HomeMy WebLinkAbout04-0073PETITION FOR PROBATE and GRANT OF LETTERS
Estate of John J. Amsley. Sr.
also known as
Deceased
Soctal Securtty No. 203 - ] 0 - 580'8
The petttton of the understgned respectfully represents that:
Your petmoner(%9, who i~a~ 18 years of age or older an the execut, r ix
m the last wtll of the above decedent, dated .February 2
and codtctl(s) dated NONE
To:
Regtster of Wdls for the
County of Cumberland
Commonwealth of Pennsylvania
in the
named
,1995
Decendent was domtciled at death tn Cumber 1 and County, Pennsylvama, wtth
h i s last family or princtpal residence at
(list street, number and munclpahty)
Decendent, then 81 years of age, dted January 2, 2004 ~L,
atCarlisle Regional Medical Centert Carlislet Pennsylvania 17.013
Except as follow's, decedent dtd not marry, was not dtvorced and dtd not have a chdd horn or adopted
after execuUon of the wd! offered for probate; was not the victim of a ktlhng and was never adjudicated
mcompetent. Decedent' war the spou.~e of Executrix
Decendent at death owned property wtth esttmated values as follows
(If domtctled tn Pa ) - /all personal property $
(If not domtcded tn Pa.) d~.Personal property tn Pennsylvama $
(If not domtctled, Ln,Pa ) ~..~ .~Personal property tn County $
Value of refil estate tn .P..ennsylvama $
situated as foflbws" ' c'
WHEREFORE, peuttoner(~ respectfully request(~ the probate of the last wtll and codtcd(s)
presented herewtth and the grant of letters testamentary
(testamentary, administration ~ t a, admm~st~anon d b n c t a )
theron
Catherine B. 'AmSley A
108 Wlllow View Drive
Carlisle, PA 17013
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~c
COUNTY OF Cumberland 3 ss
The petlttoner(s) ,~above-named swear(s) or afhrm(s) that the statements tn the foregotng petttton are
true and correct' to~ the b> o~' the knowledge and behef of pettttoner(s) and that as personal represen-
tattve(s) of the above decedent pettuoner(s) wdl well and truly admmtster the estate accordtng to law
Sworn to or a, fftrmed and subscribed f-
/beftore me tht's ~.~-~ day of |
h~s ~s to cerufy that the ~nformanon here given ~s correctly cop~ed from an original cernficate of death duly filed w~tfi me as
Local Registrar The original certificate wdl be forwarded to the State V~tal Records Office for permanent filing
WARNING. It is illegal to duplicate this copy by photostat or photograph
No Date
John J Amsley, Sr.
COMMONWEALTH OF PENNSYLVANIA · OEPAR]'MENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
. M , 203 --10 --5808 ' 1/2/2004
6/3/1922
CarllsleBoro.
John Paul Amsley ],, V1olet Little
Catherine B. Amsle¥ I~ 108 Willow View Drlv¢; Carlisle. PA 17013
~'~ ~'~ 1/6/2004 : Cumberland Valley Mem. Gr . Carlisle, PA 17013
FD 012633 L
il-z- 7..-' //~1o~ .. D
~]t[~[,O]
LAST WILL AND TESTAMENT
OF
JOHN J. AMSL£Y, SR.
!, JOHN J. A~/ISLEY, SR, of M~ddlesex Township, Cumberland County,
Pennsylvama, do make, pubhsh and declare th~s to be my Last Wdl and Testament,
hereby revoking all Wdls and Codmds made by me at any t~me
ITEM I. I d~rect that all funeral expenses, legal debts, expenses of
adm~mstrat~on and inheritance and estate taxes becoming due by reason of my death,
whether such taxes may be payable by my Estate or by any recipient of any property
shall be pa~d by my Executrix or Successor Executrix out of the property passing under
Item IV of thru Wdl as an expense and cost of adm~mstrat~on of my Estate. My
Executrix or Successor Executrix shall have no duty or obhgat~on to obtain
reimbursement for any such tax pa~d by them, even on proceeds of ~nsurance or other
property not passing ur,der th,s Will in the absolute d~scret~on of my Executrix or
Successor Executrix, such taxes may be pa~d ~mmed~ately or payment may be
postponed on future or remainder interests under the t~me possession thereof accrues
to the beneficiaries.
Page I of 5
~J/.//J. A. Sr.
ITEM II. I bequeath my automobdes, household and personal effects and other
tangible personalty to my wife, Catherine B Amsley.
ITEM III. I g~ve, devise and bequeath all of my property, real, personal and
mixed, not disposed of in the preceding port~ons of this Wdl, IN TRUST
NEVERTHELESS, pursuant to an Agreement of Trust naming my daughter, Shirley
Campbell, as Trustee, and me, as Grantor, on the ~-~ day of ~ --.,~-1¥~- ,
1995, and any amendments thereto effectwe at the t~me of my death, to be
administered, held and distributed m accordance therewith
ITEM IV. In the settlement of my Estate, my Executrix and Successor Executrix
shall possess, among others, the following powers to be exercised for the best
interests of the beneficiaries:
(a) To retain any ~nvestments I may have at my death so long as my Executrix
or Successor Executrix may deem ~t adwsable to my Estate to do so;
(b) To vary investments, when deemed desirable by my Executrix or Successor
Executrix, and to revest m such bonds, stocks, notes, real estate mortgages, or other
securities or m such other property, real or personal, as my Executrix or Successor
Executrix deems wise;
(c) In order to effect a d~wslon of the pnnc~pal of my Estate or for any other
purpose, including any final distribution, the Executrix or Successor Executrix is
(//.J~/J.A. Sr.
authorized to make sa~d d~ws~ons or d~str~but~ons of the personalty and realty partly
or wholly ~n k~nd. If such d~ws~on or d~str~but~on ~s made ~n k~nd, sa~d assets are
required to be d~wded or d~str~buted at their respective values on the date or dates of
their d~ws~on or d~str~but~on;
(d) To sell e~ther at pubhc or private sale and upon such terms and conditions
as the Executrix or Successor Executrix may deems advantageous to the Estate, any
or all real or personal estate or interest thereto owned by the Estate severally or m
conjunction w~th other persons or acquired after my death by my Executnx or
Successor Executrix, and to consummate sa~d sale or sales by sufficient Deeds or
other ~nstruments to the purchaser or purchasers, conveying a fee s~mple t~tle, free
and clear of all trust and w~thout obhgat~on or hab~hty of the purchaser or purchasers
to see to the apphcat~on of the purchase money or to make ~nqu~ry ~nto the vahd~ty of
sa~d sale or sales, also, to make, execute, acknowledge and dehver any and all Deeds,
Assignments, Options or other writings whmh may be necessary or desirable, m
carrying out any of the powers conferred upon my Executrix or Successor Executrix
~n th~s Paragraph or elsewhere ~n my W~II;
(e) To mortgage real estate and to make leases of real estate,
(f) To borrow money from any party, to pay ~ndebtedness of m~ne, or of my
Estate, expenses of adm~mstrat~on or inheritance, legacy, estate or other taxes;
Page 3 of 5
S
(g) To pay all costs, taxes, expenses and charges ~n connection w~th the
adm~mstrat~on of my Estate. My Executrix or Successor Executrix shall pay expenses
of my last dlness and funeral expenses;
(h) To vote any shares of stock which form a part of the Estate, and to
otherwme exercise all the powers incident to the ownership of such stock
ITEM V I nominate, constitute and appoint my w~fe, Cathenne B. Amsley, to
be Executrix of my Estate. Should my w~fe, Cathenne B. Amsley, fad to quahfy for
any reason or cease to act as Executrix, I hereby appoint my daughter, Shirley
Campbell, as Successor Executrix
My Executrix and Successor Executrix are specifically relieved from the duty or
obhgat~on of flhng any bond or other security.
ITEM VI. I hereby nominate, constitute and appoint my daughter, Shirley
Campbell, as Trustee of the Trusts created m Item III of th~s my Last W~li and
Testament
My Trustee ~s specifically relieved from the duty and obhgat~on of fihng any
bond or other security.
Page 4 of 5
IN WITNESS WHEREOF, I, John J Amsley, Sr, duly set my hand and seal to
this my Last Will and Testament th.s ~)/¢'~ day of f~-'/~' , , 1995.
slay, Sr ~ '~ ~7 ~-
The preceding ~nstrument, consisting of this and four (4) other typewritten
pages, m~t~aled at the bottom of each page for secunty purposes, was on the date
thereof s~gned, pubhshed and declared by John J. Amsley, St., the Testator here~n
named, as and for h~s Last Wdl and Testament ~n our presence, who, at h~s request,
~n his presence and ~n the presence of each other, have subscribed our names as
w~tnesses whereof
Page 5 of 5
COUNTY OF
We,
COMMONWEALTH OF PENNSYLVANIA
: SS:
:
, the Testator and the w~tnesses, respectfully, whose
names are mgned to the foregoing instrument, bmng first duly sworn, do hereby
declare to the undermgned authority that the Testator mgned and executed the
~nstrument as h~s Last Wdl and Testament and he had mgned wdhngly, and that he
executed ~t as h~s free and voluntary act for the purposes thermn expressed, and that
each of the w~tnesses, ~n the presence and heanng of the Testator, mgned the Wdl as
w~tnesses and that to the best of h~s knowledge, the Testator was at the t~me
mghteen (1 8) years of age or older, of sound m~nd and under no constrmnt or undue
influence
Sworn to and subscnbed
before me this ,-~.
No~ry PulSe' ~
NOTARIAL SEAL
STACEY L FINK Notary Pubh¢
East Manchester Twp York Co
Mv Commms[on E~')~r~s Fe~ 19 lg96
CERTIFICATION OF NOTICE UNDER RULE 5 6(a)
Name of Decedent John J Amsley, Sr
Date of Death January 2,2004
To the Register oDI - o~t z-I ~
I certify that notice of beneficial interest required by Rule 5 6 (a) of the Orphans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on
Name Address
Catherine B Amsley 108 Willow View Drive, Carlisle, Peimsylvama 17013
Notice has now been given to all persons entitled thereto under Rule 5 6(a) except NONE
Date
David A Banc, Esquire
O'Bnen, Banc & Scherer
17 West South Street
Carlisle, Pennsylvania 17013
(717) 249-6873
Capacity
__ Personal Representative
x Counsel for Personal Representative
~OMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128 0601
RECEIVED FROM
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003724
BARIC DAVID A ESQ
19 WEST SOUTH ST
CARLISLE, PA 17013
ESTATE INFORMATION SSN 203-10-5808
I~ILE NUMBER 2104-0073
DECEDENT NAME AMSLEY JOHN J SR
.DATE OF PAYMENT 03/26/2004
P~)STMARK DATE 00/00/0000
COUNTY CUMBERLAND
DATE OF DEATH 01/02/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,700.00
i REMARKS
SEAL
CHECK//3841
TOTAL AMOUNT PAID:
INITIALS: JA
RECEIVED BY.
REGISTER OF WILLS
~3,700.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
EV-15(X) EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
BEPT. 28O6O1
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Amsley, John J.
SOCIAL SECURITY NUMBER
203-10-5808
I--
Z
LI.I
t-t DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
ILl 01/02/2004 06/03/1922 REGISTER OF WILLS
ILl (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
1:3 Amsley, Catherine B. 201-18-7001
r~l. Odginal Return
[~4. Limited Estate
r~6. Decedent Died Testate (Attach copy of Will)
[~9. Litigation Proceeds Received
F--] 2. Supplemental Retum
r~4a. Future Interest Compromise (date of ~eath after 12-12-82)
[-'-~ 7. Decedent Maintained a Living Trust (A.ach copy of T~st)
---]10. Spousal Poverty Credit (date of daa~h between 12-3t-9~ and 1-~-95)
~--~ 3. Remainder Return (date of death pdor to 12-13-82)
r---~ 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[--~11. Election to tax under Sec. 9113(A) (Adac~ Sch O)
NAME
David A. Baric, Esquire
FIRM NAME {If Al:plicable)
O'Brien, Baric & Scherer
TELEPHONE NUMBER
(717) 249-6873
COMPLETE MAILING ADDRESS
David A. Baric, Esquire
O'Brien, Baric & Scherer
19 West South Street
Carlisle, Pennsylvania 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
--] Separate Billing Requested
7. Inter-Vivos Trensfere & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
300 354.9~,
5o,1 o7.6~,:~'
25,567.21
(11)
(12)
350,462.57
25,567.21
324,895.36
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
....... 300 354,96 x .o 0 (15)
........... 24 5~t0,4:O x .o 45. (16)
x .12 (17)
................................................. x .15 (18)
(19)
0.00
1,104.31
lw104.31
Decedent's Complete Address:
SYRh- ~ ADDRESS
108 Willow View Drive
ClTYCarlisle I STATEpA [ ZIP 17013
r
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Interest/Penaltyifapplicable
D. Interest
E. Penalty
3,7OO.O0
1 85.00
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
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.
(3)
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,104.31
3,885.00
2,780.69
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; .......................................................................................... [] []
b. retain the dght to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have eXah,inad this return, including acco,,,l~i~ying schedules and =iai~,,,ei~ts, and to the best of my knowledge and belief, it is true, correct and complete.
Dedara§on of preparer other than the personal representative is based on all infa'malton of which preparer has any knowledge.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
Ai~SR-i~'ss
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 3%
[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 0% [72 RS. ,{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 adop~ve parent,
or a stepparent of the child is 0% [72 RS. ,{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 4.5%, 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 12% [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-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John J. Amsley
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-04-0073
ITEM
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.
DESCRIPTION
1 Certificate of Deposit #6140-836476 with Citizens Bank
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
300,354.96
300,354.96
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
John J. Amsley 21-04-0073
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Shirley Campbell
108 Willow View Drive
Carlisle, Pennsylvania 17013
JOINTLY-OWNED PROPERTY:
Daughter
L~:¥¥t:~ DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A
07/16/2002 Certificate of Deposit ~240856504 Citizens Bank 100,215.22 50 50,107.61
TOTAL (Also enter on line 6, Recapitulation)$ 50,107.61
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John J. Amsley
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-04-0073
This schedule must be coi~ieted and filed if the answer to any of questions 1 through 4 on the mveme side of the REV-1500 COVER
ITEM DESCRIPTION OF PROPERTY i
INCLUDE mE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH '% OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ES?ATE. VALUE OF ASSET INTEREST (IF APPLICABLE VALUE
1. Shirley Campbell, Daughter Transfer 7/16/2002 100,215.22 50 50,107.6'
TOTAL (Also enter on line 7 Recapitulation) $ 50,107.61
{If more space is needed, insed additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEAL'rH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John J. Amsley
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-04-0073
Debta of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
1.
2.
3.
4.
5.
6.
7.
8.
9.
11.
12.
FUNERAL EXPENSES:
Ewing Brothers
Vault
Grave Opening/Closing
Bronze Memorial
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Catherine B. Amsley
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City . State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (if decedents address is not the same as claimant's, attach explanation)
Claimant None
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Carlisle Sentinel
Cumberland Law Joumal
Cumberland Crossings
Holy Spirit Hospital
Quantum Imaging
Pinker & Associates
Zip
. Zip
(Also enter on line 9, R~.carnitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
5,660.00
655.00
765.00
864.00
0.00
14,370.00
310.00
250.00
184.19
75.0O
849.00
840.00
8.04
7.16
$ 24,837.39
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVAN~,
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
John J. Amsley
NUMBER
I
SCHEDULE J
BENEFICIARIES
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
21-04-0073
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Catherine B. Amsley (Spouse) Certificate of Deposit ~140-836476 Citizens Bank
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - 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)
300,354.96
$ 300,354.96
LAST WILL AND TESTAMENT
OF
JOHN J. AMSLEY, SR.
!, JOHN J. ,~.MSL£Y, SR, of Middlesex Township, Cumberland County,
Pennsylvania, do make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils made by me at any time.
ITEM I. I direct that all funeral expenses, legal debts, expenses of
administration and inheritance and estate taxes becoming due by reason of my death,
whether such taxes may be payable by my Estate or by any recipient of any property
shall be paid by my Executrix or Successor Executrix out of the property passing under
Item IV of this Will as an expense and cost of administration of my Estate. My
Executrix or Successor Executrix shall have no duty or obligation to obtain
reimbursement for any such tax paid by them, even on proceeds of insurance or other
property not passing under this Will. in the absolute discretion of my Executrix or
Successor Executrix, such taxes may be paid immediately or payment may be
postponed on future or remainder interests under the time possession thereof accrues
to the beneficiaries.
Page I of 5
ITEM II. I bequeath my automobiles, household and personal effects and other
tangible personalty to my wife, Catherine B. Amsley.
ITEM III. I give, devise and bequeath all of my property, real, personal and
mixed, not disposed of in the preceding portions of this Will, IN TRUST
NEVERTHELESS, pursuant to an Agreement of Trust naming my daughter, Shirley
Campbell, as Trustee, and me, as Grantor, on the C-~ (vt~-~ day of ~'~~ ,
1995, and any amendments thereto effective at the time of my death, to be
administered, held and distributed in accordance therewith.
ITEM IV. In the settlement of my Estate, my Executrix and Successor Executrix
shall possess, among others, the following powers to be exercised for the best
interests of the beneficiaries:
(a) To retain any investments I may have at my death so long as my Executrix
or Successor Executrix may deem it advisable to my Estate to do so;
(b) To vary investments, when deemed desirable by my Executrix or Successor
Executrix, and to invest in such bonds, stocks, notes, real estate mortgages, or other
securities or in such other property, real or personal, as my Executrix or Successor
Executrix deems wise;
(c) In order to effect a division of the principal of my Estate or for any other
purpose, including any final distribution, the Executrix or Successor Executrix is
Page 2 of 5
y J~/J.A. Sr.
authorized to make said divisions or distributions of the personalty and realty partly
or wholly in kind. If such division or distribution is made in kind, said assets are
required to be divided or distributed at their respective values on the date or dates of
their division or distribution;
(d) To sell either at public or private sale and upon such terms and conditions
as the Executrix or Successor Executrix may deems advantageous to the Estate, any
or all real or personal estate or interest therein owned by the Estate severally or in
conjunction with other persons or acquired after my death by my Executrix or
Successor Executrix, and to consummate said sale or sales by sufficient Deeds or
other instruments to the purchaser or purchasers, conveying a fee simple title, free
and clear of all trust and without obligation or liability of the purchaser or purchasers
to see to the application of the purchase money or to make inquiry into the validity of
said sale or sales; also, to make, execute, acknowledge and deliver any and all Deeds,
Assignments, Options or other writings which may be necessary or desirable, in
carrying out any of the powers conferred upon my Executrix or Successor Executrix
in this Paragraph or elsewhere in my Will;
(e) To mortgage real estate and to make leases of real estate;
(f) To borrow money from any party, to pay indebtedness of mine, or of my
Estate, expenses of administration or inheritance, legacy, estate or other taxes;
Page 3 of 5
y J~I.A. Sr.
(g) To pay all costs, taxes, expenses and charges in connection with the
administration of my Estate. My Executrix or Successor Executrix shall pay expenses
of my last illness and funeral expenses;
(h) To vote any shares of stock which form a part of the Estate, and to
otherwise exercise all the powers incident to the ownership of such stock.
ITEM V. I nominate, constitute and appoint my wife, Catherine B. Amsley, to
be Executrix of my Estate. Should my wife, Catherine B. Amsley, fail to qualify for
any reason or cease to act as Executrix, I hereby appoint my daughter, Shirley
Campbell, as Successor Executrix.
My Executrix and Successor Executrix are specifically relieved from the duty or
obligation of filing any bond or other security.
ITEM VI. I hereby nominate, constitute and appoint my daughter, Shirley
Campbell, as Trustee of the Trusts created in Item III of this my Last Will and
Testament.
My Trustee is specificalJy relieved from the duty and obligation of filing any
bond or other security.
Page 4 of 5
IN WITNESS WHEREOF, I, John J. Amsley, Sr., duly set my hand and seal to
this my Last Will and Testament this day of ... , , 1995.
The preceding instrument, consisting of this and four (4) other typewritten
pages, initialed at the bottom of each page for security purposes, was on the date
thereof signed, published and declared by John J. Amsley, Sr., the Testator herein
named, as and for his Last Will and Testament in our presence, who, at his request,
in his presence and in the presence of each other, have subscribed our names as
witnesses whereof.
Page 5 of 5
COMMONWEALTH OF PENNSYLVANIA
We, f~ (~ .~,~ sl',~r
SS:
names are signed to the foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator signed and executed the
instrument as his Last Will and Testament and he had signed willingly, and that he
executed it as his free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the Testator, signed the Will as
witnesses and that to the best of his knowledge, the Testator was at the time
eighteen (1 8) years of age or older, of sound mind and under no constraint or undue
influence.
~. , fc~,,~ ~_ f ~; ~( :f,~.. and
, the Testator and the witnesses, respectfully, whose
Sworn to and subscribed
before me this.
Notary Pubic' J
NOTARIAL SEAL
STACEY L FINK, Notary Public
East Manchester Twp., York Co.
Mv Corem ss on ~'~:,~ir~s Feb. 19. 1996
/Wit~=~'~'-) ' " ~-
Witness / '\
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
p~cn:;fi;:r' ({[iCE C~TICE OF INHERITANCE TAX
"- -"" - ':,"Rr~AIl>EI1ENT, ALLOWANCE OR OISALLOWANCE
, ' OF,,'Dl!DUCTIONS ANO ASSESSI1ENT OF TAX
BUREAU bF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-06Dl
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
01-25-2005
AMSLEY SR
01-02-2004
21 04-0073
CUMBERLAND
101
ZOG5 JMl24 1\11 S: 18
DAVID A BARIC
OBRIEN ETAL
19 W SOUTH ST
CARLISLE
CI -C'\( ",C
,....tJ'.:\ vi
O!')PUi\~,;"'~
fit ';""'\)
E~J\":_:'
PA 17013
Allount R.llltt.d
'*
REV.1547 EX AFP (l2~04)
JOHN
J
( X) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
300.354.96
50.107.61
.00
(8)
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 ~
REV:U2;".EX.Af:"..Cllr:6!')..r:lOYICE.OF.'i:'N'HERYfA'N'cl!"i"A"X"'A.PPRA'IsEM.ir:li:"ACLowAN"cE"oii"..."..".......".
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
JOHN J FILE NO. 21 04-0073 ACN 101
ESTATE OF AMSLEY SR
TAX RETURN WAS: (
) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. stoGks and Bonds {Schedule Bl
3. Closely Held stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule OJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (S~hedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H)
10. Debts/HortgsS8 Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-.lec~.d 9113 Trusts {Schedule J)
14. Net Value of Estate Subject to Tax
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ~
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rat. (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class 8 rate (18)
19. Principal Tax Due
25,567.21
.00
Ill)
(12)
(13)
(14)
(9)
(10)
SEE
DATE 01-25-2005
ATTACHED NOTICE
NOTE: To insure proper
credit to your account~
submit the upper portion
of this form with your
tax payment.
350,462.57
25.<;67 21
324,895.36
.00
324,895.36
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
274,787.75 X 00 =
50,107.61 X 045=
.00 X 12 =
.00 X 15 =
(19)=
,
.00
2,254.84
.00
.00
2,254.84
T4Y C DITS:
r '" AI1DUNT PAID
DATE NUIlBER INTEREST/PEN PAID (-)
03-26-2004 CD003724 112.74 3,700.00
TOTAL TAX CREDIT 3,812.74
BALANCE OF TAX DUE 1,557.90CR
INTEREST AND PEN. .00
TOTAL DUE 1, 557. 90CR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYI1ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU I1AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS.] ~~
REV.'470EX (6.8B)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17126-0601
DECEDENTS NAME
John J. Amsley, Sr.
FILE NUMBER
REVIEWED BY
Sheila Megonnell
ACN
2104-0073
101
ITEM
SCHEDULE NO.
F
EXPLANATION OF CHANGES
Transfers are taxable to the person receiving the Transfer. No deductions can be claimed
against joint property as it was not the responsibility of the transferee to pay the debts.
ROW
Page 1
STATIJS REPORT UNDER RULE 6.12
Nam.e of Decedent:
John J. Amsley, Sr.
January 2, 2004
Date of Dea.th:
21-04-0073
Will No.:
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' CoUs'1 Rules, I report the .
following with respect to completion of the administration of the above-captioned estate:
1. State whether anmil'llstration oillie estate is complete:
Yes ~ No 0
2. If the answer is No; state when the personal representative reasonably believes
that the acI.:miD.i.stration 'VIrill be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes No ~
b. The separate Orphans' Court No. (if aoy) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Yes E.l No D'
Date:
c. Copies of receipts, releases, joinders and approval Of7!firmal r
informal accounts maybe file 'th the Cled fthe Orp · Court
and may be attached to this r 0 . I / ~
March 19' 2005 tf,/
Signature
David A. Baric, Esquire
Name
O'Brien, Baric & Scherer
19 West South Street
Address Car 1 isle, PA 17013
r"-
(717) 249-6873
Telephone No.
Capacity: 0 Personal Representative
~ Counsel for personal representative
uA
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-1607 EX AFP 112-04)
. ,"'tt
~C
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-22-2005
AMSLEY SR
01-02-2004
21 04-0073
CUMBERLAND
101
JOHN
J
DAVID A BARIC
OBRIEN ETAL
19 W SOUTH ST
CARLISLE
ESQ
Allount Rellitted
PA 17013
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .-.
Itv:r~tI.,.!r.A'~..rBr-"6!".......;..YARn'!n"Ner"'lr.~nYI!AWf.'b1!'.ll:1!'170W....................... ...
ESTATE OF AMSLEY SR JOHN J FILE NO.21 04-0073 ACN 101 DATE 02-22-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A S~ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-18-2005
PRINCIPAL TAX DUE:.
2,254.84
PAYMENTS (TAX CREDITS):
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-26-2004 CD003724 112.74 3,700.00
02-03-2005 REFUND .00 1,557.90-
TOTAL TAX CREDIT 2,254.84
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
.
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR1,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. 1
L:)J-O<!-(J07J
F AMIL Y SETTLEMENT AND FINAL RELEASE IN THE ESTATE
OF JOHN 1. AMSLEY. SR.
KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, John J. Amsley, Sr., late of
Cumberland County, Pennsylvania, died testate on January 2, 2004, having first made his last will
and testament duly executed on February 2, 1995;
WHEREAS, the said, John 1. Amsley, Sr., by the aforesaid last will and testament, named
Catherine B. Amsley, as Executrix of said last will;
WHEREAS, letters testamentary on the estate ofthe said decedent were duly issued by the
Register of Wills of Cumberland County, Pennsylvania, to the said Executrix, Catherine B. Amsley,
hereinafter called personal representative.
WHEREAS, the personal representative has gathered the assets of the estate of the said
decedent and the assets consist of personal property, to a total value of$300,354.96, as set forth in
Exhibit A, which is a statement of account of the said personal representative, and which is attached
hereto and made a part hereof, and marked Exhibit A;
WHEREAS, the debts and deductions, including the payment of inheritance tax in the said
estate, amount to 19,456.85, as further referenced on Exhibit A, leaving a balance for distribution
of $280,898.11;
. .
WHEREAS, the balance for distribution as shown in the said statement marked Exhibit A
. , ~ -.
has been reduced to cash and is available for distribution in accordance with the terms of the last will
and testament of the said decedent.
-'''1
c.~:
NOW, THEREFORE, KNOW YE, that we, being all of the named beneficiaries ofthe will
of the said decedent, do hereby each of us, acknowledge that we have this day had and received from
the aforesaid personal representative, in full satisfaction and payment of all sum or sums of money,
legacies, bequests, and devises as are given, devised and bequeathed to each of us respectively by
the said will of John J. Amsley, Sr., the amounts due us under said will, which amounts we have
received this day, and which amounts are in the amount set opposite our respective names in the table
and schedule of distribution in said statement attached hereto and marked Exhibit A;
AND, each of us does hereby stipulate that in order to avoid the expense and time involved
in the filing of a formal account and schedule of distribution, we each agree that no account is
necessary and we do hereby agree that we do consent to distribution being made without the filing
of an account and schedule of distribution, the same to be with the same force and effect as if they
had been filed and confirmed by the Orphans' Court Division of the Court of Cumberland County.
THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge
the said personal representative, heirs, executors, and administrators and assigns of and from the said
estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever
for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the
estate of the said decedent, and each of us do further hereby covenant and agree that should any
liability come due to the estate of the said decedent after the signing of this agreement, we and each
of us do hereby covenant and agree with each other and the aforesaid personal representative, that
we will contribute pro-rata, our share of the estate to satisfy any and all claims, demands, suits, or
causes of action which may be successfully prosecuted against the said estate or the aforesaid
personal representative after the signing, sealing and delivery of this family settlement agreement and
final release.
IN WITNESS WHEREOF, we have hereunto set our hands and seals this \81 ~day of
~iU.dgj(
Shirley ampbell, trustee -
(SEAL)
(' ~ ;7J ~,^ji
Catherine B. Amsley
(SEAL)
dab.dir/estates/amsley/familysettlement.agr
STATE OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the 31st- day of 0a.n (..uL~
undersigned officer, personally appeared Shirley Campbell (known to me or satisfactory proven) to
, 2005, before me, a Notary Public, the
be the person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~k~!~
STATE OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
COMM NWEALTH OF PENNSYLVANIA
Notarial Seal
Anl!mda L. Fisher, NotllJy Public
Carbsle Doro, CwnberJand County
M Commission Ex ires A r. 17, 2006
Member, Pennsylvania Association of Notaries
On this, the 3 i~ day of ,jo...YLl.LCLJ ,2005, before me, a Notary Public, the
undersigned officer, personally appeared Catherine B. Amsley (known to me or satisfactory proven)
to be the person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~~~
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Amanda L. Fisber, Notary Public
Carlisle Doro, Cwnberlaod County
M Commission E ires A . t 7, 2l>O6
Member, Pennsylvania Association of Notaries
EXHIBIT "A"
mFORMALACCOUNTOF
Catherine B. Amsley, Executrix
for
ESTATE of John J. Amsley, Sr.
Date of Death:
January 2, 2004
Date of Executrix's Appointment:
January 23, 2004
Accounting for the period:
January 23, 2004 to
January 25, 2005
Summary of Account
Page Current Fiduciary
Value Acquisition
Value
Proposed distribution to Beneficiaries 3 $280,898.11
Principal
Receipts I
Savings Accounts, Certificates of
Deposit, Checking Accounts $300,354.96
$300,354.96
Less Disbursements:
Funeral Expenses 2 $ 11,972.21
Administrative Expenses $ 819.19
Debts of Decedent $ 2,551.56
Federal and State Taxes $ 2,142.10
Fees and Commissions $ 6.000.00
$ 19,456.85
$280,898.11
Receipts of Personal Representative
Asset
Savings Accounts, Certificates of Deposit, Checking Accounts
Citizens Bank CD # 6140-836476
Realty
None
Personalty
None
Miscellaneous
None
GRAND TOTAL:
1
Value
(Date of Death)
$300,354.96
$300,354.96
Disbursements of Principal
Debts, Funeral Expenses and Administrative Expenses of Decedent
Debts
Cumberland Crossings
Holy Spirit
Quantum Imaging
Pinker & Associates
Hampden Township Ambulance
Burick, Azizkhan Medical
Graham Medical
Kunkle Surgical Group
Cumberland Crossing
Carlisle Digestive Disease
West Shore EMS
Philhaven Hospital
James Hardesty, M.D.
Funeral Expenses
Ewing Brothers Funeral Home
Vault
Grave Opening/Closing
Bronze Memorial
Administrative Expenses
The Sentinel (legal advertisement)
Cumberland Law Journal (legal advertisement)
Probate Fees
Tax Return Preparer Fee
Federal and State Taxes
Pennsylvania Inheritance Tax (net of estimated payment
less refund received)
Fees and Commissions
O'Brien, Baric & Scherer, attorney fees
$ 958.50
$ 840.00
$ 8.04
$ 7.16
$ 36.96
$ 128.46
$ 15.76
$ 58.38
$ 109.50
$ 22.31
$ 151.46
$ 190.37
$ 24.66
$ 2,551.56
$ 5,660.00
$ 655.00
$ 765.00
$ 864.00
$ 7,944.00
$ 184.19
$ 75.00
$ 310.00
$ 250.00
$ 819.19
$ 2,142.10
$ 6,000.00
GRAND TOTAL:
2
$19,456.85
Principal Balance on Hand
Receipts of Personal Representative
$300,354.96
Proposed Distributions to Beneficiaries
Per Item Second of Will:
TO: Catherine B. Amsley
All automobiles, household personal
effects and other tangible personalty
Per Item Third ofWiII:
TO: Shirley Campbell, Trustee
All property, real, personal and
mixed, not disposed of in the
preceding portions of this will
3