HomeMy WebLinkAbout04-0306 Will
Estatc H~LLrN H. AUSTIN
also known as
PETITION FOR PROBATE and GRANT OF LETTERS Will
No. - -
To: Register of Wills for thc
County of Cumberland in the
Commonwealth of P~nnsylvan-la
deceased.
Social Security No. 201-07-4015
The petition of the undersigned respectfully represents that:
Your petitioner(s) is/are 18 years of age or older and the execut ors
dated January 30 20 0/4 and codicil(s) dated
named in the last will of the above decedent
(State r~levant circumstances, e.g. lk"nuncietion, dea~ of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with h er
residenceat 210 Big Spring Road, Newville, Pennsylvania 172/+1.
last family or principal
at
offered for probate, was not the victim of a killing and was never adjudicated incompetent
(list street number and municipality)
Decedent, then 85 years of age, died February 26 ,20 0/4
Green Ridge Village Nursing Home, Newville, Pennsylvania
Except as follows, decedent did not many, was not divorced and did not have a child bom or adopted after execution of the will
Decedent at death owned property with estimated values as follows:
$ 1,000.0Oand up~rds
$
$ I'~ )
(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:
WHEREFORE, petitioner(s) respectfully request the probate of the last will and codicil(s) presented herewith the grant of
letters testamentary theron.
(Testamentary, administration c.ta., administration d.b.n.¢.ta.)
Signature(s) and Residence(s)
Farmers and Merchants Trust Company of Pctitioner(s)
eatherC. Etter
state Administration Officer
Lynn A. Obe~rg J
807 Gallant Fox Lane
20 South
P.O. Box ~ Street Cranberry Township, Pennsylvania
Chambersburg, Pennsylvania 17201 16066
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland SS
Thc petitioner(s) above named, swear(s) or affirm(s) that the statements in the foregoing petition are tree 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
lruly administer the estate according to law.
Sworn to or aft'tn'ned and subscribed
before me this ~ day of
Farmers and Merchants Trust Company
Heather C. Etter
Estate Administration Officer
~'/L~n A. 0be~
Estate of ~ H. AUSTIN Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW, 3 ~ ~(t~LC~ ,20 ~ .., ~ comidemfion of ~e petition on ~e reveme side hereof,
safisfacto~ proof hav~g been presented before me, ~ IS DEC~ED ~at ~e ~en~s) ~ted
described therin be admitted to probate and filed of record as the last will of
.I-l,
Documents Attached:
Oath of Subscribing Witness(s) []
Oath of Non-subscribing Witness(s) []
Oath of Witness(s) to mark []
Renunciation(s) []
TIMOTItY S. SPOlqRI~I.T.~ (~9!~_59.x
ATTOR1NEY (Sup. Ct. I.D. No)
14 NOR~ Hal8 S~ S~ 215
~~B~G, PA 17201
ADDI~ESS
(717) 263-3939
PHONE
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: HELEN H. AUSTIN
Date of Deat~lZk~fi~2004
File Numb~~003~)
To the Reef
I certify that notice of (beneficial interest) estate administration required by Rule
5.6(a) of the Orphans' Court Rules was served or mailed to the following beneficiaries of the above
captioned estate on April 2, 2004.
NAME and ADDRESS:
Lynn A. Oberg
807 Gallant Fox Lane
Cranberry Township, Pennsylvania 16066
Presbyterian Homes, Inc.
1217 State Hill Road
Camp Hill, Pennsylvania 17011
Notice has now been
except- (NONE).
Date: April 2, 2004
given to all persons entitled thereto under Rule 5.6(a)
Signature
NAME: Timothy S. Sponseller
ADDRESS: 14 North Main Street
Suite 215
Chambersburg, Pennsylvania
17201
TELEPHONE (717) 263-3939
CAPACITY: COUNSEL FOR PERSONAL
REPRESENTATIVE
hLs ~s to cerufy that the ~nformauon here g~ven ~s correctly cop~ed from an ongtnal certificate of death duly filed w~th me as
Local Registrar The original ceruficate wdl be forwarded to the State V~tai Records O~ice for permanent fihng
WARNING: It Is illegal to duphcate this copy by photostat or photograph
Fee for this cernficate, $2 00
P 9964529
No
Local Registrar
l 00Z g 0 8VN
Date
.......................... o¥-
Helen H. Austin
Cumberland
Office Manager
210 Big Spring Road
Newville, PA 17241
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
, Female * 201 --07 --4015 , February 26, 2004
1-13-1919 .,.~.~O t~.* [] ~o~0 I~ n,~,~..O ~
NGreen Ridge Village Nursing ~t ~ White
Newville Home ]~'~ *~
,m ~ Cumberland ~'~? ,Td[O ~.~'~a~d ~
,, William Hopple
~ Lynn Ober$
8%~7~*G~21~an~Ft~ La%%TcZ~ra~erry Township, PA 16066
Cremation Society of
PA Crematory ~,~ Harrisbur PA 17109
of PA
MEDICAL EXAMINER~CORONER
TIMOTHY S SPONSELLE~
LAST WILL AND TESTAMENT
I, HELEN H. AUSTIN, of 115 Green Pddge Lane, Newvdle, West Pennsboro Township,
Cumberland County, Pennsylvama, betng of sound mind, memory and understandtng, do make,
pubhsh and declare thts as and for my Last Wtll and Testament, hereby revoking and maktng void
any and all wills by me at any time heretofore made
FIRST: I dtrect that all myjust debts, funeral expenses and tnhentance taxes shall be pard
by my Executors hereinafter named, as soon as may be convenient after my death
SECOND I hereby gtve and bequeath to my mece, Lynn Oberg, of Cranberry Township,
Pennsylvania, such Items of my tangtble personal property whtch she may desire
THIRD: I give, devise and bequeath all of the rest, residue and remainder of my estate,
real, personal and mixed, whatsoever and wheresoever sttuate, as follows
a Fifty (50%) per cent thereof to my mece, Lynn Oberg, of Cranberry
Township, Pennsylvama, and
b Fifty (50%) per cent thereof to Presbyterian Homes, Inc, of Camp Hill,
Pennsylvama, to be used exclusively for the financial support of residents of
facthtles owned by Presbyterian Homes, Inc who are in need
FOURTH: I nominate, constttute and appoint Farmers and Merchants Trust Company of
Chambersburg, Pennsylvania and my mece, Lynn Oberg, as Co-Executors of this my Last Wtll and
Testament, without bond
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ~O day of
Helen H Austin, Testatrix
Signed, sealed, pubhshed and declared by the Testatrix, HELEN H. AUSTIN, as and for
her Last Will and Testament, in the presence of us, who at her request stgned this will as wttnesses,
tn the presence of the Testatrix, and of each other
WITNESS.~.. ,,'~ : __
WITN~S~:~ O~ ~V~ ~0. ~ ¢~
TIMOTHY S SPONSELLER
ATTORNEY AT LAW
14 NO~TH MAIN STREET
SUITE 215
We, HELEN H. AUSTIN, Testatrix, and the W~tnesses whose names are s~gned to the
foregoing instrument, being first duly sworn/affirmed, do hereby declare to the undersigned
authority that the Testatrix stgned and executed the foregoing ~nstmment as her Last Will and that
she had s~gned wdhngly, and that she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the Witnesses, in the presence and hearing of the Testatrix,
signed the Will as W~tnesses and that to the best of the knowledge of each Witness, the Testatrix
was at the time eighteen (18) years of age or older, of sound mind, and under no constra,nt or
undue influence
Sworn/affirmed and subscribed to and
acknowledged ~fore me this
~-C3 ~ day of,--.~k~,~ q ,2004
; ) ,,Nota~bllc
Helen H Austin, Testatrix
Witness
Witness
¢--~. .-=, -, .
r,o ~5 0
COMMONWEALTH 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.
REV-1162 EX(11-96)
CD 003978
........ fold
FARMERS AND MERCHANTS TRUST CO
20 SOUTH MAIN STREET
PO BOX 6010
CHAMBERSBURG, PA 17201
ESTATE INFORMATION: SSN: 201-07-4015
FILE NUMBER: 2104-0306
DECEDENT NAME: AUSTIN HELEN H
DATE OF PAYMENT: 05/26/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 914,250.00
REMARKS: F&M
TOTAL AMOUNT PAID:
$14,250.00
SEAL
CHECK# 222878
INITIALS: AC
RECEIVED BY'
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEP1; 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
._21._ _ ___04__ 0306
DECEDENTS NAME (LAST' FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-- AUSTIN, HELEN H.
Z
U.I
~'t DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MI~DD-YEAR THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
LLI 02/26/04 01/13/19
(,3 REGISTER OF WILLS
I,LI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE iNITIAL SOCIAL SECURITY NUMBER
~ N/A
~oo
[~1. Odginal Return [] 2. Supplemental Return
[] 4. Limited Estate [] 4a. Future Interest Comprom*es (date ofdea~h a~ 12-1
['~6. Decedent Died Testate (A~ ~opy ol W~ll) [] 7. Decedent Maintained a Livi~j Trust (Atta~ copy of
[] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (dam (~ death ba~n ~2-31-9~ and
TIMOTHY S. SPONSELLER
(717) 263-3939
]5. Feders/Estate Tax Return Required
I~ 8. Total Number of Safe Deposit Boxes
]11. Election to tax under Sec. 9113(A) (Atta~ Sch O)
COMPLETE MAILING ADDRESS
14 NORTH MAIN STREET SUITE 215
CHAMBERSBURG, PENNSYLVANIA 17201
1. Real Estate (ScheduleA) (1)
2. Stc~ks and Bonds (Schedule B) (2)
3, Closely Held Coq~oration, Pa~ership or Dele-Pmprietomhip (3}
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Scheduta F) (6)
[] Separate Silling Reque~tad
7. Intar-Vives Transfers & Miscellaneous Non-Prebata Pmba~ (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 Baductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmenta~ Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
227,119.6(~ : ~
122,198.43
(8) ,
29,259.00
296.51
(11)
(12)
349,3t8.03
u9
29,555.51
319,762.52
(13)
{14)
159~881.26
159,88t .26
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Arr~unt of Line 14 taxable at the spousal tax
rate, or transfem under Sec. 9116 (a)(1.2) x ,0 (15)
16. Amount of Line 14 taxable at lineal rate x .0 (16)
17. Amount of Line 14 taxable at sibling rote x .12 (17)
18. AmountofLine14taxableatcollataralmte 159,881.26 x .15 (18)
19. Tax Dua (19)
23~982.19
23~982.19
LU
REV-1508 EX+ (6-98) ~
-,~'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN H. AUSTIN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21-04-0306
include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
10.
11.
12.
13.
14.
15.
16.
M & T BANK-CERTIFICATE OF DEPOSIT NUMBER 033100039139003744
DUE 7-5-04 RATE 3.160%
ACCRUED INTEREST
M & t BANK-CERTIFICATE OF DEPOSIT NUMBER 03310003913903752
DUE 7-5-04 RATE 3.160%
ACCRUED INTEREST
MBNA AMERICA-CERTIFICATE OF DEPOSIT NUMBER 408359218
DUE 1-20-05 RATE 2.150%
ACCRUED INTEREST
MBNA AMERICA-CERTIFICATE OF DEPOSIT NUMBER 408359200
DUE 1-20-05 RATE 2.150%
ACCRUED INTEREST
ADAMS COUNTY BANK-CERTIFICATE OF DEPOSIT NUMBER 160471
DUE-I-20-05 RATE 2.1950%
ACCRUED INTEREST
ADAMS COUNTY BANK-CHECKING ACCOUNT NUMBER 187720
ACCRUED INTEREST
MBNA AMER!CA-MONEY MARKET ACCOUNT NUMBER 572495208
ACCRUED INTEREST
SMITH BARNEY ClTIGROUP-ACCOUNT NUMBER 746-07176-19-192
1,071.95 SHARES OF SMITH BARNEY CAPITAL & INCOME FUND CLASS A
DRYFES TREASURY PRIME CASH MANAGEMENT FUND, POA ACCOUNT,
F & M TRUST DEPARTMENT ACCOUNT NUMBER 51060700
1-1925-D-2-1/2 DOLLAR INDIAN GOLD
MEMBERSHIP REFUND, AARP
READERS DI~EST ASSOCIATION-REFUND
PPL ELECTRIC UTILITIES CORP.-REFUND
PRESBYTERIAN HOMES-REFUNDS OF CHARGES
ARMED FORCES INSURANCE EXCHANGE-REFUND
KUHN COMMUNICATIONS-REFUND
30,179.14
209.02
30,179.14
209.02
30,820.38
10.86
30,820.38
10.86
25,747.55
306.47
2,554.14
1.41
5,015.90
1.96
17,187.65
52,570.61
20.23
125.00
7.80
2.33
67.27
979.57
81.12
11.79
TOTAL (Also enter on line 5, Recapitulation) $ 227,119,60
(If more space is needed, insert additional sheets of the same size)
11/16/2004 17:00 FAX 717 264 7129 F&M TRUST ~005
Helen H. Austin Estate
e/o FarmerS & Merchants Trust Co.
Attention: Trust Dept.
P.O. Box 6010
Chambersburg, PA 17201
Re: Estate of: Helen H Austin
Social Security: 201-07.4015
Date of Death: Februa_~ 26. 2004
Fax (302) 934-2955
May 10, 2004
with this bank fl~ foUow~g:
Tj,pe of Account
Accoum Number
Opening Date
Balance on Date o/Death
Accn~ed Interest
Total
Current Balance
2. Type of Account
,4ccount Number
Ownersh(v (Names oJ)
Opening Date
Batonce on Date of Death
,4ccru~ lnterest
C~r~tB~once
Cert~¢ate
05100591J905744
Helen H ~tm
05~5~
$~0,179.14
$ 2O9.02
$30,388.16
C~if~ of ~oslt
031~91~903752
Helen H A~in
05~5/00
$30.179.14
$30,3~ 16
$30,41~90
Please be advised there was no safe deposit box found for thc above decedent For f~l~her account information,
closurcs and/or rcimburscmcn! of rituals, cie. please call the High S~rect. Carlisle Office # 717-240-4536.
Since~ly,
N~ey Clagetx
Records Mana~,ement
Dear Ms. Heather C- Etter:
Per your inquiry dated April 30, 2004, plcaae be advised ~ at thc time of death, the above-named d0c~ de, n ~ had on deposit
11/16/1004 17:00 FAX 717 16¢ 7129
T
May 26, 2004
Heather C. Etter, Trust Officer
Farmers & Merchants Trust Co.
Attn: ~rust Department
P.O. Box 6010
Chambersburg, PA 17201
Subject: Estate of Helen H. Austin
Dear Ms. Etter:
We recently received your request to prov/de the date-of-death balance for the below
referenced account(s).
The information that you requested is as follows:
Account Type Date-of-Death Accrued Interest
Number of Account Balance Included in Date-of-
February 26, 2004 Death
408359~'18 Certificate of Deposit $30,831.24 $10.86
572495208 Money Market $5,017.86 $1.96
If you have any questions, please call Joanne Di Joseph directly at 1-800-441-7048,
extension 34287 Monday through Friday from 8 a.m. to 5 p.m., (Eastern time). If you prefer,
you may write to P. O. Box 15103, Wilmington, DE 19850-5103.
artment
11/16/2004 17:00 FAX 717 254 7129 F&M TRUST
11,'~/2~,~ 12:5'7 MBNfl TaX COI~P[_f~IC'~ -~ 9171'7~5~7129
~007
NO.
November 9, 2004
Heather C. Etter, Trust O/ricer
Farmers & Mer~{,A-_t~ T~umt Co.
Attn: ~'ust Dep~rtment
Y.O. Box 6010
C~m~rsb~, PA 1~01
Subject: Emte of Helen H.
Dear Ms. ElXer,
Wc tuc~tly ~ived your re, quit to provide th~ dat~-of-dea~ _K~{,~o for {ilo below ~ed
The reformation that you ~qu~s~l i~ ~ follows:
Accotmt Typ~ Date-of-Death Accrued/merest Account
Numba' o£ Account Balance hcludcd in Date-of- Registration
Febru~t 26, 2004 D~th Balance
408359200 Certificate of $30,831.24 $10.86 Helen H. Ausiin
If you have ~uy quemtioum, pkase cai{ 1-800-441-7048, e. xt~ion 34287, Mou~y fia'~ugh FHday f~om 8
a.ra. to 5 p.m., (Eastern tin~). If you prefer, you may w~i~ to P. O- Bo~ 15103, Wilm~,~gto~, DE 19850-
5103.
Deposit Service{ dep~,'m~nt
11/15/2004 17:01 FAX 717 25¢ 7129 F&M TRUST
NATIONAL BANK
April 23,200,i
F & M Trust
c/o Trust Dept.
PO Box 6010
Chambersburg, PA 17201
Re: Estate of Helen H. Austin
Dear Ms. Etter:
The following information is being provided as per your request:
Acer, Type Account Account Accrued Ownership Date Account
No. Principal on Interest to Opened
D.O.D. D,O,D.
Checking 187720 $2,554.14 $1.41 Individual 5-2-01
C.D. 160471 $25,747.55 $306.47 Individual 10-3-02
Inquiries concerning ACNB Corporation stock information should be directed to the Registrar
and Transfer Company at 1-800-368-5948. If you need any additional information, please
contact rm: at (717)338-2171.
Sincerely,
Lois Kirne
Deposit SerVices
11/16/200 17:01 FAX 717 264 7129 ~009
SMITH BARNEY_
¢ t qroupT
April a6, aoo4
Helen H. Austin Estate
C/o Farmers & Merchants Trust Co.
Attention: Trust Dept.
P.O. Box 6OlO
Chambersburg PA ~TeOl
RE: The Estate of Helen H. Austin
746-07176-19-192
Dea': Mrs. Etter and Mrs. Oberg:
In response to your letter, I am providing you with the value of the account, as of February 26,
2oo4. Below is information as follow~:
Account # 746-0717649-X9a Type: joint account
In the name of: Eugene H. Austin Dee'd
Helen H. Austin dTI'EN
Account Opened: April ol, x98~
Approximate Account Value as of February a6, 2oo4:$17,~87.65
The closing price on February 26, 2004:
Smith Barney Capital & Income
Fund Class A
15.99/pershare
Ifyou haveanyquesfionsorneedadditionalinformationpleaseeontactmyofficeat(7~7)854.
5553.
We are in the process of changing the account to an Estate account. In order to proceed we need
to have the 2 enclosed documents signed and returned in the envelope provided.
Sincerely,
Sabrina L. Walters
Financial Consultant
ks:SW
This information is being provided at your request and does not replace or supersede the client's monthly Smith Barney
customer sta'cemcnt. This information is based upon the market value of the account as of the close of business on February 26t~.
2oo4, and is subject to daily marke! fluctuation.
11/16/2004 17:01 FAX 717 264 7129 F&M TRUST ~011
~ L. SPIDEL
BUY * SELL * APPRAISE
COINS ~ OLDBOOI~
1423 Breebbill Rd. Chambet~burg, PA. 17201
ph 717-263-42~7 ANA r113213
__11/16/2004 17:02 FAX 717 264 7129 F&~ TRUST ~012
co.--o-~,,*,,.~,,,,.-,,~.~,* SAFE DEPOSIT BOX
"""'"'"' °' ""~' I N V E N TO R Y
~DECEDENT'S NAME IL~ST. FIEST. MIDOLG)
ADDRESS O~ DfCED~T (~EE~
SOCIAL SECURIIY OR DEATH CEKTifi~.ATE NUMBE~
:ZOI- 07 -~t01~'
DAT[ OF DF. AT#
~NAME AND ADDRESS OF FERS~N REQUESTING THE OPENING OF T~E SAFE DEPOSIT BOX
~NAME AN[~ ADDRESS OF FINANg|AL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
DAlE Of CO~RA~ TO Rl~/BOX ~ NUM~ER OF BOX
/d e'~' V,' t I C, f~"q / )~¥/
BOX
(S;E~.T,aDDEE3 31 .... (cra,) (ST, rTE) ~P COD~ ....
11/16/2004 17:02 FAX 717 264 7129 F&M TRt~ST ~013
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIOI S ......
(1) Cash: Repeal total only.
(2! Stocks: Ltl! In detail every commQn 0¢ preferred certificate, wacrant oz' othe¢ righls found in box. Sto~s are
to bc dosiana, ad by name af campany, ce~ificat~ number date of ce~fica~e, name in which stoc~ s ~9istered,
and number of shares and dass of uock.
~3) Obligations of U. S. Gavernmenh Number a~ ilems, dale at issue, face value~ names ~n which
and lype of ownership, i.e., ioinlly held, payable on dealh, elc.
(4) Bendil Designal~ by nome, amount, serial number, o~ mher desJ~nmi~n. (Bea~er
(Si Bank and Sav~ngs and Loan Passbeo~s: Slase name ef depos~tor, numb~ of beak, ~st date appealing
book, name of bank end branch, and balance.
[6) Jewels, Coins, Stamp~, Manuscripls, eta: Usl and desc~e as ~fly as possible.
(7) Deeds, Me,gage,, Current Insurance Pelicie~ er ether evidences a~ inde~tedneu: LJU and descrlbe
fully as ~ssJble.
(B) All otke~ =entente.
V
REV-1510 EX+ (6-98~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RBTURN
RESIDENT DECEDENT
ESTATE OF
HELEN H. AUSTIN
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-04-0306
This schedule must be completed and filed if the answer to any of questions I through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE 'tHE NAME OF ~HE TR~=EREE, THEIR RELATION,~dlp TO 0ECEDENT A~ID DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DA~E OF TRANSFER~ ATTACH A COP? OF THE DEE~ FOR REN- ESTATE. VALUE OF ASSET INTEREST IIF A,=CLICABLEI VALUE
1. METLIFE ANNUITY CONTRACT NUMBER 071052400AB 50,000.00 100% 50,000.(:
INTEREST ACCRUED TO DATE OF DEATH 44,291.43 100% 44,291.4
2. F&M TRUST DEPARTMENT-IRA ACCT NO. 68060700 27,907.00 100% 27,907.{:
BENEFICIARY:PRESBYTERIAN HOMES INC.
MISSION FUND
TOTAL (Also enter on line 7 Recapitulation) $ 122,198.4:
(If more space is needed, insert additional sheets of the same size)
EV-1511 EX+ (12-99)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN H. AUSTIN
SCI~DULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21-04-0306
Debts of decedent must be reported on Schedule .
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
5.
6.
7.
8.
9.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) FARMERS AND MERCHANTS TRUST CO. & LYNN A, OBERG
SocialSecudtyNumber(s)/EINNumberofPersonaIRepresentatives EIN-23-0570230 SSN-201-40-5869
StreetAddress 20 SOUTH MAIN STREET P,O, BOX 6010 CHAMBERSBURG, PA 17201
City 801 GALLANT FOX LANE CRANBERRY TOWNSHIP
State PA Zip 16066
Year(s) Commission Paid: 2004
Attomey Fees TI~O'I_'H¥ S. SPO~S~LL~R
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State __Zip
Relationship of Claimant to Decedent
Probate Fees iRIg~IS~ER OF ~ILLS
Accountant's Fees
Tax Return Preparer's Fees
CARL SPIDEL-COIN APPRAISAL
NEWS CHRONICLE COMPANY-LEGAL ADVERTISING
CUMBERLAND LAW JOURNAL-LEGAL ADVERTISING
F & H-12,752.00
OBERG--3,188.00
12,752.00
366.00
25.00
101.00
75,00
TOTAL (Also enter on line 9, Recapitulation) $ 29,259.00
(If more space is needed, insert additional sheets of the same size)
11/16/2004 17:01 FAX 717 264 7129 F&~ TR['ST ~010
MetLife
Statement of Value of Annuity Contract
1. Name and address of Insurance Company
Metropolitan Ufe Insurance Company, One Madison Avenue, New York, NY 10010
2. Name of Annuitant 3. Date of Annuitant's Death I 4. Annuitant's Social Sec. NO.
Helen Austin 02/26/04 201 07 4015
5. Contract Number 6. Type of Annuity 7. Date of Issue
071 052 400 AB Nonqualified 08120192
8. Owner's Name 9, Aseignee'a Name 10. Date Assigned
(Attach copy of Appliostion) (Attach copy of assignment)
Helen Aunt. in N/A NIA
11. Name~s) of Beneficiary{les)
I~esbyterian Homes Inc
12. Description of Contract
Non~uaJifJed Tax Deferred Annuity
13. Value of annuity contract on date of death of Annuitant-~'~
$95,415,82. This represents the death benefit es follows: "~
AGcumulation Vsluc on Date of Death $94,291.43. Y,-"" '
Cost Basis/Return of Payments $50,000.00
Interest ~45,415,82
Total Payout $95,41, 5.82
14. How payable: One Sum
'~e Remarks
15. Remarks
The undersi~lned hereby, ceftlfies that (his statement sets forth t~ue and correct information.
16. Date of Certification Signature Title
duly 8, 2004 *~"~Z~*~,,,,,'~I/~,~' Claim Appro~',,
REV-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
EBTATE OF
HELEN H. AUSTIN
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21-04-0306
Include unreimbursed madical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
4.
RICHARD RUNDLE~MEDICAL CLAIMS SERVICE
SWAIM HEALTH CENTER-TELEPHONE SERVICE
PPL-UTILITIES
F & M TRUST FEES
5.00
21.20
74.59
195.72
TOTAL (Also enter on line 1 O, Recapitulation) $ 296.51
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX* (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAN RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN H. AUSTIN
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-04-0306
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Bo Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
LYNN A. OBERG
807 GALLANT FOX LANE
CRANBERRY TOWNSHIP, PENNSYLVANIA 16066
NIECE
5O%
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 g113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
PRESBYTERIAN HOMES, INC.
1217 STATE HILL ROAD
CAMP HILL, PENNSYLVANIA 17011
5O%
TOTAL OF PART,- 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)
LAST WILL AND TESTAMENT
I, HELEN H. AUSTIN, of 115 Green Ridge Lane, Newville, West Pennsbom Township,
Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revoking and making void
any and all wills by me at any time heretofore made.
HRST: I direct that all my just debts, funeral expenses and inheritance taxes shall be paid
by my Executors hereinafter named, as soon as may be convenient after my death.
SECOND: I hereby give and bequeath to my niece, Lynn Oberg, of Cranberry Township,
Pennsylvania, such items of my tangible personal property which she may desire.
THIRD: I give, devise and bequeath all of the rest, residue and remainder of my estate,
real, personal and mixed, whatsoever and wheresoever situate, as follows:
a. Fifty (50%) per cent thereof to my niece, Lynn Oberg, of Cranberry
Township, Pennsylvania; and
b. Fifty (50%) per cent thereof to Presbyterian Homes, Inc., of Camp Hill,
Pennsylvania, to be used exclusively for the financial support of residents of
facilities owned by Presbyterian Homes, Inc. who are in need.
FOURTH: I nominate, constitute and appoint Farmers and Merchants Trust Company of
Chambersburg, Pennsylvania and my niece, Lynn Oberg, as Co-Executors of this my Last Will and
Testament, without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this ~ O day of
. 94. (sEe)
Helen H. Austin, Testaffix
Signed, sealed, published and declared by the Testatrix,' HELEN H. AUSTIN, as and for
her Last Will and Testament, in the presence of us, who at her request signed this will as witnesses,
in the presence of the Testatrix, and of each other.
We, HELEN H. AUSTIN, Testatrix, and the Witnesses whose names are signed to the
foregoing ins~-urnent, being first duly swom/affn-med, do hereby declare to the undersigned
authority that the Testalrix signed and executed the foregoing instrument as her Last Will and that
she had signed willingly, and that she executed it as her free and voluntary act for the purposes
therein expressed, and that each of the Witnesses, in the presence and hearing of the Testatrix,
signed the Will as Witnesses and that to the best of the knowledge of each Witness, the Testatrix
was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or
undue influence.
Sworn/affirmed and subscribed to and
acknowledged ~,fore me this
~.~ C3". day of~.cL-~.~ Al ,2004.
I
V No blic
Helen H. Austin, Testatrix
Witness
Witness
?.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OFINDIVIDUAL TAXES
OEPT 280601
HARRISBURG, PA 17128-0§O1
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD O04669
FARMERS AND MERCHANTS TRUST CO
20 SOUTH MAIN STREET
PO BOX 6010
CHAMBERSBURG, PA 17201
fold
ESTATE INFORMATION: SSN: 201-07-4015
FILE NUMBER: 2104-0306
DECEDENT NAME: AUSTIN HELEN H
DATE OF PAYMENT: 11/24/2004
POSTMARK DATE: 11/24/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/2004
ACN
ASSESSMENT
CONTROL,
NUMBER
AMOUNT
101 ~9,019.69
TOTAL AMOUNT PAID:
69,019.69
REMARKS:
SEAL
CHECK//227969
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REY-1547 EX AFP 112-041
TIMOTHY S SPONSELLER
STE 215
14 N MAIN ST
CHAMBERSBURG PA 17201
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-07-2005
AUSTIN
02-26-2004
21 04-0306
CUMBERLAND
101
HElEN
H
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT'ALONG:PUS Lr..... ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
REv;r!\"f.ft--AF'~Cl1'"--6J'..N6i'.t'cE.oj!.iNHErtt'flN.cE.i''X'X.APPRA.isEiiEN'~.Ai:towlNCE.oR.............. ...
" ,,' DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF "';AUS1IN HElEN H FILE NO. 21 04-0306 ACN 101 DATE 03-07-2005
'-.).. TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
0-)
('v')
'....j ".""""'~ ': "':"'" '
< ''''- r,.... .;,'
RESERVATIbB CONC~8ING FUTURE INTEREST - SEE REVERSE
APPRAISEIt'<YALUE 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. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. 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
227,119.60
.00
122.198.43
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this forll with your
tax paYllent.
349,318.03
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage 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 Subject to Tax
(9)
(10)
29,259.00
296.51
(11)
(12)
(13)
(14)
29.555 51
319,762.52
220,980.48
98,782.04
I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
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:
.00 X
.00 X
.00 X
98,782.04 X
00 =
045 =
12 =
15 =
(19)=
.00
.00
.00
14,817 .31
14,817 .31
~
TAX ~REDITS:
,,~v~.. . T+) AMOUNT PAID
DATE NUtlBER INTEREST/PEN PAID (-)
05-26-2004 CD003978 740.87 14,250.00
11-24-2004 CD004669 .00 9,019.69
TOTAL TAX CREDIT 24,010.56
BALANCE OF TAX DUE 9,193.25CR
INTEREST AND PEN. .00
TOTAL DUE 9,193.25CR
. 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 "CREDlr" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV,147Q EX (6-68)
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO Box 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
FILE NUMBER
Helen H. Austin
REVIEWED BY
ACN
ANITA MCCULLY
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
G
Transfers are taxable outright to the beneficiaries before figuring residue.
ROW
2104-0306
101
Page 1
>!rr("/y~cr>
BUREAlI OF INDX~E.r~'j
IllERITAIICE TAX DIVISION L.t
PO lOX 28D611
HARRlsalJllS PA 17128-8601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
l:NHERl:TANCE TAX
STATEMENT OF ACCOUNT
..
REV-16D' EX AFP (03-05]
?nn< '\1')1'1 ?? >',l... . 11, : c:; L
,_,~"J h. "_..... t';.l vii
C.l FPV OF
'.,~-, ,,' ......
iT'! 1RT
TIMOTHY g ;~PDNSELI.E~ . ",/"
STE 215
14 N MAIN ST
CHAMBERS BURG PA 17201
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-28-2005
AUSTIN
02-26-2004
21 04-0306
CUMBERLAND
101
Aaount R_ittH
HEI.EN
H
i
,
MAKE CHECK PAYABLE AND REMIT PAY.,ENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your accGU1t, subllit the upper portion of this for. with your ~ ~t.
CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS ~ .
...............................................................................................................1
REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF AUSTIN HELEN H FILE NO.21 04-0306 ACN 101 DATE 3-28-2005
T1as STATEllENT xs PROVXDED TO AIIIIXSE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAIlED ESTATE. S BELOlI
IS A _RY OF THE PRIIICIPAL TAX DUE, APPLICATION OF ALL PAYltENTS, THE CURRENT BALANCE, AND, IF APr ICABLE,
A PROJECTED INTEREST FIguRE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 02-28-2005
PRINCIPAL TAX DUE, '14,817.31
PAYMENTS (TAX CREDITS),
~
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
CD003978 740.87 14,250.00 ,
05-26-2004 ,
11-24-2004 CD004669 .00 9,019.69
03-11-2005 REFUND .00 9,193.25-
,
TOTAL TAX CREDIT 1~,817 .31
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE I .00
. XF PAm AFTER THIS DATE. SEE REVERSE
SXDE FOR CALCULATION OF ADDnXONAL XNTEREST.
( XF TOTAL DUE IS LESS THAN .1,
NO PAYItENT XS REllUIRED.
XF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI,
YOU HAY BE DUE A REFllIIlI. SEE REVERSE SIDE OF THIS FORM FOR DSTRUCTXONS. I
~.!}'lf,.,
/.:0/ \~,....:\
{~( ~ ,-\
"1, "\
\~ ~,
~
~ _~_."____~ _,-,-t~"':'"f\!~il"jJ_ _.e~_____"L__ii_--..2 0_...,~--.~~
n::,.~~J1.~II,.(~r (IJIJi. W';) JLJ!.lLSi tUilL \0IULl!.JdllU!!Ck'l!.i::UlliUL 'LA,jltULJi.Jitl.j
STATUS REPORT lH\il}ER RULE 6,12
Name of Decedent: HELEN H. AUSTIN
Date of Death:
02/26/2004
Estate No.:
2004-00306
.
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 wh9her administration of the estate is complete:
Yes rEf 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. ~~~ [] p~~iia1 ~tative file a final accoUUt withtlie COurt? .
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the person~resentative state ~J. account LTlformally to the parties in
interest? Y es ~ 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.
s;?!ffr- .
Date:
II/flot
/
~:"
TIMOTHY S. SFONSELT.F.R. F.~QUTRE
Name
14 NORTH MAIN STREET, SUITE 215
CllAMBERSBURG, FA 17201
Address
7/;l~)fJ-3f3;
,
Telephone 1'To.
" ,
Ca-pacity: U 73oD.al P_eprescrr:a::i'vc
~ C.ol1.TI.se.l for persoTlal representative
\(1;
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/13/2006
SPONSELLER TIMOTHY S
14 NORTH MAIN STREET SUITE 215
CHAMBERS BURG I PA 17201
RE: Estate of AUSTIN HELEN H
File Number: 2004-00306
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS I COURT RULES I NO.
103 SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing is due by:
2/26/2006
Your prompt attention to this matter will be appreciated.
Thank You.
SincerelYI
In . Y' A~~L.mA1i
)tt/~--~j~T
".--.",..~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge