real estate. VALUE Of ASSET INTEREST DECEDENT'S INTEREST 1. A. 6/1199 PSECU, regular share account $55.77 0.50 $27.89 2. A. 6/1199 PSECU, checking share account $7,159.58 .50 $3,579.79 . TOTAl (Also enter on line 6, Recapitulation) $ 3.607.68 (If more space is needed, insert additional sheets of the same size) : SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS IIE'M511EX. (1-11) eot.t.4OhWEALTH OF PENNS'ttVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF Doris Mae Stiverson F(lE NU~BER 21-01";0843 Debts of decedent must be reported on Schedule I. ITEM NUMBER A DESCRIPTION 1. FUNERAl EXPENSES: Dugan Funeral Home B. ADUINISTRATIVE COSTS: Personal Rep-esentative's Coolnissions Name of Personal Representative (s) Carole A. Brunner Social SecI.Iity Number(s) I EIN Number of Personal Representative(s} 178-50-5697 Street Mtess 35 Geor~etown Rd. City Gardners State P A ~ 17324-9657 Year(s) Commission Paid: nla Attoo1ey Fees Douglas, Douglas & Douglas Famitj Exemption: (If decedents adtess is not the same as claimants, attach explanation) Clamant Carole A. Brunner Street Ad:iess 3 5 Geor~etown Rd. City Gardners State P A Relationship of Claimant to Decedent dau2hter 1. 2. 3. MI--M ~ 17324-9657 4. Probate Fees Register of Wills 5. Accountanfs Fees Greenawalt & Co. preparation of Fiduciary Return 6. Tax Return Preparef's Fees 7. 8. Adams County Legallouma1. advertise letters Gettysburg Times, advertise letters TOTAl (Also enter on line 9, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) AMOUNT $7,003.50 $0.00 . ,. $1,000.00 $3,500.00 $57.00 $300.00 $40.50 $42.00 11,901.00 1lEV-1513 EX +(1-11) COMMONWEAlTH Of PENNS'flVANIA INHERITANCE TAX RETURN RESDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Doris Ma ~ ,...., 21-01-0843 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 Qnclude outright spousal distributions} 1. Carol A. Brunner Daughter All ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET ll. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. . . B. CHARITABLE AND GOVERNMENTAl DISTRIBUTIONS 1. TOTAl OF PART II - ENTER TOTAl NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEE $ (If more space is needed, insert additional sheets of the same size) ~ Jt:til MORRISONS AUTO SALES 1560 Holly Pike Carlisle, PA 17013 (717) 249-6262 1/0 ~ i I'~C s- (ANb,~9 L/ f) S .eg~,j ,,~~ ..... . _.~ c. \c 1< i\. \\ e 113 b ""';::. ~ 5.A\~ '(A.(\.1>.) A~~J<. ~~ ACCOUNT,NO. 2679028239 m M&f'~<l CLASSIC CHECKING SEP.20-OCT.19,2001 1 OF 1 00 0 0433SM NH 017 43955 DORIS H STIVERSON CAROLE A BRUNNER 35 GEORGETOWN RD GARDNERS PA 17324-9657 NORTH "IDDLETOH ACCOUNT SUMMARY IE$IHHIHQ: " " :: :<:::DEP:O$IT$::&::: ;: :a.LNlte::;; :" " ::; :ottitft ;:ADb:tt:lONS NO I AHOUNT 1,064 10 OUI 0 00 eHa:Ct~PAID : NO I AtIOUNT 01 0 00 OTHER ,CURRan: I, "SUBtRActIONS: : ,,1MtefteST::1>>O NO I AttOUKT 1 I 1,064 10 0 00 , ' EUftyuro., , , , , Bil~!/: :: o 00 '"PG$TINCt: " . ..... .... . DEPOSIT$:..IHlEREST ::CHEC1(.$:&: OTHER : : : DAILY:' , : :DATe; : : :.:::':':l'UMSAtTXGM:'::DEStRIP:t;tGii:::,:::::':.: : : &::OTHI:RAOOItt()NS : ::.::SUlTRAcT10NS :IALAMtI:::: : 09-20- 01 BEGI"'ING BALANCE $1, 064 10 10-04-01 CLOSEOUT 1, 064 10 0 00 ENDING BALANCE $0 00 ACCOUNT ACTIVITY REFER A FRIEND TO "'T BANK AND GET A FREE GIFT! MOW I WHEN YOU ASK A FRIEND TO OPEN A CHECKIHG ACCOUNT WITH. "&T, NOT ONLY WILL YOU GET A FREE GIFT - so WILL YOUR FRIEND. STOP BY ANY "&T BRANCH OR CALL H&T'S TELEPHONE BANKING CENTER AT 1-800-724-2440 TO GET A REFER-A-FRIEND COUPON. .r HURRY, GIFT QUANTITIES ARE LI"ITED. FREE GIFT PROVIDED AT TI"E OF ACCOUNT OPENING. LOOM (12/93) PSECIt; the financiallinkm October 11,2001 Account # 0179209510 GEORGE F DOUGLAS III 27 W HIGH STREET POBOX 261 CARLISLE, P A 17013-0261 Dear MR. DOUGLAS III: The following is the status of DORIS STIVERSON's account with PSECU as of the date of death. Joint Owner's Name Date Established Date of Death Date of Birth CAROL S BRUNNER, JOINT TENANT WIROS 06.01.1999 09.01.2001 04.22.1922 Share(s) Regular Shares (S 1) Checking Shares (84) Balance $ 55.77 7,159.58 Accrued Dividend $0.00 0.00 Loan(s) IA (Variable Rate Share) L5 (Variable Rate Share) Balance $ 0.00 0.00 Accrued Interest $0.00 0.00 The dividend earned from January 1,2001 through the date of death was $295.06. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our t01l- free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. ... Sincerely, .r ~~7 Meacie Fairfax Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place. Harrisburg, PA 17110-2990 . (717) 234-8484 . (800) 237-7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . (717) 777-2100 (TOO) . (800) 472-1967 (TOO) Web Address: www.psecu.com Savings federally insured up to $100,000 by the National Credit Union Administration. COtItONWEAlTH OF PENNSYlVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO.Zl 01-0843 ACN 01152744 DATE 11-13-2001 TYPE OF ACCOUNT EST. OF DORIS M STIVERSON D SAVINGS S . S. NO. 179 - 2 0 - 9 510 (Xl CHECKING DATE OF DEATH 09-01-2001 D TRUST COUNTY CUMBERLAND 0 CERTIF. REHIT PAYHENT AND FORKS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE" PA 17013 1EY-1545 EX IEP ("-II) CAROLE A BRUNNER 35 GEORGETOWN RD GARDNERS PA 17324 PSECU has provld8d the D8pa..~t dth the info....tion listed below which has been used In calculating the pot....tlal tax due. Thei.. ..eco..ds indicate that at the death of the ebove decedent, you ...... a joint owne..lbeneficl...y of this account. If you feel this Info....tlon Is Inco....ect, pl.ase obtain ..dtt.... corACtlon f..OII the financial institution, .ttach a copy to this fo... and ...turn it to the IIbove address. This 8CCDW1t is taxable in 8ccordance ..ith the Inheritance Tax Laws of the C~lth of PennsylvanIa. Questions _y be ....swer.d by calling (717) 781-SSZ1. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account. No. 0179209510 Date 07-31-1982 Est_lishec:l Account aalance Percent Tax_le AIIow1t Subject to Tax Tax Rate Potential Tax Due x 7,,159.58 50.000 3,,579.79 .045 161.09 TAXPAYER RESPONSE To insure proper c..edit to your BCc:oult, two (2) copies of this notice IIUst accOllpallY your paYll8l1t to the Register of Wills. Mak. check payable to: "Register of Wills, Agent... x NOTE: If tax paYll....ts are aade ..ithin th.... (3) aonths of the decedent" s date o'f death, you aay deduct a 5% discount of the tax due. Any inheri tanc. tax due ..Ul beCDM delinquent nine (9) aonths after the date of death. PART [!] i!l~~lfi~~~~~~jilf~~~;;JL;fI!t:J~t~~~;f;j~;Lt}~~iiI~I:!!lll1t{:!J:~~;Jl1::~lL~~r13t ..... A. 0 The above InforaaUon and tax due is correct. 1. You ny choose to r.it p~t to the Register of Wills ..ith two copies of this notice to obtaIn a discount or avoid interest, or you aay check box -Aft and return this notice to the Register of Wills and an official asses..-nt ..ill be issued by the PA Departaent of Revenue. 8. 0 The above asset has been or ..Ul be reported BI1d tax paid ..ith the Pennsylvania Inheritance TalC return to be filed by the declIdent"s representative. C. D The IIbove info....tlon Is Incor..ect and/or debts and deductions WlIre paid by you. You IIUst COIIplete PART lIJ and/or PART @J below. [CHECK ] ONE BLOCK ONLY If you indicate a different tax rate" please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Establ1shed 1 2. Account aalance 2 3. Percent Taxable 3 X 4. ~t SUbject to Tax 4 5. Debts IInd Deductions 5 6. ~t Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART [!] DATE PAID PAYEE D~SCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Co.putation) I $ Under penal ties of per jury" I declare that the facts I have reported above are true, correct and COIIPlete to the best of .y knowledge and belief. HOME ( ) WORK ( ) T^VP^VI:'D C::YOlIATIIDI: G. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Doris Mae Stiverson , Deceased No. 21-01-0843 Date of Death September 1, 2001 Social Security No. 179-20-9510 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. (f\Ne verify that the statements made in this inventory are true and correct. If\Ne understand that false statements herein made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Geor,ge F. Dou,glas, III, Esquire 1.0. No.: 61886 Address: 27 W. High S1. Carlisle PA 17013 Carole A. Brunner 35 Geor,getown Rd., Gardners, P A Dated November 29,2001 Telephone: 717 243-1790 Description Value 1991 Pontiac Sunbird, 4 door sedan $1,725.00 M & T Bank, checking account $1,064.10 Erie Ins. Refund $311.00 PSECU, regular shares and checking account shares 1/2 value (joint with dau.) $3,607.68 Total (Attach Additional Sheets if necessary) $6,707.78 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 \ 1?~6- 9 . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUR~AU OF INDIVIDUAL TAXES INHE'ITANCE TAX DIVISION DEPT. 280601 HARRISBURG 1 PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT" ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Reconjcr: Re~~jEi.e'- DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2002 STIVERSON 09-01-2001 21 01-0843 CUMBERLAND 101 GEORGE F DOUGLAS III ~ JAN 18 P 3 :14 DOUGLAS ETAL 27 W HIGH ST CARLISLE Clerk PA Qn~t;!;~n "__.._'.. PA '* REV-1547 EX AfP Cl2-00> DORIS M A..ount Re..itted (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 31100.10 3,607.68 .00 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE" PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ii'fV'=is4-j-i;f-AFP--ri'2:olir-NOY-iCE--OF-YNHEifiTANCi-YAX-APPRAisEirEN~--Ai:.i-oWAiiCi-(rR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STIVERSON DORIS M FILE NO. 21 01-0843 ACN 101 DATE 01-21-2002 TAX RETURN WAS: ) ACCEPTED AS FILED ( x) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule Bl 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H] 10. Debts/Mortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J] 14. Net Value of Estate Subject to Tax (9] UO] 11.,501.10 NOTE: To insure proper credit to your account" sub..it the upper portion of this for.. with your tax pay..ent. (8] 6,,707.78 .00 Ul] (12] U3] U4] (15] .00 X 00 = (16) .00 X 045 = (7) .00 X 12 = U8} .00 X 15 = (9)= 11 .501 10 4,,793.32- .00 4,,793.32- TAX CREDITS: PAY"ENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED" SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1" NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR)" YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV.'470 EX (6-88) # '* INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME FILE NUMBER STIVERSON, DOIS 2101-0843 REVIEWED BY ACN LARRY SZOLLOSY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES H B-2 Reduced to $3,100.00. Family exemption can only be claimed against assets subject to will or intestacy. ROW Page 1 .,-'" \,. ~~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: VO.clS VV--(;.~ ~+\ ~ Date ofDeath: ~ (/ 2-00 ( Will No.: ~O 1 "g-~ Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State wh. administration of the estate is complete: YesJ:2(.. No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal z::Er~ntative file a final account with the Court? " J1 11 1. _ Yes _ No M p.,e.t ~-- Oj~'--" b. The separate Orphans' Court'1~. lfany) ~~~~=tativ;,J110"2.- account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date:~'l\~? .~~~iZ' tignatur c2>eo(''te,.F 004(6-11 ill Name ~~es~.H+-ST~ ~ ~ll2.-'{~ \l~~O Telephone No. (',J f"-- I f.y-'>t, 'j ~ "'# "'JI' Capacity: bJ P~nal Representative ~ounsel for personal representative