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HomeMy WebLinkAbout02-0075PETITION FOR PROBATE and GRANT OF LETTERS Estate .of'~l~-,f'~ //, /~--/Y~..~/:7.~ No. 21-02-75 also known as To: Deceased. Social Security No. / 7t~5 ~_/['~9 z~ qt9 '7 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executt-t~' in the last will of the above decedent, dated ()O73A'~A and codicil(s) dated Register of Wills for the County of _C~_~,-~?,~- ~/~//)in the Commonwealth of Pennsylvania named - ,19 (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in /'.7r'.~.~. ~_~-W~ a/Z) County, Pennsylvania, with h~r- last family or principal residence at I/~1 /~7~r~2/.~..~-~ ~a9. fT~.~,/~o Ad/// (list street, number and muncipality) Decen,dent,.theh;--)~ 7 years of age, died _ '~-7 '~Y ' as fgllows~, de,cedent d~d not marry, was not divorced and did not have a child born or adopted after execuuon of ~he,wfil offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~ , :. ~E Decendent at death-owned property with estimated values as follows: (If domiciled i~ff?.~.).~?~ All personal property (If not domi~ile&.in ~a.) Personal property in Pennsylvania (If not doinicile~d in>Pa.) Personal property in County Value of real est'rite in Pennsylvania situated as follows: $ WHEREFORE, petitioner(s) respectfully e_L~qBest(s) the,probate of the last will and codicil(s) presented herewith and the grant of letters ?~d/Yz~7~//~/~--- (testamentary; ~ministration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE :" COMMONWEALTH OF PENNSYLVANIA ~ COUNTY OF , ~,?U.~I~i3.ERL,.~M~D ~ 88 · ' ---~:~'~ 'q-~ .:7'~ ' ' ~':' The petlUon~r(s~boye-named :s'Eear(s) or affirm(s) that the statements ~n the foregoing pem~on are true and correct to-the/best'of the kn6&ledge and belief of petitioner(s) and that as personal represen- tative(s) of the abov~ decedent ,petitioner(s) will well' and trUly administer the estate according to law. Sworn to or-affirmed and subg~ribed 'V ~~~' ~~~~ ~ before me this 18th day of [ _ _ . - ~' /J~U~Y ~ ,.~J ~ _ ' ~ NO. 21-02-75 Estate Of NETTIE V KEMRER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JANUARY 23 x~2002.., in consideration o5",:he petitiou ,on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated OCTOBER 25, 1989 described therein be admitted to probate and filed of record as the last will of ~ NETTIE V KEMRER ; and Letters TESTAMENTARY are hereby granted to CONSTANCE C WEBB FEES Probate, Letters, Etc .......... $. 60.00 Short Certificates( ) .......... $. 9.00 6.00 ~gfua~es. latlon ................ $ JCP $ 5.00 TOTAL __ $ 80.00 Filed .. ,IA~.U. ARY..1.8,. 2.Q02 .............. ATTORNEY (Sup. Ct:I;D. No.) ADDRESS PHONE 105.805 REV 9/86 oHgii%l~ c~rtifi'Bate%Will 'W/~RNING:: l1 DECE OE NT 'S USUAL OCCU P~'ION -//KIND OF 8USINESS/INDUSI'Ry - OECEDENT'S ED h~erjr,:. ,- .>. LAST WILL AND TESTAMENT OF NETTLE V. KEMRER. 21-02-75 I, NETTIE V. KEMRER, of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, and revoke any and all Wills and Codicils previously made by me. ITEM I: I direct that all my just debts, funeral expenses and last medical expenses shal'l be paid from the assets of my estate as soon as practicable after my decease. ITEM II: Ail federal, state and other death taxes payable because of my death with respect t~ the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be'Paid out of the principal of my estate, without apportionment or right of reimbursement. ITEM III: I give, devise and bequeath all of my estate of every nature and wheresoever situate to my Granddaughter,. cOnstance C. Webb of Camp Hill, PA,. provided that she shall survive me by thirty (30) days. ITEM IV: I appoint my Granddaughter, Constance C. Webb, as the Executrix of this my Last Will ~and Testament. ITEM VIII: I direct that my Executrix, and her successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~5~ay of ~~_ , 1989. N~WfTiE V. KEMRER The preceding instrument, consisting of this and two other typewritten pages, was on the date thereof signed, published and declared by Nettie V. Kemrer, the testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. //~/f~'_/~ ~ Residing at ,~~-~/~ Re s idi ng at COMMONWEALTH OF PENNSYLVANIA : )SS: COUNTY OF DAUPHIN : WE, NETTIE V. KEMRER, Christine L. Swart~nd Ruth 1;~aits , the testatrix and the witnesses, respectfully, 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 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 their knowledge the testatrix was at the time eighteen years of age or older, of sound mind and under no constraint and undue influence. S ~ubscribed, sworn to and acknowledged before me, by Nettie ¥. Kemrer, the Testatrix, and subscribed and sworn to before me by ~.~'D$7~3~ ~.~0~_~_~and ~ ~OL~f~ , witnesses, this ~3~day of ~-~~ , 1989. Nota~ ~ubl ic My CommisSion Expires: tNOTARIAL SEAL KATHY E. FOLK ~' Commission Expires Apr'il G. 19~2 Harrisburg Oa~phin County ~£V-1500 EX + (6-00)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 0 0 7 COUNTY CODE YEAR ~ ~ NUMiR I- Z UJ Z O* ,n UJ n~ o Z Z 0 X DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL KEMRER, NE'I-RE V. DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) 01/06/2002 I 01/04/1 895 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 1 7 0-5 0-4 3 0 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r~l. Original Return El4. Limited Estate [~6. Decedent Died Testate (Attach copy of Will) E~9. Litigation Proceeds Received r~2. Supplemental Return ] 4a. Future Interest Compromise(datoofdeothefter12-12-82} E]7. Decedent Maintained a Living Trust (Attach copy ef Trust) r~ 10. Spousal Poverty Credit (dato ofdeathbetweon 12-3'1-91 and 1-1-95) [~]3. Remainder Return (date of death prior to 12-13-82) U5. Federal Estate Tax Return Required O 8. Total Number of Safe Deposit Boxes [--] 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS NAME Jill M. Wineka, Esquire. FIRM NAME (If Applcabb) Purcell, Krug & Hailer TELEPHONE NUMBER (717) 234-4178 1719 North Front Street Harrisburg, PA 17102 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) 34Z52~ 82 (Schedule E) .6. Jointly Owned Properly (Schedule F) (6) 1~,394.69 ] Separate Billing Requested ,r".: 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) '?'. (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 7,902.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 37.00 11. Total D~ductions (total Lines 9 & 10) (11) 12 Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) OFFICIAL USE ONLY 35,922.51 7,939.00 27,983.51 27,983.51 SEE INSTRUCTIONS ON REVERSE SIDE FOF~ 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 20. X __ (15) 27,983.51 X .045 (16) 1,259.26 X .12 (17) X .15 (18) (19) 1,259.26 'Decedent's'Complete Address: STREET ADDRESS 1191 Letchworth Road CITY Camp Hill, Tax Payments and Credits: 1~ Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty ISTATE PA IziP 17011 (1) 1,259.26~! 0.00 0.00 Total Credits ( A + B + C ) Total Interest/Penalty ( D + E ) (2) (3) 62.96-! 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 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. (4) (5) (5A) '(5B) 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; .............................. . .......................................... [] [] b. retain the right 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 consideratinn? .......................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death2 ............... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designati~2..: ............................................................................................... [] [] 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 d~clare that I have examined this return, including accompanying schedules and statements, and to the best of my know[edge and beief, it is true, correct and complete. Decbration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU~=~F PE~N RESPO.b~SIBLE F,OR F~II'J~ RETURN DATE ADDRESS Constance C. Webb, 1 191 Letchworth Road, Camp Hill, . PA 17011 SlGNATU~F~ O~F PREPARER OTHER TN(AN REPRFSENTATIVE ADDRESS Jill M. Wineka, Esquire, 1719 North Front Street, Harrisburg, ' DAT~ PA 17102 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 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 0% [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 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 fransfers 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. LAST WILL A~D TESTAMENT OF ~r~m~ V. ' KE.-~LR~ ER I, NETTIE V. KEMRER, of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, and revoke any and all Wills and Codicils previously made by. me. ITEM I: I direct that all my just debts, funeral expenses and last medical expenses shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: Ail federal, state and other death taxes payable because of my death with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with sudh tax, shall be considered a part of the expense of the administration of my estate and shall be paid out of the principal cf/my.'estate, without apportionment or right of reimbursement. ITEM III: I give, devise and bequeath all of my estate of every nature and wheresoever situate to my Granddaughter, Constance C. Webb of Camp Hill, PA, '"'provided that she shall survive me by thirty (30) days. IT~ IV: I appoint my Granddaughter, Constance C. Webb, as the Executrix of this my Last Will and Testament. ITEM VIII: I direct that my Executrix, and her successors, shall not be required to give'bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~'k-day of ~.~3~ ~(_.L____ , 1989. NETTIE V. KE~RER ~ The preceding instrument, consisting of this and two other typewritten pages, was on the date thereof signed, published and declared by Nettle V. Kemrer, the testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. //~/~Z~'_/. ~/5~ Residing at // ' 'REV-1508 EX* (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF FILE NUMBER KEMRER, NETTLE V, ;~1 0;~ 0075 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM NUMBER 1. ¸2. DESCRIPTION Allfirst Bank Certificate of Deposit No. 87008000177080 See attached Statement from Allfirst Bank) ~lembers 1st Federal Credit Union Savings Acct. No. 82363-00 See attached Statement from Members 1st Federal Credit Union) First Union National Bank Certificate of Deposit No. 247412063617066 (See attached Statement from First Union National Bank) Waypoint Bank Certificate of Deposit No. 409128205 Waypoint Bank Certificate of Deposit No. 416013088 Keystone Health Plan Central refund Misc. refund for internment OF DEATH 1,005.70 16,570.80 9,653.83 2,399.75 4,782.74 105.00 10.00 TOTAL (Also enter on line 5, Recapitulation) $ 34,527.82 (If more space is needed, insert additional sheets of the same size) Uall rst Allfirst Financial Center N.A. P.O. Box 900 Millsboro, DE 19966 February 25, 2002 Law Offices Purcell, Krug & Hailer 1719 North Front Street Harrisburg, PA 17102-2392 Dear Ms. Wineka: Estate of Nettie C. Kemrer Date of Death: January t5, 2002 Social Security Number: 170-50-4307 In response to your request, please be advised that at the time of death, the above- named decedent, had on deposit with this bank the following accounts. 1. Account T~pe ........................... Checking Account '~ Account Number. ...................... 0050841785 Ownership (Names oJ) ..............Nettie V. Kemrer or Constance C. Webb Opening Date ........................... 09/28/68 {account closed 02/19/02) Balance on Date of Deattt .........$2,789.17 Accrued Interest $ 0.21 Total ....................................... $2,789.38 These accounts were converted from the acquisition of another financial institution. Unfortunately, we are unable to access any reformation pertaining to the date the account was made joint Account Type ........................... Certificate of Deposit Account Number. ...................... 87008000177080 Ownership (Names ofl ..............Nettie V. Kemrer Opening Date ........................... 02/23/82 (account closed 02/19/02) Balance on Date of Death. .........$1,000.00 Accrued Interest $ 5.70 Total ....................................... $1,005.70 · Page 2 February 25, 2002 This letter does not include any accounts kn which the deceased may have been listed as power of attorney, 'custodian of uniform transfers, representat/ve payee, or trustee under a written trust agreement. For any additional information on these accounts, please contact our branch at: 344 South 104 Street Lemoyne, PA 17043-1707 Phone: {717) 737-3322 Sincerely, Charlene Warrington, Associate I (302) 934-2722 'Membersl FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT': Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 82363 -00 12/03/1986 $16,566.85 $3.95 $16,570.80 None Insurance Products Supervisor February22,2002 Estate of: NETTIE V. KEMRER Date of Death: 01/06/2002 Social Security Number: 170-50-4307 First Union National Bank Attn: Account Verifications P O Box 40028 Roanoke VA 24022-7313 Reference ID: 234167 February 13, 2002 PURCELL, KRUG & HALLER LAW OFFICES 1719 NORTH FRONT STREET HARRISBURG, PA 17102-2392 SUBJECT: Verification / Confirmation of Account and Balance Information provided for: NETTIE V KEMRER (SSN# 170-50-4307) Date of Death: January6, 2002 Account Type Deposit Account Information Account Date of Death Average Date Maturity Number Balance Balance* Opened Date CERTIFICATE OF DEPOSIT 247412063617066 LEGAL TITLE: NETTLE V. KEMRER $9,539.83 9/26/1985 '~ 3/26/2003 Interest Accrued YTD Date Rate Interest Interest Paid Closed $114.00 $0.00 * Due to system limitations, we can only provide a twelve month average balance on depository accouhts. No Safe Deposit Box found for customer. * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. c,qV o 00 '3 ~ Signature of De~osit0r~ Representative Julia Son'ells Depository Representative February 13, 2002 Date Servicenter Associate (540)563-7323 Title Phone Number sss; ag 001032 Wag LOOK FOR US. WE'LL GET YOU THERE,. 02/11/2002 PURCELL KRUG & HALLER 1719 N FRONT ST HARRISBURG PA 17102 The information which you requested on the account(s) of NETTIE KEMRER DECEASED (Social Security Number 170-50-4307) is/are as follows: Account Number 409128205 416013088 Class of Account CERTIFICATE CERTIFICATE Date Opened 05/23/77 01 / 16/81 Principal Balance 2398.65 4779.66 Accrued Interest 1.10 3.08 Balance at Date of 2399.75 4782.74 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established SOLE Account Number Class of Account Date Opened Principal Balance Accrued Interest ~, Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information' Requested PLEASE COMPLETE W-9 cerely, , SENIOR SERVICES REP. PO. Box 171 I. HARRISBURG PENNSYLVANIA 17105-1711 Toll I=r~ 1-866-WAYPOINT (!-866-9i~9-7646) · www.wagpointbanl<.com ~EV. 1509 EX. (1-97) ~ COMMONWEALTH OF'PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER KEMRER, NETTLE V, If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 0O75 SURVIVING JOINT TENANT(S) NAME A.' Constance C. Webb 1191 Letchworth Road Camp Hill, PA 17011 ADDRESS RELATIONSHIP TO DECEDENT Granddaughter JOiNTLY-OWNED PROPERTY: LETTER DATE . DESCRIPTION OF PROPERTY % OF DATE OF DEATH iTEM FOR JOINT MADE Inciude name of financial institution and bank account number or simibr identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for joint¥-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1.' A. 9-28-68 Allfirst Bank Checking Acct. No. 0050841785 2,789.38 50. 1,394.6~. (See attached Statement from Allflrst Bank) TOTAL (Also enter on line 6, Recapitulationi $ 1 ,394.6! (if more space is needed, insert additional sheets of the same size) CD~MC)~WF_ALT~ OF PE~NSYL¥^NI^ INI-IERIT^NCE T^× RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF KEMRER, NETTLE V, Debts of decedent must be reported on schedule I. FILE NUMBER ~1 Og 0075 ITEM NUMBER DESCRIPTION 8. 9. 10. 11. FUNERAL EXPENSES: Musselman Funeral Home, Inc. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / FIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Purcell, Krug & Hailer Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills State Zip Accountant's Fees Tax Return Preparer's Fees Register of Wills - Short Certificates Register of Wills - Short Certificates Register of Wills - J.C.P. fee Register of Wills - Inventory filing fee Register of Wills - PA Inheritance Tax Return filing fee AMOUNT 6,070.00 1,700.00 66.00 24.00 9.00 5.00 13.00 15.00 · TOTAL (Also enter on line 9, Recapitulation) $ 7,902.00 (If more space i? needed, insert additional sheets of the same size) REV-1512 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS ESTATE OF KEMRER. NETTLE V. Include unreimbursed medical expenses. FILE NUMBER ,2_,1 02 0075 ITEM NUMBER DESCRIPTION AMOUNT 1. Holy Spirt Hospital - medical services 37.00 TOTAL (Also enter on line 10', Recapitulation) 37.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9,~~ , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF I~IEMREF' NETTIE~ V, NUMBER [. 1. U. 1. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Constance C. Webb 1191 Letchworth Road Camp Hill, PA 17011 FILE NUMBER 2~1 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Granddaughter 1 00% 0075 AMOUNT OR SHARE 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 1.I - 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) BUREAU OF TNDTVTDUAL TAXES INHERITANCE TAX DZVTSTON DEPT. 180601 HARRISBURG, PA 17118-0601 JILL H NINEKA ESQ PURCELL ETAL 1719 N FRONT ST HBG CUT ALONG THIS LINE ~ COHHONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX REV-i$,~? EX AFP C01-02) Red .~e~ of Wii!s '02 It/tY 17 PZ:zll DATE. 05-13-2002 ESTATE OF KEHRER DATE OF DEATH 01-06-2002 FILE NUNBER 21 02-0075 COUNTY CUHBERLAND ACN 101 Amount Remitted HETTIE HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAIN LOWER PORTION FOR YOUR RECORDS ~ V REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF KEHRER NETT:[E V FILE NO. 21 02-0075 ACN 101 DATE 05-1:5-2002 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/PartnershAp Interest (Schedule C) ($) ~. Not,gages/No,es ReceAvable (Schedule D) (~) 5. Cash/Bank Deposits/Nisc. Person~l Property (Schedule E) (5) · 6. JoAntly Offned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTIONS: 9. Funeral Expenses/Adm. Costs/NAsc. Expenses (Schedule H) (9) 10. Debts/Nor~gage LAabAIAtAes/LAens (Schedule 1) (10) 11. Total Deductions 12. Net Value of Tax Return 15. lq. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate SubSect to Tax $~t527.82 1~$9~.69 .00 NOTE: To insure proper .00 credAt to your account, .00 submAt the upper portAon .00 of thAs form wAth your tax payment. (8) 7,902.00 $7.00 35,922.51 (11) 7. q-~9. (12) 27,985.51 (is) .'00 (i~) 27,98:5.51 NOTE: zf an assessment was issued previously, Z/nas 14,~ 15 and/or 16, 17, 18 and 19 w111 reflect f/gures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ at Spousal rate 16. Amoun~ of Line 1~ taxable at LAneal/Class A'rate 17. Amoun~ of LAne lfi at SAblAng rate 18. Amount of LAne lq taxable at Collateral/Class B rate 19. PrAncApal Tax Due TAX CREDITS: PAYflENT RECEIPT DZSCOUNT (+) DATE NUNBER INTEREST/PEN PAZD (-) O~-O2-ZOOZ CD001026 62.96 (15) .00 X O0 : (26) 27,98:5.51 x Oq5= (17) .00 x 12 : (18) .00 X 15 : (19)= AHOUNT PAID 1,196 .$0 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .0O 1,259.26 .00 .00 1,259.16 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,259.26 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. 1F TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTXONS: ADHIN- XSTRAT[VE CORRECTIONS: DISCOUNT: ·PENALTY: INTEREST: Estates of decedents dying on or before December 11, 19aZ -- if any future interest in the estate is transferred in ~ossessioh ar enjoyment toClass B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lamful Class S (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side: --Hake check or money order payable to: REGISTER OF N/LLS,. AGENT A refund of a tax credit, ~hich mas not requested on the Tax Return, may be requested by ~omplating an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications are available at the Office . of the Register of Hills, any'of the 25 Revenue Oistrict Offices, or by cmlllng the special Z4-hour ans~mring service f~r forms ordering: 1-800-361-2050; services for taxpayers ~ith ~pacJel hearing and / ar speaking needs: 1-800-447-3010 (TT only), : Any party in interest not satisfied ~ith the appraisement, allowance, or disallomance of daductions,*or assessment of tax (including discount or interest) as. sho~n on this Notice must object within sixty (60) days of rmceipt of this Notice by: --a~ittmn protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1011, - OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should bm addressed in ~riting to: PA Department of Revenue, * Bureau of individual Taxes, ATTN: Pest Assessment Reviem Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787~6505. See page 5 of the booklet "~nstructions for Inheritance Tax Return for a Resident Decedent" (REV-1SO1) for an explanation of administratively correctable errors. ' If any tax due i*s paid mithin three (3~ calendar months after the dacmdent's death, a five percent (51) discount of the tax.paid is a11o~md. The 151 tax amnesty non=p~rticipation penalty is computed on the total of the tax and interest assessed, and not: paid before January 18,. 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time perlod as you would appeal the tax and lnterest that has been assessed as indicated on this notice. [ntermst is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the data of death~ to the date o¥ payment. Taxes ~hich became delinquent before January 1, 1981 bear lnterast at the rate of six (61) percent per annum calculated at a daily'rate of .000164. All taxes ~hich became delinquent on and after. January l, 1982 ~ill bear interest at a rate mhich ~ill vary from calendar year to calendar year mith that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest 1982 ZOZ .000548 1992 9X 1983 161 .000458 ~- 1993-1994 · 71 1984 111 .000301 , 1995-1998 91 1985 13Z .000356 1999 71 1986 101 .00017~ ZOO0 81 1987 91 .000Z47 Z001 91 1988-1991 llZ .000~01 ' ZOOZ 61 --Interest is calculated es folloas: Rate Daily interest Factor .000247 .000191 .000147 .000192 .000119 .0001~7 .0D0164 TNTEREST = BALANCE OF TAX UNPAXD X NUNBER OF DAYS DEL,'rNQUENT X DAILY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the NotJce~ additional interest must be calculated. 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 REV-1162 EX(11-96) NO. CD 001026 PURCELL KRUG & HALLER ATTYS 1719 NORTH FRONT STREET HARRISBURG, PA 17102 ........ fold ESTATE INFORMATION: SSN: 170-50-4307 FILE NUMBER: 2102-0075 DECEDENT NAME: KEMRER NETTLE V DATE OF PAYMENT: 04/02/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/06/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,196.30 TOTAL AMOUNT PAID: $1,196.30 REMARKS: PURCELL KRUG & HALLER ATTYS SEAL CHECK# 48O97 INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS IN RE: ESTATE OF NETTLE V. KEMRER, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-0075 FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASF IN ESTATE OF NETTLE V. KEMRER, DECEASEI') KNOW ALL MEN BY THESE PRESENTS, that: WHEREAS, Nettle V. Kemrer, late of Lower Allen Township, Cumberland County, Pennsylvania, died testate on January 6, 2002: WHEREAS, Letters Testamentary on the Estate of the Decedent were duly issued by Mary C. Lewis, the Register of Wills of Cumberland County to the Executrix, Constance C. Webb on January 23, 2002; WHEREAS, the Executrix has gathered the assets of the Estate of the Decedent and the assets consist of personal property with a total liquidation value of $34,988.29, as set forth in the Statement of Account which is attached hereto and marked Exhibit "A"; WHEREAS, the Executrix has paid the debts of the Estate in the amount of $9,071.30, as set forth in the Statement of Account; WHEREAS, the Decedent's Granddaughter, Constance C. Webb, as the sole beneficiary of the Estate and the only party signing this Family Settlement Agreement and Final Release, previously acknowledged in writing her individual receipt of $20,000.00 paid on April 1, 2002 as a partial distribution of' her respective portion of the residuary Estate as set forth in the Acknowledgment of Partial Distribution which is attached hereto and marked Exhibit "B"; WHEREAS, the balance for distribution is in the amount of $5,986.99, which will be distributed in accordance with the Statement of Distribution which is attached hereto and marked Exhibit '%"; NOW, THEREFORE, I, Constance C. Webb, being the sole beneficiary of the assets of the Estate of Nettle V. Kemrer, do hereby acknowledge that I have received the liquidated proceeds of all assets due me by virtue of the Decedent's Last Will and Testament, as set forth on the Statement of Distribution attached hereto as Exhibit "C". AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and proposed schedule of distribution, agree that no account is necessary and I consent to distribution being made without the formal filing of an account and schedule of distribution, the same to be with the same force and effect as if the documents had been filed and confirmed by the Orphans' Court Division of the Court of Cumberland CountY. THEREFORE, I do hereby release and forever discharge Jill M. Wineka, Esquire and the law firm of Purcell, Krug & Hailer, the Attorneys for the Estate, their assigns, executors and administrators, from all actions, suits, payments, accounts, and claims whatsoe, ver, touchi'ng upon the Estate of the Decedent. I also agree that should any liability come due to the Estate of the said Decedent after th~ signing of this Agreement, I covenant and agree that I will be solely responsible for ;satisfying any and all taxes, liabilities, claims, demands, suits or causes of action which may be successfully prosecuted or assessed against the said Estate after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. IN WITNESS WHEREOF, I have set my hand and seal to the Family Settlement Agreement and Final Release on the date as indicated below. WITNESS: Constance C. Webb COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF ./~ pPH tA,[ : On this, the '7y'A day of -..~U~L-'- , 2002, before me, a Notary Public, the undersigned officer, personally appeared Constance C. Webb, known to me (or satisfactorily proven) to be the person who name is subscribed to the within instrument, and acknowledged that she executed this Family Settlement Agreement for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ': S L) ~. ~: c_ -~ /Notary Public :-.-~'L~': . .~ My Commission Expires: t NOTARIAL SEAL [ r~y. uommtssion E~ms ~ 17, 2OO3 IN RE: ESTATE OF NETTLE V. KEMRER, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND CO., PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-02-0075 ACKNOWLEDGMENT OF PARTIAL DISTRIBUTION KNOW ALL MEN, BY THESE PRESENTS, THAT the undersigned does hereby acknowledge that she has received from the ESTATE OF NETTLE V. KEMRER, the sum of TWENTY THOUSAND ($20,000.00) DOLLARS as a partial distribution of the sums of money owed to her. The acknowledgment of the partial distribution of Twenty Thousand ($20,000.00) Dollars is made without prejudice and in no way waives any objections Constance C. Webb may wish to later assert against the administration of the Estate of Nettie V. Kemrer. IN WITNESS WHEREOF, Constance C. Webb does hereunto set her hand and seal the ~'Z~day of CONSTANCE C. WEBB (estates~kemrer\partial release) EXHIBIT B STATEMENT OF DISTRIBUTION TOTAL GROSS ASSETS: Amount retained by beneficiary from refund for interment TOTAL NET ASSETS TOTAL GROSS DEBTS Amount of debtS paid directly by beneficiary when Estate was opened TOTAL NET DEBTS TOTAL FOR DISTRIBUTION Cash distribution previously made and acknowledged by beneficiary: Constance C. Webb- partial distribution on 4/1/02 BALANCE FOR CASH DISTRIBUTION: Constance C. Webb $34,988.29 $ 10.00 9,071.30 80.00 $20,000.00 $34,978.29 $ 8,991.30 $25,988.99 $ 5,986.99 $ 5,986.99 EXHIBIT C STATEMENT OF ACCOUNT ASSETS: AIIfirst Bank Certificate of Deposit No. 87008000177080 (liquidation value) Members 1st Federal Credit Union Savings Account No. 82363-00 (liquidation value) First Union National Bank Certificate of Deposit No. 247412063617066 (liquidation value) Waypoint Bank Certificate of Deposit No. 409128205 (liquidation value) Waypoint Bank Certificate of Deposit No. 416013088 (liquidation value) Keystone Health Plan Central refund Misc. refund for internment (retained by Executrix) Holy Spirit Hospital - refund of overpayment Allfirst Bank - Misc. Interest payment TOTAL ASSETS $ 999.50 16,603.19 9,701.83 2,409.66 4,810.47 105.00 10.00 337.00 11.64 $34,988.29 DEBTS: Register of Wills - Probate fees (paid by Executrix) Register of Wills - Short Certificates (paid by Executrix) Register of Wills - J.C.P. fee ( paid by Executrix) Register of Wills -'Short Certificates Musselman Funeral Home, Inc. - Fdneral bill Register of Wills - Fee to file Inventory Register of Wills - Fee to file Inheritance Tax Return Register of Wills, Agent - PA Inheritance Tax Holy Spirit Hospital- Hospital bill Register of Wills - Additional Probate fee invoiced by Register of Wills EXHIBIT A 66.00 9.00 5.00 24.00 6,070.00 13.00 15.00 1,196.30 337.00 10.00 PA Department of Revenue - 2001 Income Tax Due Register of Wills - Fee to file Family Settlement Agreement Purcell, Krug & Hailer - attorney's fees TOTAL DEBTS 34.00 17.00 1,275.00 $ 9,071.30 Name of Decedent' STATUS REPORT UNDER RULE 6.12 NETTLE V. KEMRER Date of Death' 1/6/2002 Will No 2002-00075 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of ' the administration of the above-captioned estate' State whether administration of the estate is complete' Yes )q No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete · · 3. If the answer to No. 1 is Yes, state the following: a. Did the personal repreqsentative file a final account with the Court ? Yes No ii b. The separate Orphans'Court No. (if any) for the personhl representative's account is' c. Did the personal representative state accoum infom~ally to the parties in interest ? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date' -Si~amre , .Jill M. Wineka, Esquire Name (Please type or print) 1719 North Front Street Harrisbur,q~ PA 17102 Address {(71 ) 7) 234-41 Tel. No. , Personal Representative X Counsel for personal representative IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: NETTIE V. KEMRER Date of Death: 1 /6/02 Will No. 2002-00075 Adm. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was sensed on or mailed to the following beneficiaries of the above-captioned estate on 2/6/02 Name Address Constance C. Webb 1191 Letchworth Road Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: _ Z ~ (z ~U Z- ~. -.. c:... ,~_ i,.: 3 r _;.. _ '~ i~ ~_ _~ :..: (Signature Name: Jill M. Wineka, Esquire Address: 1719 Narth Front Street Harrisburg, PA 17102 Telephone ((71) 7) 234- 41 Capacity: Personal Representative X Counsel for Personal Representative -J IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INVENTORY Estate of NETTIE V. KEMRER also known as Deceased No. 21 02 0075 Date of Death 116/02 Social Security No.170-50-4307 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. UWe verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Jill M. Wineka, Esquire I.D. No.: 58802 Address: 1719 North Front Street Harrisburg, PA 17102 Telephone: (717) 234-4178 Personal Representative /ifi/ cllilif'!~` L Constance C. Webb Dated ~ "_ 02 f' _ ~j _~ Description Allfirst Bank Certificate of Deposit No. 87008000177080 Members 1st Federal Credit Union Savings Account No. 82363-00 First Union National Bank Certificate of Deposit No. 247412063617066 Waypoint Bank Certificate of Deposit No. 409128205 Waypoint Bank Certificate of Deposit No. 416013088 Keystone Health Plan Central refund (Attach Additional Sheets if necessary) Value 1,005.70 16,570.80 9,653.83 2,399.75 4,782.74 105.00 Total 34,527.82 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory NETTIE V. KEMRER 21 02 0075 Page 1 Description of Inventory ~~.. ~_,