HomeMy WebLinkAbout02-08-08
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15056041125
REV -1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 ~- -- RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 7
File Number
o 5 0 1
Date of Birth
16612 614 9
o 5 1 6 2 007
02201917
Decedent's Last Name
Suffix
Decedent's First Name
BURGER
BEATRICE
MI
V
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 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 Daytime Telephone Number
FILL IN APPROPRIATE OVALS BELOW
[&J 1. Original Return
o 4. Limited Estate
[&J
o
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
o
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
D A V I D W REA G E R
717 763 1 3 8 3
Firm Name (If Applicable)
REA G ERA D L E R P C
r REGISTER OF~ILLS USEON~v,-i
I . .-) "", I
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First line of address
233 1 MAR K E T S T R E E T
Second line of address
ZIP Code
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L---PA!~~I~ ~_~ :~":_I
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City or Post Office
State
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C AMP H ILL
P A
17011
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Correspondent's e-mail address:DWREAGER@REAGERADLERPC.COM
Under penalties of pe~ury, 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 a complete. D aration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
TURE OF ON RE P NSIBLE OR FILING RETURN
DA E (
..2 /)
MECHANICSBURG
PA 17050
DATE
~- 'S. J6
PA 17011
CAMP HILL
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: BEATRICE V. BURGER
RECAPITULATION
166126149
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
17500000
2. Stocks and Bonds (Schedule B)
.................................. 2.
381296
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) 0 Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested. . . . . .. 7.
6454262
8. Total Gross Assets (total Lines 1-7) 8. 2 4 3 3 5 5 5 8
.......................... .
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 1 3 2 0 2 7
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 1 7 3 2 2 4
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 3 0 5 2 5 1
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 3 0 3 0 3 0 7
13. Charitable and Govemmental 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. 2 3 0 3 0 3 0 7
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.O _ 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable 2 3 0 3 0 3
at lineal rate X .O~ 0 7 16. 1 0 3 6 3 6 4
17. Amount of Line 14 taxable 0 0 0
at sibling rate X .12 17. 0 0 0
18. Amount of Line 14 taxable 0 0 0 0
at collateral rate X .15 18. 0 0
19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 0 3 6 3 6 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056042126
--.J
REV-1500EX Pag~~
Decedent's Complete Address:
DECEDENT'S NAME
BEATRICE V. BURGER
. -_._.._-_..--'---~~---~---~--
STREET ADDRESS
113 NORTH 36TH STREET
1--------------------
i
1------
. CITY
CAMP HILL
File Number
0501
----_._----_._--_."._._-~---_...._-._-
STATE
PA
ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
10,363.64
9,500.00
499.99
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
9,999.99
I
It
Total Interest/Penalty ( D + E)
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.
(3)
(4)
(5)
(5A)
(5B)
0.00
0.00
363.65
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
363.65
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; ...................................................................... 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, benefits or care? ....................................................... 0 00
2. 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. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 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.
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
's three (3) percent [72 P.S. ~9116 (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. ~9116 (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. ~9116(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. ~9116(1.2) [72 P.S. ~9116(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. ~9116(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-1502 EX + {6-981
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
I3EATRICE V. BURGER 0501
All real property owned solely or as a tenant in common must be reported at fair market value. Fair mar1<et value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real DrODertv which is iointlY-owned with riaht of survivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
113 NORTH 36TH STREET, CAMP HILL, PA 17011 (SETTLEMENT SHEET
ATTACHED)
VALUE AT DATE
OF DEATH
175,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
175000.00
REV-1503 EX + (6-98)
W'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
BEATRICE V. BURGER
I
FILE NUMBER
0501
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
VALUE AT DATE
OF DEATH
1,196.16
2.
CHOICEPOINT, INC. - STOCK 16 SHARES
623.84
3.
EQUIFAX INC. - STOCK 46 SHARES
1,909.92
4.
RETAIL CREDIT COMMON STOCK NOW EQUIFAX INC. - 2 SHARES
83.04
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3,812.96
REV-1508 EX + (6-98)
W'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY I
FILE NUMBER
0501
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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BEATRICE V. BURGER
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
DESCRIPTION
COMMERCE BANK - CHECKING ACCOUNT 032078743
3801 PAXTON STREET, HARRISBURG, PA 17111
VALUE AT DATE
OF DEATH
7,871.98
CITIZENS BANK - CHECKING ACCOUNT 6100604764
525 WILLIAM PENN PLACE, PITTSBURGH, PA 15219
5,254.49
CITIZENS BANK - SAVINGS ACCOUNT 6140-217415
525 WILLIAM PENN PLACE, PITTSBURGH, PA 15219
49,551.46
CAPITAL BLUE CROSS REUND
101.80
VERIZON BALANCE REFUND
11.47
PERSONAL PROPERTY
1,632.00
TRAVELERS (HOMEOWNER REFUND)
100.00
EQUIFAX STOCK DIVIDEND AND AFLAC REFUND
18.22
COMPUTERS HARE STOCK DIVIDEND
1.20
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
64 542.62
REV~1511 EX.".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
BEATRICE V. BURGER
FILE NUMBER
0501
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
MALPEZZI FUNERAL HOME
4,356.21
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. Attorney Fees REAGER & ADLER, PC 3,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 310.00
5. Accountanfs Fees
6. Tax Retum Prepare~s Fees
7. SHORT CERTIFICATES 24.00
8. ADVERTISEMENT - CUMBERLAND LAW JOURNAL 75.00
9. ADVERTISEMENT - THE PATRIOT-NEWS 121.02
10. REAL TV TRANSFER TAX, TAX CERT. FEE, NOTARY FEE 1,760.00
11. PRORATED COUNTVITOWNSHIP TAXES 166.83
12. PRORATED SCHOOL TAXES AND SEWER/REFUSE SHARE 135.21
13. ATTORNEY FEES - COYNE & COYNE, PC 1,372.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
11 320.27
R~V-1512 E~ + (12-03)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BEATRICE V. BURGER
FILE NUMBER
0501
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. WOOF APPRAISAL GROUP - REAL ESTATE APPRAISAL/FAIR MARKET VALUE
APPRAISAL OF PERSONAL PROPERTY
VALUE AT DATE
OF DEATH
495.00
H DIVINE HOCH - HOUSECLEANING
100.00
3. PP & L - ELECTRIC BILL
192.15
4. UGI- GAS BILL
385.75
5. COMCAST - CABLE BILL
185.22
6. PA AMERICAN WATER- WATER BILL
119.25
7. JOAN SHAMBAUGH- REPLACE DEHUMIDIFIER & REAL ESTATE SIGNS
207.02
8. VERIZON - PHONE BILL
30.18
9. AT & T - PHONE BILL LONG DISTANCE SERVICE
17.67
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 732.24
- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRI BUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. JOAN M. SHAMBAUGH Lineal 115,151.54
5101 INVERNESS DRIVE
MECHANICSBURG, PA 17050
2. JANE N. PRITZ Lineal 115,151.53
8136 HILLCREEK DRIVE
MIDLOTHIAN, VA 23112
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
":",,m,.*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BEATRICE V BURGER
SCHEDULE J
BENEFICIARIES
FILE NUMBER
0501
(If more space is needed, insert additional sheets of the same size)
. REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:
_9,500.0Q
Discount: --~______499.99
interest Table
1'--'--'~
--..---..---..--..-- ..-----,---
Year Days Delinquent Balance Due Interest
this time period this year this period
e 1981 -+
------~
~==--=--=-=~-I -- t----- --
-
----- --- --- ----J -~ -t==-----------=
- ------- ---1
---~.-----+-. --
throughj991_t____
- ----- ---.---.---------.-----.---- ----'---'- ---
!~...OUgh~!>>.!__t -----l-~-____
through 199L-t= t---------~
---------------- --------
-~~-~= I
----------------+--
I
~=====-t--
I ---
-~-~=~.:.-=-~~~=~
-------+ I
- --.--------- ---+-- ~
--- -- ------------- ----I
------------. --- ------.--..--- +--------- -'---,--
-"'---'-"-~,--- ~---------- -------.------ ..1--_______________
TOTALS
t
I
I
- -=!------------_L__
-----~J
rBefor
1_1982
(1983
[1984_
1_198!
11986
11987
'--'-
1988
[1992
L1~~
11995
r---
11999
~~~~~-
~--
12002
f------- ---
i 2003
f---._-.._
i 2004...
1_20~
, 2006
1-----
!
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17,1996:
Penalty:~______
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.DFmHA 3. [g]CONV. UNINS. 4.DVA 5. DCONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT 07-387 46434
8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER:
6.375/F/432.13 LHM
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked 'TPOC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (RIVERA.SHIRLEY.J. .PFDI07 -387/23)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Joan M. Shambaugh, Executrix PENNSYLVANIA STATE EMPLOYEES
Shirley J. Rivera Estate of Beatrice V. Burger CREDIT UNION
216 Harris Street 250 Green Lane Drive 1 CREDIT UNION PLACE
Harrisburg, PA 17102 Camp Hill, PA 17011 HARRISBURG, PA 17110-2990
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 I. SETTLEMENT DATE:
113 N. 36th Street Midstate Abstract Company
Camp Hill, PA 17011 July 27,2007
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
2331 Market Street
Camp Hill, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 175,000.00 401. Contract Sales Price 175,000.00
102. Personal Property 402. Personal Property
103. Settlement Chames to Borrower (Line 1400) 3,648.41 403.
104. 404.
105. 405.
Adjustments For Items Paid Bv Seller in advance Adjustments For Items Paid By Seller in advance
106. CitvlTown Taxes to 406. CitvlTown Taxes to
107. County Taxes 07/27/07 to 01/01/08 166.83 407. Countv Taxes 07/27/07 to 01/01/08 166.83
108. School Taxes 07/27/07 to 07/01/08 1,293.19 408. School Taxes 07/27/07 to 07/01/08 1,293.19
109. Sewer/Refuse 3rd Otr. 07/27/07 to 10/01/07 92.21 409. Sewer/Refuse 3rd Otr. 07/27/07 to 10/01/07 92.21
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 180,200.64 420. GROSS AMOUNT DUE TO SELLER 176,552.23
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. DeDosit or earnest money 2,000.00 501. Excess Deposit (See Instructions)
202. Principal Amount of New Loan(s) 50,000.00 502. Settlement CharQes to Seller (Line 1400) 12,780.61
203. Existing loan(s) taken subiect to 503. Existina loan(s) taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Payoff of second Mortgage
206. 506. DeDosit retained bv seller 2,000.00
207. 507.
208. 508.
209. 509.
Adjustments For Items Unoaid Bv Seller Adjustments For Items Unpaid By Seller
210. CitvlTown Taxes to 510. CitvlTown Taxes to
211. CountvTaxes to 511. County Taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 52,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 14,780.61
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 180,200.64 601. Gross Amount Due To Seller (Line 420\ 176,552.23
302. Less Amount Paid By/For Borrower (Dne 220) ( 52,000.00) 602. Less Reductions Due Seller (Line 520) ( 14,780.61
303. CASH ( X FROM) ( TO) BORROWER 128,200.64 603. CASH ( X TO) ( FROM) SELLER 161,771.62
OMS NO 2502-0265 ,=r
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
B~owe' .~ ~
Shirley J. Rivera
Seller
--.
-'--..
~----
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ @ % PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701.$ to FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to
aDo. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Application Fee to PENNSYLVANIA STATE EMPLOYEES CREDIT UNION POC:B300.00
806. Flood Certification Fee to PENNSYLVANIA STATE EMPLOYEES CREDIT UNION 8.00
807. Underwriting Fee to PENNSYLVANIA STATE EMPLOYEES CREDIT UNION 100.00
808. Document Preparation Fee to PENNSYLVANIA STATE EMPLOYEES CREDIT UNION 150.00
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 07/27/07 to 08/01/07 @ $ 8.732900/day ( 5 days 6.3750%) 43.66
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 vears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months $ per month
1002. Mortgage Insurance months $ per month
1003. CitylTown Taxes months $ per month
1004. Countv Taxes months $ per month
1005. School Taxes months @ $ per month
1006. months @ $ per month
1007. months @ $ per month
1008. months @ $ oer month
1100. TITLE CHARGES
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Electronic Document Prep. to Midstate Abstract Company 50.00
1106. Closing Service Letter to Midstate Abstract Comoanv 35.00
1107. Attorney's Fees to Midstate Abstract Company
(includes above item numbers: )
1108. Title Insurance to MIDSTATE ABSTRACT 1 233.75
(includes above item numbers.11 02, 1103 & 1104 )
1109. Lender's Coverage $ 50,000.00
1110. Owner's Coverage $ 175,000.00 1,233.75
1111. En<!orsements 100, 300, 8.1 to Midstate Abstract Company 150.00
1112. Notary Fee to Midstate Abstract Company. 10.00
1113. Notary Fee to Midstate Abstract Company 5.00
1114. Overnight Fees & Handling to Midstate Abstract Company 15.00
1115.
1116.
1117.
1118. Prepayment of Inheritance Tax to Cumberland County Register of Wills 9,500.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 64.50; Releases $ 103.00
1202. Citv/Countv Tax/Stamos: Deed 1,750.00' MortGage 1,750.00
1203. State Tax/Stamos: Deed 1,750.00; Mortgage 1,750.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Insoection to
1303. Sewer/Refuse 3rd Qtr. to Hamoden Township Sewer Authority 128.53
1304. Tax Certification Fee to Marie Huber, Treasurer 5.00
1305, 2007-8 School Taxes to Marie Huber, Treasurer A 1,392.08
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) II 3,648.41 12,780.61
By signing page 1 of this statement, the signatortes acknowledge receipt of a completed copy of paga 2 of this two page statement. 1fi
Midstate Abstract Co~any
Page 2
Settlement Agent
Certified to be a true copy.
-'----.
.~-
-~
(07-387107-387123 )
-'.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0501
07127678
06-20-2007
REV.lS43 EX ~p (09.00)
EST. OF BEATRICE V BURGER
S.S. NO. 166-12-6149
DATE OF DEATH 05-16-2007
~qUNTY CUMBE~LA~P
TYPE OF ACCOUNT
D SAVINGS
\Xl CHECKING
D TRUST
D CERTIF.
CLAIR Y BURGER
113 N 36TH ST
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
COMMERCE BANK has provided the Department with the inforution listed bdow which has been used in
calculating the potential tax due. Their records indicate thaf at the death of the above decedent, you were a joint owner/benefIciary of
this account. .If you feel this information is incorrect. please obtain written correction fro. the financi~l.institution. attach a COpy
to this form and return it to. the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
91 P,anns.ylvania. Quastions may be ans,,"aF'.~ bv calling (717) 7~7"93214
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 032078743
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rate
Potential Tax Due
PART
[!]
Date 10-30-1997
Established
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
7,871.98
X 50.000
3,935.99
X .15
590.40
TAXPAYER RESPONSE
NOTE: If tax payments are made within three
(3) months of the decedent's da e of death,
you may deduct a 5X discount of the tax due.
Any inheritance tax due will be o.e delinquent
nine (9) months after the date of death.
[CHECK ]
ONE
BLOCK
ONLY
A. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you lIay check box "A" and return this notice to the Register of
Wills and an official assess.ent will be issued by the PA Department of Revenue.
B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
c. [] The above information is incorrect and/or debts and deductions were paid by you.
You .ust complete PART ~ and/or PART ~ below.
OF
1
2
3
4
5
6
7
8
TAX ON JOINT/TRUST ACCOUNTS
PART
~
TAX RETURN - COMPUTATION
If you indicate a different tax rate. please state your
relationship to decedent:
LINE 1- Date Established
2. Account Balance
3. Percent Taxable
4. Amount Subject to Tax
5. Debts and Deductions
6. Amount Taxable
7. Tax Rate
8. Tax Due
PART
~
DATE PAID
~~YEE_
x
x
DEBTS AND DEDUCTIONS CLAIMED
DESCR I PTI ON
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation)
$
that the facts
belief.
have reported
and
HOME
WORK
]CT-25-2007
1"....f"")
C'o::::.l
='. iJ~
;:fJMllil>lWEAL TH OF PEHIoISYLVANIA
flEPA'/.HENT OF IlEVENUE
.U~EAU OF INDIVIDUAL TAXES
UEPT. 2Ba~nl
"Af<RISaURG. PA 17128-0&01
'*
INFORMAT10N NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO.21 07-0501
07139706
10-09-;?007
R~-JI5~ p: "FP (49-~4)
TYPE OF ACCOUNT
EST. OF BEATRICE V BURGER
S~S. NO. 166-12-6149
DATE OF DEATH 05-16-2007
COUNTY CUMBERLAND
~.J SAVING"
[iJ CHECIU NG
[J TRUST
[J CERTH
CLAIR Y BURGER
113 N 36TH ST
CAMP HILL PA 17011
REMIT PAYHEHT AND FORMS TO;
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
en lZENS BANK OF PA "'as ".-ovldag ~h" Dtlp"M:lllont wHh tho ~nro..."t1on l1sted bolo.. ..nicn "''"S ll.an useo In
calc;Jlotino tho potenthl tax du... Th"ir r.cc>rds inolie..ta that at the d.o.th of 'tho obov. dee.d..nt. \IOU w..... . :joint o"nar/benofic; '..." 0.1
d,., > "ccount. If YOU j'oel thl~ inforl""tion is ineor-r-act, plaasa obh1r\ .".i thn corr-.cUon froll tha finenc101 InsH tutian. '\ttllch e CODY
to "'I' ro...'" and ,.atu..n it to the a\love ..dO.....!!. Th15 a"C9\1n1; .is tllKable in .ello...llance with tho Inherihnce TitX. Laws ot tho C"llIll1onwult,.
0': ,.:'l.Jfmsvlv.nii3. ~f.A...t 10n'5".....".--.b...IIJ'lSlil'......'!t.-w-.o..Wnu {'71-1} ,B7-a327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAY"ENT INSTRUCTIONS
Account No. 6100&047&4
Da1:1l
Established
10-13-1998
To in5\1ru or-OPlIr cr.dit to yOU'" account, t~o
(2) copies of thl~ nuti'cEI IIust DCCO_Plny ),j'HUf'
"ay.."t to th" R,,"~sh,. "f Wilh. MlIk" en"cK
plJl(abiu t". "R,sishr of Wills. AlIent".
Account Balance
Por",ant Taxable
Amount S~bjact to Tax
lax !lato
x
5.254.49
50.000
2t627.25
.15
394.09
TAXPAYER RESPONSE
NOTE I II tax IUll/ll"nh e,.. ....do ..ithin thr,..
CS) .onth~ of tho dllc"dent'5 dato of a..th
you .."y deduct 1I 51>: dhcount of tho tax du<c.
AN:J 1n",...lta",,0 '"tU all" will blleaa'dallnq"ont
n~ne ~9> .on.hs' a1.a,. tho date of d,,"th.
x
Potont1Dl Tax Dug
PAR1
CD
1'~~~pY;PTr'r-J~~:1~ D'-1l:J..~~~I1;;.:to;p~tlf,~.Jil::1fN~ -"FJ.ltlnl1t:";:~~R:~r:~~:"~-~"'-' 1...,....~~-_.:~:~.:.r..L~l-t....;~..-~~'I..II' ji~ I~r~! I r :;. ~ -~ :-:" .....r~-;'~ "'..';;__~___w__ .':':~-'J::::""..:\:~ ;~l.::....~:, ..-~ .: .JI:j,~, ~ ~i.<(~: ~.....r i<i~~lq:J:I"''''-' ..t':"'iJl'!l!~
1 P:,,' ,..W\,"~ ~,~Jt:;eL;'J~"~c1:fr.~J-,~~':'1,w:-':~~.t~...~-t3:_ rW~ j~_ --CJ1"(;1.;.:::-j: ..:"""~L:.11,C'''' -~~' :",-:.: ..)__;....._ __ _.. _ :':-:;- ." r'.. ~t;I.J:fJ.' :":_~.-"...lJ..:i..L-~~!:' '''I:
i!illi ~11l1hlll~1 'W"~ .Hii ."",1 . .,_ll: ..C,'_'_.~_J_I."._"__,," "'" '" "n, ,,-.t.. I,d. '.t ,.'~ .-l1l!1;l'...Il.d,1,'li '"I,'".... """,,., ,., , "'0" ,....,. ..,..:,..."'...d",._.i. ,".._',.r'~L, tnbH., to., , ~ I,
A. 0 The
I.
~bav" infar..tiQn ~nd t.x dYi 1:8 co,..,.ec't,
You f1U'Y choose to !"'a.ii: pOJYfllfilnt to thlit R_ag;i.ste~ of Wil15with two copio.5 01 thi$ not!c" ~o obta..n
. db,count Dr ,"v"id intpr..st, 0... you lUll e~"ck bOl( "A" .."d ,..turn this notic.. to tho RUllister 0'
Will s and an offiCial u$lls"...nt Iii II b. issued by thll PA Oepart."nt of Rev.nue.
CHECK --,
ONE
BL.OCK
tJNLY
B. 0 The a.,ove asset has be.n Or' will bQ I"'4PQrted and tax J1dild with thlil Pann.sylvilnitl Innlr-itan(;o Te:x r.tlJ,..n
to b~ filed bY th. dQced8nt's r8P~~sent~tivu,
C, 0 The l!IIpavg .i.nfO,..~'t1on 1;5 Incor-r-8ct ~11d/D"" debt::li l\n&1 (UJC:Juctlon:s wor. p.2id by YOU.
You ..u,S,t <:U4flpl..t:_ PMT 0 and/or" P-"R."r ~ balow.
?AfH
12'1
TAX
(.INE
RETURN - COMPUTATION OF
, . D.te E" hbl1s!'i'.i'" 1
.., ACCOUnt Blllanee Z
~ .
:5 . Perc..nt TIlx8ble :5
~. Amount Subj..ct to T..x "
5. DQbts and n..du",tlon$ 5
,; AIllOl.lnt Taxablo 6
. . Tax R"t.. 7
8, Tax Due a
TAX ON JOINT/TRUST ACCOUNTS
It YOU lnd1cat. a differ-ent tax r.to. pl&asg stat.. your
r.l.tlQn~nlp to decedont;
')(
x
PAR:
r;:-'
~;
DATF. PAID
PAYEE
DESCRIPTION
AMOUNT PAID
TOTAL CEnt or on Line S 01 TSK Co.~utat1an)
J
t
~
Und*r pun.Itll1s Of Qo.-jury, I declare th~t tho faet~ I h~vo ro~a...t8d 8POVO .r-o tr-uo,
"nmpl..t. to tho bo~t of my know19dga and ballef.
correct ..nil
TAXPAYER SIGNATURE
HOME (
WORK (
TELEPHONF
)
)
Nll"""::.:I
nA""'::
'::!CT -25-2007
.1'--'. '--'1-'
0:::::.'':::::'0
D.04
GENERAL INFORHATIOH
i:Ar~URE TO RESPOND WILL J;lESULT IN AN OFFICIA~ TAX ASSESSMENT with l>l)pllcalllu intura.t band an infar.."han
~.(JtJm1tt43d b~ tha financial institut;i,on.
'J ! nh~I..'t""nC:iIJ tax. b.cOll.~ deliraquant nillQ ..onthSi ~t't.,.. 'the declliClent. S dat& of d.l!I-th.
~~ A ']Olot ~ccount 15 taxable Q~gn tbau&h thQ decedent"s na.Q was added a~ d .stter of cQ"v8ni.n~g.
~. ^tc~ynts Clnclud1r.g thos. h.l~ b8t~Q~n hU$b~nd and wife) which tho d.cadant put in joint n~.s within one year pr1o~ to
ll:Coc.tHl dre fully tax.bIG illS t-.....ns.fers.
5. Ar';t"mts ~stablhnod iainU" IlGtween l1...sb.lnd lInd ..1fe "'Dr. than ono "Oar prior t<l death "ra not taxl>Dle.
(,. A';:cclInt" nold by .. decedent "in trust for" anelther or others are taxable 1ully,
REPORTING IHSTR~CTIONS
PART
1
TAXPAVER RESPONSE
.\.
JilOGK A . If ~no infDr.ution lInd COllIlOut/tUon in tho nDtica ar. "orract .and <l8ductll>ri6 are r.~t boinll d/li...d. plllc. "n "X"
,,,\ L>16eK "A" of Pll....t ] of thv "'raxpayer Response" Stlctlotl. Sig", lWD capias ftnft sub.it t~e. W1th your chock fDr the BllIaunt of
,,,. 1:0 tho Rogistor of Wills 1>1' 1;~o ",ounw indicated. Tho PA O.Pllrt....nt of R.vanu. 10/111 1s6ue IIn offlchl OSSl>S_oot
~ut~ft, REV",15'i8 EX) upan receipt of the f"'&turn f~ulll thg Rooistol"' af Willli~
!:I('lCK e . If tho .l!SSGt SPtlCit1aQ on t't~18 notIce ha!:: b.an or will bQ rDPortea
,,)~ Re turn flIed by 'thQl dGc.Qaent' ~ r~pr.S8ntl!lt IV'e, glal:;D ,an "X" in .block W8'.
;.,1jJY and return to tho PA Dupartment o.f' K&ve"ue I Bur-aau Df Indiyidu~l T~.$I
.,nv6!OP8 ~ro~idad.
alOCK C - If th.. notic.. intoNutlon i. incorrect ,mellor deducUaM lire bein" cl..i....d, chDel< bloclo; "C" ami co.plet. P..rts 2 ond ~
. ,"ccardinll to the inatructlans b.~o... silln two capies ",nd sublttH th.,. ..it.. "Ollr ~ha~k fQr tha ...ount of tax ~"lf"blu tot"" Ihlli"ter
of W;11~ ot tha county 1ndi~ated. The PA Dep.rt."nt Of R.~.nu. will iss~.. an offi~1.1 a6sess.Ont CFar.,REV-1548 EX) upon ".C"ot
~i te.. raturn f~a~ the R"lIistor of Wills.
An~ t~x P4IHI w1th 'the P4fnns,ylvolinia Inl'lDritonca
of Part 1 of thQ HTtsXtldiy~r Rospon':'iaH sQcticm.
Dspt 280601, HarriSburg, PA 17128-0601 in tho
Si"n 0110
TAXRETURH
PART
2
TAX COMPUTATION
'.,-Jltl-
I. C;-ll\.?r
H(l'l~ ;
the d~ta "t'hq aCCQunt originally W.$ IIst;"blished 0,.. t:ltler::f in ttUJ ...nnQ'r' Qxistin$ll .:It d~t. of c1litilth:.
Fo,' .. d.."odant dYinll ..1ur 12/12/82. "'~co"'nts which the de.cad"r\t put in joint n...... within on. 0) lIear of d....th ilrg
t~x.bl. full~ as tr.n$fgr~~ HOW.V.~f th.re is an axclusion not to exceed t3,OOO. p~,.. t~6n~fura~ ~e8Brdlu5s of th. v~lua It
the account or tile nu.ba~ of DC~ounts hald.
It a (.faUbla ast.r-lsk ('Illl) OSPI:38*"',fii XI.fora )tOU'" f1rst nlllllla 1n -thg addres.s por'tlon of th1'S noticu. thG t3,OOO DJCr;:lusion
al.....dy no", b..." d..ct...cteCl fro,. the accalffit bal"no:o lIS reported by 'tM f.inancid in",tit~ti"n.
2. t'~~ur tho tot~l belance of ~h" ~ccount .ncl~ding 1ntarest accru~d to thy dllto Df daath.
~. 1". f>arcant <If the ""CGllnt that i$. taluble f..... ...ch ...rv.vor i.. dete,..jned lIS follOWS,
/>.. Tha ll..rcent taxable fo.. j.aint. assets est;abl1shed .....a 'tl'lllhono ya'lr prior to the decedent'. duth l
DIVIDED 8V TOTAL HUHllER OF DIVIDED 8Y TOTAL HUH.eft OF x 1.00 PEItCEHT TAXABLE
JOINT OWNERS SURYIVI"'~ JOHH OWHEll:S
h.t.pl.., A jaint .:rnt r.gishred in th.. n641. of tho ll.o:ad.nt and 1:.... othor par".ns.
. DIVIDED BV ~ (JOINT OWNERS) DIVIDED BV 2 (SUJ;lVIVORS) ~ . H7 X lllO
1.. '/X ctAXABLE FOR EACH SURVIIIOR)
In.. "8 r'"c:wn1; tl!lXablli1 for- ~SS8t:s. Ct"9iH.d. wi t:hin Dna y.~r of tho c1&cedent t ~ d,(H!lth or DCCDLmts r:wned bV tlHl decedent but MaId
tn t....st for ;another lnd1vidual(.) (~r"st beneflcleri.s);
, DIVIDED UY TOTAL NUMBER OF SURV'VIH~ JOINT
OWNERS OR TltllST BEIiIlFICIARIES
X 100
PERCENT .rAX....LE
t..xatngllill, Joint account r8gistered 1~ tn. n~g of the decadent And tWfI othar parson.s 13nd Q$tr.tblishe" wl.thln Qtltll)(&/!II"" of dUQ,.h by
tho dacedant.
I DIVIDED IlY 2 (SURVII/ORS) - .50 X 100 Sax (TAXAIlE FOR EACII SURYIVOR)
r I,. oNlount .ubioot to tax n1no ~J is data~lIin.d by lIul.t1Plyil'\d tho ,,"coLlnttlalDnca Gin.. 2) lly Ula percDnt h:o:"blo Oine :0\).
c~..r tn. tot~l of tho ~.bt. and deduetl..ns listed in P'Irt 3.
Tt-1l~ OlU'IUH,mt taxabl.. (lin_ ,) :i;s d.ter.lned by 5ubt,.~ct;ing thg cleb'tt. 8(ld LI~ducticn~ Clino 5) frt'R1 tne aGlount :lub~'.ct to t.u: (linllil 41,
f:lH." tno "pprOllrillta tllX rl>to Cline 7) .., detaMlined ba~o"'.
Oate D1' 0881:11
07/01/94 to 12/31/94
Ol/01/9~ to 06/50/00
07/01/00 to pr8~8nt
SpgYS8
L.lnaOll
Sibling
CoUlIteral
3"'
'.
6r.
15Y.
is:.:
or.
6X
157.
15r.
or.
4.5::.:"
12~
157.
-Th. taz ra ~ ]ap058d C~ th. ~.~ v. ue 0 tr.n$f~r~ fr~ ~ d~cease ohl1d tw.nty-on. YD.r$ Q ~ae or ~o~n8.r.at
dDath to or for tho ..:sa of .. natural par.nt, 'In .dopt1 ye 1>8..ent, or a ~t.pp.r"nt of tho ell.lld is Dr..
Thu l. ~n..:l.al c).~$" of h81~.5 inc:l"'cles g,.andp.,.erwts, perlints I chl1dr-on, and 1, j.n9~1 de5cenc:Jent!l:. UChild,.en" include,; natu,..el ehl1dr.ttn
\oIrl~tl.....t!", 0'" n.ot thay' h.aVA naen edoptgd 'by othG"., adopted c;h;i.lqr~n ~nd :;.t.1i!P t:h~ldr'oPl. ht.,:lnlltol d"lIscendlnt.s:" l'lt:;lu~tt:s ~ll l;:tdldl"'&n or ")e
n~tu.ul. pOf"Qnta and their d"scvnQentsl "'h.-thol"" ar nQt tnev havtJ balln ~doptQ(1 J')y othOt"'s, ./!dDptad dgsc:eodan1;$ ",,,4;1 thit:1r dasC:;CJnd~nt~
~r:d ;;::r)P-(lo<Slcondi/lnts. "Siblings" d1ra dafioed as indlvidual.s wha h""i at 188~t an. p~u"lInt in co_cn W1th t.hu docodDnt. \oIhath.... by blugd
Qr ZH_h,JIJti.lln. The OlCCllst.aral" c.lass of hair!; inchH~4is. a.ll other b~nq.fici.lrio.s.
CLAIMED DEDUCTIONS
PART
3
DEBTS AND DEDUCTIONS CLAIMED
~\l..J.aJw;sbl.. dClltJ't5 dnlY d&ductions ere l:Jettlrllliopd ;liS followsl
A. Vnt.a l.gell~ z:IIrlil r.:5pona1Dle for pa~.iJnt, or- the Dstatg s~bjQt:.t to, Qd.~n;istr.tign bV it P9,.son~1 r'Ui~rQ>>ln'tJltive 15 lnsuff1ciDnt:
to ~lOY tl1a 'h.ductibl" ita.s.
"IoU 8c~uall" "'Bid th.. dabts 3fter deoth of the doo:edent end can furni,h proof ~f pall."ot.
i:J..Pts be1nll cl..i...d OlUst 1>. it.u.iz.d fully 1n Port 3. If .ad1t1Dn..l ,,'ace is Madoc, use plll;Jn p~per 8 1/2" x 11". Proof 0 f
1;.:1Y_Dn't 1IIl8Y be raquG:stod by the PA D'liIs;usrtIlt8nt or ReVanUD.
TOTAL ::', r~iL
,i~
~.~
~. co
," ;>
.;:>~
J~
i25
~co
~ l
~ .
i
~
!
CODICIL TO LAST WILL
OF
BEATRICE V. BURGER
I, BEATRICE V. BURGER, of the Township of Hampden, Cumberland County, Pennsylvania,
declare this to be the sole Codicil to my Last Will, dated March 20, 1984.
Item 1: I hereby revoke Item 3 of my Last Will and replace it with the following: Should any
beneficiary entitled to a share of my estate not have attained the age of twenty-five (25) years at the time
of distribution to him or her, I devise and bequeath the share of such beneficiary to the SURVIVING
SPOUSE of my deceased daughter, as Trustee, to be held in separate trusts, to hold, manage, invest and
reinvest the share so received, in accumulation of income thereon, and to use and apply the income and
principal, or so much thereof as, in Trustee's discretion, may be necessary or appropriate for such
beneficiary's maintenance, support, and education (including college education, both graduate and
undergraduate) without regard to his or her parents' ability to provide for such maintenance, support or
education, or to make payment for these purposes, without further responsibility, to such beneficiary's
parents or to any person taking care of such beneficiary. Any principal or income not so applied shall be .
distributed to such beneficiary absolutely when he or-she attains the age of twenty-five (25) years. If he
or she dies before attaining the age twenty-five (25), the Trust shall terminate and such share shall be
distributed to his or her personal representative.
, .j
I
'I
I
If
II
-I!
!
Item 2: In all other respects, I hereby ratify, confirm and republish my Last Will, dated March
20, 1984, together with this sole Codicil, as and for my Last Will.
IN WITNESS WHEREOF,
I have hereunto set my hand this
I~
day of I
_.A({~U,-
,2005.
~~ V7 ,s~~-
BEATRICE V. BURGER
Signed, published and declared on the date thereof by the above named BEATRICE V.
BURGER as and for the sole Codicil to her Last Will, dated March 20, 1984, in the presence of us, who,
at her request, in her presence, in the presence of each other, have subscribed our names as witnesses
hereto.
residing at
0?50 6Ft 66d l~j6 f7e {Jtffl,P dt LL !tI1/2JJ
I
residing at
S('3~ U't((~il"e~~ M~to~~V"
J /.
2..1 (CZ.:
'I
I
II
I'
,I
II
II
. !
, ,
COMMONWEALTH OF PENNSYLVANIA )
) ss:
COUNTY OF CUMBERLAND )
We,
BEATRlCE
V.
BURGER,
S-f e.1Ie..1 L
:s Iwr- bfvt I-..
"
and
/-to w ,ttJ f t.-; 1L
, the Testatrix and the witnesses respectively, whose names are
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
lundersigned authority that the Testatrix signed and executed the instrument as the sole Codicil to her
Last Will, dated March 20, 1984, and that she had signed willingly, and that she executed it as her free
and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and
hearing of the Testatrix, signed the Codicil as witness and that to the best of his or her knowledge, the
Testatrix was at the time eighteen (18) years of older, of sound mind and under no constraint or undue
influence.
L
1-1 ./
Subscribed, sworn and acknowledged before me t.A.L'j (; &1tt-Lo
IB~GER, the . Testatrix, and subscribed ) and v sworn to
Sfc.vuJ L. ShA.....bw'li- and f-kw4tU1. /J"-I h-
I ~ -n... day of fl\41t.6t i ,2005.
by BEATRlCE V.
before me by
the witnesses, this
J
;1 i
II
q
I,
I'
! i
! ~
i!
f i
t!
II
II
1\
IF
IOTAtIAlEM.
181ft COOIE.IOfARYmuc
IMIPDEllWP.. CUMBERlNtD COUIlY
flY COMMISIOI EXPIRES JUME n. ..
tl
\;..
:>
H
~~
II
II
II. .
I.
I
LAST WILL AND TESTAMENT
OF
BEATRICE V. BURGER
I , BEATRICE V. BURGER, of the Township of Hampden,
Cumberland County, Pennsylvania, declare this to be my last
Will and revoke any Will previously made by me.
ITEM 1. I devise and bequeath all of my estate of
every nature and wheresoever situate together with insurance
thereon, to my husband, CLAIR Y. BURGER, providing he shall
survive me by thirty (30) days.
ITEM 2. Should my husband, Clair Y. Burger, predecease
me or die on or before the thirtieth day following my death, I
devise and bequeath all of my estate of every nature wheresoever
situate, together with insurance thereon, to my issue, per
stirpes, living on the thirty first day following my death.
ITEM 3. Should any of my issue entitled to a share
of my estate not have attained twenty five years at the time of
distribution to him or her, I devise and bequeath the share of
each such issue, to the Commonwealth National Bank, Harrisburg,
Pennsylvania, in separate trusts to hold, manage, invest and
reinvest the share to be received and the accumulation of income
thereon, and to use and apply the income and principal, or so
much thereof, as, in Trustee's discretion, may be necessary for
such issue's medical care, support and education (including
college education, both graduate and under graduate), without
regard to his or her parents' ability to provide for such support
or education,or to make payment for these purposes, without
further responsibility, to such issue orto such issue's parents
or to any person taking care of such issue. Any principal and
income not so applied shall be distributed to my issue in the
following manner.: Fifty';(-SO%) percent when he or she attains
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twenty-five (25) years of age and the balance when he or she
attains thirty (30) years of age. If he or she dies before
attaining age thirty (30) , the trust shall terminate and such
share shall be distributed to his or h~r per~onal representative.
ITEM 4. I direct that all my just debts and funeral
expenses shall be paid from the assets of my estate as soon as
practicable after my decease.
ITEM 5. I direct that all taxes that may be assessed
in consequence of my death, whatever nature and by whatever
jurisdiction imposed, shall be paid from my residuary estate as
a part of the expense of the administration of my estate.
ITEM 6. I appoint my husband, CLAIR Y. BURGER, of
this my last Will. Should my husband, Clair Y. Burger, fail
to qualify or cease to act as Executor, I appoint my two
daughters, JOAN M. DUNKLE and JANE N. SCHAFFNER, Co-Executors
of this my last Will.
ITEM 7. I direct that my personal representatives
and trustee or their successors shall not b erequi red to give
bond for the faithfulperforinanceof their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
;ltJ ~. day of' '?l~ ' 19 i .~
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BEATRICE . B GE
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The preceding instrument, consisting of this and
two (2) other typewritten pages, each identified by the signature
of the Testatrix, BEATRICE V. BURGER, was on the day and date
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thereof signed, published and declared by BEATRICE V. BURGER, the
Testatrix therein named, as and for her last Will, in the presence
of each other have subscribed our names as witnes~es hereto.
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COMMONWEALTH OF PENNSYLVANIA )
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COUNTY OF CUMBERLAND )
WE, BEATRICE V. BURGER, \:::)i\\liD C. S'1-\I\'l(~~'t>tA-g~ , and
. \4ELE.J H. (")9.\f~n4. . , the Testatrix and the
witnesses respectively, whose names are signed to the attached
or foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the Testatrix signed and
executed the instrument as her last Will and that she signed
willingly, and that she executed it as her free and voluntary
act for the purpose therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed
the Will as witness and that to the best of his or her knowledge,
the Testatrix was at the time eighteen (18) years of age or older,
of sound mind and under no constraint or undue influence.
-&~ti~rfE r'~~/
ERE V. BURG
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Subscribed, sworn to and acknowledged before me,
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~~ ' by BEATRICE V. BURGER, the
subscribed and sworn to before me by [)lf1AH1/J E
and .Ii~ J}n _ ~=ttf/ ,witnesses, this
day of ihA~~... ' 19~.
I,/~ t::
Testatrix, and
164Jmf~AFSEAL)
My Commission Expires:
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