HomeMy WebLinkAbout03-0892PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' "~"/Ito,~ ~Y~. '~-~ ~ 6 L~. t'~ No.
also known as To:
Deceased.
Social Security No. ~ 0 c) ~, ~ tt ~ ~ c~
Register of Wills for the
County of
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut r~ ~
in the last will of the above decedent, dated ~'~L] ~. ?
and codicil(s) dated
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~ v,~ 6 ~ c]-,~ ,v o . County, Pennsylvania, with
lastfamilyorprincipalresidenceat IYq /~t},,~d,~i.e t~n t~,~? #,/) Pp ltv;)
at
Decendent, then
(list street, number and muncipality)
"7 ~x years of age, died
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the w_ill offered for probate; was not the victim of.a killing and wlts never acljudicated
incompetent: [q~S~4.~ ~l//;,,/z UPp~' y d))~ ~u~Ap ~,~,~ I,,,.'o ~,.-~l'5 ~
Decendent at death owned property with estimated values as follows:
(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:
$ ~O0, oO rJ
$
$
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters.
theron.
request(s) the probate of the last will and codicil(s)
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Q ~\~c\c~~ ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief 9-[ petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well a?a/{rulj,/admi~ the estate according to law.
Sworn to or affirmed and subscribed ~~~
befor~me this ~ ....... day of ~
No. ~'
Estate Of ~x,~ ~
DECREE OF PROBATE AND GRANT OF LETTERS
, Deceased
AND NOW (~'~k~X_ ~, eQ. CN.3 ~ ~ ,., in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated ~Na. ~, ~ ~\;
described therein be admitted to probate and filed o~ recor~ as the last will of.
and Letters
are hereby granted
FEES
Probate, Letters, Etc ..........
Short Certificates( ) ..........
TOTAL
Filed iC~.:.~...q.-..0.3 ......................
-e~ter of Wi~ ~-~'~j
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
I, JANE M. BUSLER, of 149 Allendale Way, Camp Hill, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, to my son DONALD M. BUSLER, provided he survives
my death by thirty (30) days. Should my son predecease me or be deceased on the thirty-first
day after my death, I give and bequeath all such items and insurance thereon to those of his issue,
per stirpes, as survive my death by thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to my son DONALD M. BUSLER,
provided he survives my death by thirty (30) days. Should my son predecease me or be deceased
on the thirty-first day after my death, I give, devise, and bequeath all the rest, residue, and
remainder of my possessions and estate of every nature and wherever situate to those of his
issue, per stirpes, as survive my death by thirty (30) days.
ITEM IV. Should any beneficiary entitled to a share of my estate not have attained the
age of twenty-five (25) years at the time for distribution to him or her, I devise and bequeath the
share of such beneficiary to my hereinafter named trustee, IN SEPARATE TRUSTS, to hold,
manage, invest, and re-invest, the shares so received, and the accumulation of income thereon,
and to use and apply from time to time such portion of income and principal thereof as my
trustee thinks proper for the comfortable support, maintenance, health, welfare, and education of
the beneficiary(ies) or to make payment for such purposes, without further responsibility,
directly to such beneficiary(ies), or directly to any person taking care of such beneficiary(ies).
Any principal or income not so applied shall be distributed to such beneficiary when he or she
attains the age of twenty-five (25) years, or if he or she dies prior thereto, to his or her personal
representative.
ITEM V. I appoint my son DONALD M. BUSLER trustee of the trust or trusts created
by this my last will. Should my son predecease me or otherwise fail to qualify or cease to serve
as trustee of this my last will, I appoint my daughter-in-law MOLLY ANNE BUSLER trustee of
the trust or trusts created by this my last will.
In addition to the other powers and authorities granted to my trustee by Pennsylvania
Law and by the preceding paragraph of this my last will, I hereby give my trustee the following
special powers and authorities:
A. To retain any or all of the assets of my estate, real or personal
(including any stock or securities of any corporate fiduciaries), without any regard
to any principle of diversification, risk, or productivity;
2
B. To invest and re-invest in all forms of property without restriction to
investments authorized for Pennsylvania Fiduciaries, as my trustee deems proper,
without regard to any principle of diversification, risk or productivity;
C. To sell at public or private sale, to exchange or to lease, for any period
of time, any real or personal property and to give options for sales, exchanges, or
leases, for such prices and upon such terms or conditions as my trustee deems
proper and in the best interest of the beneficiary or beneficiaries of said trusts;
D. To allocate receipts and expenses to principal or income or partly to
each as my trustee from time to time deems proper in its sole discretion;
E. To compromise any claim or controversy;
F. To exercise any option, right, or privilege granted in insurance policies
or in any other investments;
G. My trustee may accumulate the income from this trust during the term
thereof but may, from time to time, distribute from current income or from
accumulated income or from principal such amounts as my trustee, in its sole
discretion, deems advisable for the education, welfare, and comfort of the trust
beneficiary.
ITEM VI. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM VII. I appoint my son DONALD M. BUSLER executor of this my last will.
Should my son predecease me or otherwise fail to qualify or cease to serve as executor of this my
last will, I appoint my daughter-in-law MOLLY ANNE BUSLER executrix of this my last will.
ITEM VIII. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
4
ITEM IX. I direct that my personal representatives and fiduciaries 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 this
, /c,~( 2003.
day of
JAN~' M. BUSLER
The preceding instrumem, consisting of this and FIVE other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by JANE M. BUSLER, 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.
6
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
)
(SS:
)
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free
and voluntary act for the purposes therein expressed..:)
JAN~ M. BUSLER
Sworn or affirmed to and acknowledged
before me by the testatrix named above
this, MI day of ~xxj~.j~C~ -~, , 2003.
)
( SS:
)
COUNTY OF CUMBERLAND
WE, .- i..... :: ; . and , the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testatrix sign and execute the instrument as her last will;
that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to
the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and
under no constraint or undue influence.
Sworn or affirmed to and acknowledged
betbre ,~ 24 day of
! ,2003.
7
Mxo~z~x~ L. B~6s
~_TTORNEY ~T L~W
~o~ SOUTH I~TH ~TREET
G~MP HILL. PENNSYLV2MNI2k 17011
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Will No.:
To the Register:
Jane M. Busler
October 23, 2003
21-03-0892
Admin. No:
I certify that notice of beneficial interest (estate administration) 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 October 30, 2003:
NAME ADDRESS
Donald M. Busler
550 Appalachian Avenue, Mechanicsburg, PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none.
Date:
MICHAEL L. BANGS, Esquire/~/
302 South 18th Street, Camp Hil~, PA 17011
(717) 730-7310
Capacity: Counsel for Personal Representative
COM~.,~ONWEALTH 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 003767
BUSLER DONALD M
550 APPALACHIAN AVE
MECHANICSBURG, PA 17055
fold
ESTATE INFORMATION: SSN: 209-24-4639
FILE NUMBER: 2103-0892
DECEDENT NAME: BUSLER JANE M
DATE OF PAYMENT: 04/05/2004
POSTMARK DATE: 04/02/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 10/23/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $18,176.33
REMARKS:
TOTAL AMOUNT PAID:
$18,176.33
SEAL
CHECK# 1027
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
429 SOUTH 18TM STREET
CAMP HILL, PA 17011
E-mail: mikebangs~verizon.nct
BAN iS LAW OFFICE
PHONE: 717-730-7310
FAX: 717-730-7374
MICHAEL L. BANGS, Attorney-at-Law
WENDY S. CHESBRO, Paralegai
April 2, 2004
WILLIAM E. MILLER, JR.
Of Counsel
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013/"
RE: Estate of/Tane M. Busier )
File No/21-03-0892
Dear Ms. Strasba~
Enclosed please find the following documents:
1. Two original Pennsylvania Inheritance Tax Returns; ~
2. An Inventory; and
3. A check in the amount of $18,176.33 to pay the tax shown to be due.
Please file the inheritance tax return and inventory accordingly. I have enclosed a separate check in the
amount of $25.00 to pay the filing fee for these documents. Please send me a filing receipt in the
enclosed, stamped, pre-addressed envelope.
If you have any questions or require anything further, please contact me directly.
wsc
Enclosures
cc: Mr. Donald M. Busler
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
cAPB
HpRL
EpIO
CRAC
KOTK
ES
C
O
R
R
E
S
REV-1500
INHERITANCE TAX RETURI
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Busler Jane M.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
10/23/2003 I 06/01/1931
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. original Return ~ 2~! SupplementaIReturn
4. Limited Estate . Future Interest Compromise (date of death after 1Z- 12-8Z)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
[~]9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit
(date of death between 1Z-31-91 and 1 - 1-95)
R
E
C
A
P
I
T
U
L
A
T
I
O
N
C
O
M
T
0
NAME
Michael L. Bangs
FIRM NAME (If Applicable)
OFFICIAL USE ONLY
FILE NUMBER
21-03-0892
COUNTYCOOE YEAR NUMBER
SOCIAL SECURITY NUMBER
209-24-4639
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
sOCIAL SECURITY NUMBER
TELEPHONE NUMBER
(date of death
3. Remainder Return prior to 1Z-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
Election to tax under Sec. 9113(A)
(Attach Sch O)
717/730-7310
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
COMPLETE MAILING ADDRESS
42q South 18th Street
Camp Hill, PA 17011
{3 C:
162,596~00
248,506,00
NOne
None
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & 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.
18,126.92
None
None
14,307.69
11,002.74
Charitable and Governmental 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2)
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
403,918.49
OFFICIAL ~3E ONLY
(8) 429,228.92
(11) 25,310.43
(lZ) 403,918.49
(13)
(14) 403,918.49
X .0 0 (lS) 0.00
X .0 45 (16) 18,176.33
X .12 (17) 0.00
X .15 (18) 0.00
(19) 18,176.33
Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREE~ ADDRESS
149 Allendale Way
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
3. Interest/Penalty if applicable D. Interest
E. Penalty
I
0.00
STATE
PA
IZIP
17011
(1)
18,176.33
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E ) (3)
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 (4)
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A, This is the BALANCE DUE.
0.00
0.00
0.00
18,176.33
0.00
18,176.33
(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
· retaintheuseorincomeofthepropertytransferred; .........................
. 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 consideration? ................................
3.Did decedent own an "in trust for" or payable upon death bank account or security 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 examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct.~ complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge,
SlGN7~/IRE ? P~I REyONSlBLE FOR FILING RETURN Donald Bus ler
,l/ ~ ";/ ! 550 Appalacian Ave.
/~~ Mechanlcsbur~, PA 17055
DATE
SI~NATUREOFPREPAREROTHER.T~HANREPRESENTATIVE MICH/~L L ~JX[7,S, ES~ DATE
//~; ~; · ~/~7 /~/'/~ ,~'~n South'18th Street'
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. e of the
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(aX1)].
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(aX1.3)]. 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.
Copyright (c) ZOO0 form software only T he Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00)
REV-1502 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
FILE NUMBER
Jane M. Busler SS~/ 209-24-4639 10/23/2003 21-03-0892
All real pro~,-ty owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with ricjht of survivorship must be disc..'o_~ed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 149 Allendale Way, Upper Allen Twp.
(Sold on 03/05/2004; see settlement sheet attached)
TOTAL (Also enter on line 1, Recapitulation)
162,596.00
$ 162,596.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97)
A. Settlement Statement u.s. Department of Housing and Urban Development
B. Type of Loan OMB No. 2502-0265 REV. HUD-1 (3/86) FINA[
2, E]FmHA 3, E]Conv, Unins. 6. File Number J ......... ' ...........
1, FIFHAJ 7, Loan Number 8. Modgage Insurance Case Number
4. I'qVA 5. IqConv. Ins. MT2004-19RCS
I his torm is furnished to give you a s atement ct actual settlement costs. Amounts paid to and by the settlement agent are ShOWn.
C, Note: Ilems marked "(p.o.c )" were paid outside the closing; they are shown here for information purposes and are not included in the totals TitJeExpress Settlement System
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon
conviction can include a fine and imprisonment For details see: Title 18 U. S. Code Section 1OO1 and Section 1010. Printed 03/02/2004 at 14:23 KLL
D. NAME OF BORROWER: Kathy Kyle
ADDRESS:
E. NAME OF SELLER: Estate of Jane M. Busier
ADDRESS:
F. NAME OF LENDER: Cash
ADDRESS:
G, PROPERTY ADDRESS: 149 Allendale Way, Camp Hill, PA 17011
Lower Allen Township
H, SETTLEMENT AGENT: Saidis, Shuff, Flower & Lindsay, Telephone: 717-243.6222 Fax: 717-243.6486
PLACE OF SETTLEMENT: 2109 Market Street, Camp Hill, PA 17011
I. SETTLEMENT DATE: 0310512004
J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales price 175,000.00 401. Contract sales price 175,000.00
102. Personal Property 402. Personal Properly
103. Settlement charges to borrower(line 1400) 3,002.88 403.
104. 4O4.
105, 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
107, County taxes 03/05/04to12131/04 568.33 407. County taxes 03105104to12131/04 568,33
108. SchooITaxes 03105104to06/30104 525.86 408. SchooITaxes 03105104to06130104 525.86
109. Sewer 03105104to03/31104 7.10 409. Sewer 03105104to03131104 7.10
110, Trash 03105104to03131104 14.60 410. Trash 03105104to03131104 14.60
111. 411,
112, 412.
120. GROSS AMOUNT DUE FROM BORROWER 179,118.77 420. GROSS AMOUNT DUE TO SELLER 176II15.89
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 5,000.00 501. Excess Deposit (see instructions)
202. Principal amount of new loans 502. Settlement charges to seller (line 1400) 13,519.89
203, Existin,q loan(s) taken subiect to 503. Existing loan(s) taken subject to
204. 504, Payoff of First Mort,qage Loan
205, 505,
206, 506.
207, 507,
2O8. 508,
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
213. 513.
214. 514.
215. 515.
216, 516,
217, 517,
218. 518.
219, 519,
220, TOTAL PAID BY/FOR BORROWER 5,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 13,519.89
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross amount due from borrower (line 120) 179,118.77 601. Gross amount due to seller (line 420) 176,115.89
302. Less amounts paid by/for borrower (line 220) 5,000.00 602. Less reduction amount due seller (line 520) 13,519.89
303. CASH FROM BORROWER 174~118.77 603, CASH TO SELLER 162,596.00
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained here n s important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return,
a negligence penalty or other sanction will be imposed on you if th s item is requ red o be repoded and the IRS determines that it has not been reported. The Contract Sales Price described on
line 401 above const tutes the Gross Proceeds of this transaction.
SELLER INSTRUCTIONS: If this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions,
complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040).
You are required by law to provide the settlement agent (Fed. Tax ID No: with your correct taxpayer identification number tf you do no prov de your correct taxpayer identification
number, you may be subject to civil or criminal penalties imposed by law. Under pena ties of per ury, certify that the number shown on this statement is my correct taxpayer identification number.
TIN: / SELLER(S) SIGNATURE(S): /
SELLER(S) NEW MAILING ADDRESS:
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: MT2004-19 FINAL PAGE 2
SETTLEMENT STATEMENT REV. HUD-1 (3/86) TitleExpress Settlement System Printed 03/02/2004 ~
L. SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SALES/BROKER'S COMMISSION based on price $175,000.00 ~ 6.000 = 10,500.00 BORROWER'S SELLER'S
Division of commission (line 700) as follows: FUNDS AT FUNDS AT
701. $ 5t275,00 to Glise Realty SE-I-TLEMENT SE1-FLEMENT
702. $ 5,225.00 to ERANRT, Inc.
703. Commission paid at Settlement 10,500.00
704. Transaction Fee to ERA NRT, INC./Glise Realty 100.00 125.00
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Ori.qination Fee %
802. Loan Discount %
803. Appraisal Fee
804. Credit Report
805. Lender's Inspection Fee
806. Mort.cla.qe Applicat on Fee
807. Assumption Fee
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. interest From to @$ /day
902. Mod.qa.qe Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. ~ $ /mo
1002. Mort.qa.qe Insurance mo. ~ $ /mo
1003. City Property Tax mo. ~, $ /mo
1004. County Property Tax mo. ~ $ 50.00/mo
1005. School Taxes mo. ~,, $ 135.55/mo
1009. A,q,qre,qate Analysis Adjustment
1100. TITLE CHARGES
1101. Settlement or closing fee
1102. Abstract or title search
1103. Title examination
1104. Title insurance binder
1105. Document Preparation
1106. Notary Fees to Saidis, Shufft Flower & Lindsay 4.00 4.00
1107. Attorney's fees to Michael Bangs, Esq. POC
(includes above items No: )
1108. Title Insurance to ACCP, Inc. 1,110.36
(includes above items No: )
1109. Lender's Policy
1110. Owner's Policy 175,000.00 - 1,110.38
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin.q Fees Deed $ 38.50 ; Mort.qa,qe $ ; Release $ 38.50
1202. City/County tax/stamps Deed $1,750.00 ; Mortgage $ 1 ~750.00
1203. State Tax/stamps Deed $1,750.00 ; Mod.clafle $ 1 ~750.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. 2004 CtyFFwp Tax to Bonnie Miller 686.89
1302. Home Warranty to Buyers Resale Warranty Corp. 449.00
1303. Tax Ced to Bonnie Miller 5.00
1304. Home Inspect/Pest/Radon to South Central BUYER POC
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K) 3,002.88 13,519.89
~...~J2~4~RPI~'~"t~Q.~YER AND SELLER
I h,a?e carefully reviewed the HUD-1 Settlement .~¢,et~,ment and. t~ th~.~e_st, of my knowledg~ and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me
in this trans~ify~. -~ ¢,ment Siatement,
Kathy Ky~e _~ttJ
estate of Jane M Busier l '
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN iNCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S, CODE SECTION 1OO1 AND SECTION 1010.
The HUD-1 Settlem,e. nt, Q~~ I have prepared is a true and accurate account of this transaction.
I have caused o~.will cause th,e, funds2~ be disbursed in accordance with this statement.
DA~..,/~
REV-1503 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
Jane M. Busier SS# 209-24-4639 10/23/2003
All property jointly-owned with right of survivorshil~ must be disclosed on Schedule F.
FILE NUMBER
21-03-0892
ITEM DESCRIPTION UNITVALUE VALUEATDATE
NUMBER OFDEATH
1 6,284.46 Bank Deposit Program 1.00 6,284.46
2 4,750.29 SB High Income Fund A 6.83 32,444.48
3 2,453.03 SB Appreciation Fund A 12.83 31,472.37
4 3,009.37 SB Fundamental Value A 12.24 36,834.69
5 7,331.76 Bank Deposit Program 1.00 7,331.76
6 5,074.28 SB Capital & Inc. A 14.43 73,221.86
7 594.96 SB Capital & Inc. B 14.33 8,525.78
8 2,671.21 SB High Income A 6.83 18,244.36
9 294.11 SB Muni High Inc A 14.72 4,329.30
10 4,450.29 SB Div Strat Inc A 6.70 29,816.94
TOTAL(Alsoenteronline2, Recapitulation) 248,506.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97)
SMITH BARNEY_
c t gmup-F
Jane M. Busler
Prices as of 10/23/03
IRA account
724-64631-16-334
Shares Description Price Value
6284.46 Bank Deposit Program $1.00 $6284.46
4750.29 SB High Income Fund A 6.83 32444.48
2453.03 SB Appreciation Fund A 12.83 31472.37
3009.37 SB Fundamental Value A 12.24 36834.69
TOTAL VALUE $107036.00
Individual account
724-09010-12-334
Shares Description Price Value
7331.76 Bank Deposit Program 1.00 $7331.76
5074.28 SB Capital & Inc A 14.43 73221.86
594.96 SB Capital & Inc B 14.33 8525.78
2671.21 SB High Income A 6.83 18244.36
294.11 SB Muni High Inc A 14.72 4329.30
4450.29 SB Div Strat Inc A 6.70 29816.94
TOTAL VALUE $141470.00
The information herein has been obtained from sources we believe to be
reliable, but do not guarantee its accuracy or completeness
Cifigroup Global Markets Inc.
11 North 3rd Street, 2nd Floor Harrisburg, PA 17101 Tel 717 780 1700 Fax 717 233 2090 Toll-free 800 237 1700
REV- 1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane M. Busler SS# 209-24-4639 10/23/2003 21-03-0892
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1
2
Citizens Bank - Account #6140171113
2002 Buick Park Avenue
VALUE AT DATE
OF DEATH
1,126.92
17,000.00
TOTAL (Also enter on line 5, Recapitulation) $ 18,126.92
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
TIRt ER
BUICK
COMPANY
"We take care of you"
December 8, 2003
To Whom It May Concern:
This appraisal for the estate of Jane M Busler 149 Allendale Way Camp Hill Pa. 17011
VIN. 1G4CW54K624136662 2002 Buick Park Avenue with 22063 miles.
Cash value $17000.00
Y
David M. Smith
USED CAR MGR.
4201 CHAMBERS HILL ROAD, HARRISBURG, PA 17111
(717) 564-2240 FAX (717) 564-2473
CITIZENS BANK
CITIZENS BANK
1510 CEDAR CLIFF DR
CAMP HILL PA 17011
OCT. 31, 2003
TO WHOM IT MAY CONCERN:
MS JANE BUSLER HAD A SAVINGS ACCOUNT WITH CITIZENS BANK, ACCOUNT
NUMBER 6140171113. THIS WAS IN HER NAME ONLY AND WAS OPENED 12/29/1972
AT THE TIME OF HER DEATH THIS ACCOUNT HAD A BALANCE OF 1126.92. THE
YEAR TO DATE INTREST EARNED WAS 2.29.
MELISSA AUMAN
TELLER MANAGER
717-731-4858
REV- 1511 EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane M. Busler SS~/ 209-24-4639 10/23/2003 21-03-0892
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
FUNERALEXPENSES:
Rolling Green Memorial Park
Parthemore Funeral Home
Parthemore Funeral Home & Cremation Services,
VFW New Cumberland - Funeral Luncheon
IRC.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees Bangs Law Office
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal
The Sentinel
State Zip
Estate Advertising
Estate Advertising
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
870.00
545.00
8,234.00
1,099.00
3,000.00
386.00
75.00
98.69
$ 14,307.69
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
REV-1512 EX + (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE T~0( RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Jane M. Busler SS~/ 209-24-4639 10/23/2003 21-03-0892
Include unreimbursed medical exl~enses.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Amerigas
Erie Insurance Group - Final Bill
Ewing Roofing - Roof Repairs
Expense - Verizon (11/1 to 11/30)
Expense - GM_AC (payoff of car loan)
Expense - Verizon
Ruell's Lawn Care
Verizon (10/19 to 11/13)
Verizon (10/19 to 11/18)
PA American Water Co. (10/3 to 11/3)
Comcast Cable
Messiah Village
Hospital Services
GM Card Services
PPL Electric Utilities
Verizon Wireless
PA American Water Co. (11/3 to 12/3)
Home Paramount Services
Internists of Central PA - Final Bill
Keystone Oil Company - Delivery/Invoice
Lower Allen Township - Sewer and Refuse
Telephone service
MCI Telephone Services
Total of Continuation Schedule(s)
79.42
7 00
75 00
36 75
7,710 36
59 64
143 00
14 95
37 38
18 38
8 95
1,438.44
9.00
714.75
106.22
4.96
16.23
47.69
7.46
24.76
73.35
7.65
6.27
355.13
TOTAL (Also enter on line 10, Recapitulation) $ 11,002.74
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97)
Estate of: Jane M. Busler
Soc Sec #: 209-24-4639
Date of Death: 10/23/2003
Continuation of Schedule I
(Debts of Decedent, Mortgage Liabilities and Liens)
Item Description
Amount
24 PA American Water Service 1/6/04 to 2/4/04
25 Water Service
26 PP&L Electric - Service 12/29/03 to 1/27/04
27 Electric Service
28 Ruell's Lawn Care Yard Maintenance
29 Verizon - Phone Service
30 Phone Service
16.03
15.79
38.15
41.72
170.00
36.72
36.72
355.13
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jane M. Busler SS# 209-24-4639
NUMBER
II.
SCHEDULE J
BENEFICIARIES
10/23/2003
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spou~l distributions, and
transfers under Sec. 9116~(1.Z)]
Donald Busler
550 Appalachian Avenue
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Son
FILE NUMBER
21-03-0892
AMOUNT OR SHARE
OF ESTATE
Entire
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
I, JANE M. BUSLER, of 149 Allendale Way, Camp Hill, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, to my son DONALD M. BUSLER, provided he survives
my death by thirty (30) days. Should my son predecease me or be deceased on the thirty-first
day after my death, I give and bequeath all such items and insurance thereon to those of his issue,
per stirpes, as survive my death by thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to my son DONALD M. BUSLER,
provided he survives my death by thirty (30) days. Should my son predecease me or be deceased
on the thirty-first day after my death, I give, devise, and bequeath all the rest, residue, and
remainder of my possessions and estate of every nature and wherever situate to those of his
issue, per stirpes, as survive my death by thirty (30) days.
ITEM IV. Should any beneficiary entitled to a share o£mv estate not have atta~.~ed
age of twenty-five (25) years at the time for distribution to him or her. I devise and bcc!uc~tn
share of such beneficiary to my hereinafter named trustee, IN SEPARATE TP, U ~'I-~. :, it,Icl,
manage, invest, and re-invest, the shares so received, and the accumulation of income
and to use and apply from time to time such portion of income and princi?al thereof a'~
trustee thinks proper for the comfortable support, maintenance, heahh, xvclfare, anti cciuc~ i~n of
the beneficiary(les) or to make payment for such purposes, without fi~rther re?onsi b ili~v
directly to such beneficiary(les), or directly to any person taking care o f such ben e fi ciarv
Any principal or income not so applied shall be distributed to such bencficiaD' when hc
attains the age of twenty-five (25) years, or if he or she dies prior thereto, to his or her
representative.
ITEM V. I appoint my son DONALD M. BUSLER trustee of the trust or trut4s ,:mazed
by this my last will. Should my son predecease me or otherwise flail to qualil%~ or cease t:) se:w,'
as trustee of this my last will, I appoint my daughter-in-law MOLt. Y ~XNNE I3(~S[.t(R
the trust or trusts created by this my last will.
In addition to the other powers and authorities granted to my trustee by Pennsvlv::ma
Law and by the preceding paragraph of this my last will. I hereby give my trustee the lbi 13wing
special powers and authorities:
A. To retain any or all of the assets of my estate, real or personal
(including any stock or securities of any corporate fiduciaries), without any
to any principle of diversification, risk, or productivity:
B. l'o invest and re-invest in all forms of property without restriction to
in., csm~nt.~ aulhorized for Pennsylvania Fiduciaries, as my trustee deems proper,
wit!a(~u~ regard to any principle of diversification, risk or productivity;
~'. 1'o sell at public or private sale, to exchange or to lease, for any period
of tinac, any real or personal property and to give options for sales, exchanges, or
ice, scs. i~)r such prices and upon such terms or conditions as my trustee deems
pr(?cr ~nd ia the best interest of the beneficiary or beneficiaries of said trusts;
I ). 1'o allocate receipts and expenses to principal or income or partly to
e:tci~ :~s my trustee from time to time deems proper in its sole discretion;
Il. '1~o compromise any claim or controversy;
}: ~ '?o exercise any option, right, or privilege granted in insurance policies
~:)r ,~,~ :my other investments;
G. My trustee may accumulate the income from this trust during the term
thereof but may, from time to time, distribute from current income or from
~cc~m~tlrrtcd income or from principal such mounts as my trustee, in its sole
di sc rct~oa, c~eems advisable for the education, welfare, and comfort of the trust
bcncfici~r).
ITEM V I. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation (,r 1:o v~)[untary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM VII. I appoint my son DONALD M. BUSLER executor of this my last will.
Should my son predecease me or otherwise fail to qualify or cease to serve as executor of this my
l asl w/Il, I appoint my daughter-in-law MOLLY ANNE BUSLER executrix of this my last will.
ITEM VIII. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
cr its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
4
I'I'EM IX. I direct that nay personal representatives and fiduciaries shall not be required
t: .... ._._,x'c bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this ..2 ! day of
· ~( ~ 2003.
.lANcE M. BUSLER
as wimesses hereto.
The preceding instrument, consisting of this and FIVE other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by JANE M. BUSLER, 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
6
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
)
( SS:
)
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free
and voluntary act for the purposes therein expressed.//)
JAN~ M. BUSLER
Sworn or affirmed to and acknowledged
before me by the testatrix named above
this day of ~MJ.t 1 ~4/-~ , 2003.
)
( SS:
)
Sworn or affirmed to and acknowledged
before~~. 2-( day of, 2003.
9tnrv p,,hll
7
COUNTY OF CUMBERLAND
WE, /~'~,,.~,c/~' /~,-v '~' and , the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testatrix sign and execute the instrument as her last will;
that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to
the best of our knowledge, the testatrix was at that time 1.8 or more years of age, of sound mind, and
under no constraint or undue influence.
HEATH L. ALLEN
N. DAVID RAHAL
CHARLES W, RUBENDALL Tr
ROBERT L. WELDON
EUGENE E. PEPINSKY. JR.
,JOHN H. ENOS T1-1'
GARY Ir. FRENCH
DONNA S. WELDON
BRADFORD DORRANCE
JEFFREY S. STOKES
ROBERT R. CHURCH
STEPHEN L. GROSE
R. SCOtt SHEARER
ELYSE E. ROGERS
CRAIG A. LONGYEAR
DONALD M. lEWIS trr
BRIDGET M. WHITIEY
UOHN A. FEICHTEL
ELIZABETH U. GOLDSTEIN
BARBARA a. GALL
STEPHANIE KLEINFEITER
Glenda Famer Strasbaugh
Register of Wills for Cumberland County
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of George B. Fox
No. 2003-0605
Dear Ms. Strasbaugh:
KeefeR WOOD ALLEN & RAHAL, LLP
210 WALNUT STREET
P. O. BOX 11963
HARRISBURG, PA 17108-1963
PHONE {717} 255-8000
EIN NO. :='3-0716135
www.keeferwood.com
April 2, 2004
ESTABLISHED IN 1878
OF COUNSEL:
SAMUEL C. HARRY
WEST SHORE OFFICE:
415 FALLOWFIELD ROAD
CAMP HILL, PA 17011
(717) 612-5800
WRITER'S CONTACT INFORMATION:
(717)255-8027
E-mail Address:
bwhitley~kee ferwood.com
Enclosed for filing, please find the following:
1. Two copies of the Pennsylvania Inheritance Tax Return for the Estate of George B. Fox
2. One copy of the Inventory, which is one page in length.
The tax due with the Pennsylvania Inheritance Tax return is $19.37. I enclose a check in this amount, payable to
"Register of Wills, Agent." I also enclose a check in the amount of $20 for the filing fee the inventory and tax return. This is a
spousal return, for which the filing fee is $10.
Please confirm your receipt and filing of the Pennsylvania Inheritance Tax Return and Inventory by date stamping the
enclosed confirmation copies of the first page of each. I enclose a self-addressed, stamped envelope for your use.
Thank you for your assistance in this matter.
Very truly yours,
KEEFER WOOD ALLEN & RAHAL, LLp
Bridget M. Whitley
Enclosures
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estate of Jane M. Busler
also known as
, Deceased
No. 21-03-0892
Date of Death 10/23/2003
Social Security No. 209-24-4639
Donald Busler,
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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/~Ve verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: Michael L. Ban~s
I.D. No.: 41263
Address: ~-']~3~,(~ South 18th Street
Camp Hill, PA 17011
Telephone: 717/730-7310
Personal RepresentatiV~
Signature:
bonal~ Busier
Signature:
Address: 550 Appalacian Ave.
Mechanicsbur~;, PA 17055
Telephone: 717/796-1539
D,ted:
Description
(See continuation page(s) attached)
(Attach additional sheets if necessary)
, ' Valu
Total: 429,228.92
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.
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-? (1992)
Estate of:
Date of Death:
County:
Jane M. Busler
10/23/2003
Cumberland
INVENTORY
CASH:
Citizens Bank - Account
#6140171113
PERSONAL PROPERTY:
2002 Buick Park Avenue
STOCKS/LISTED:
Bank Deposit Program
SB High Income Fund A
SB Appreciation Fund A
SB Fundamental Value A
Bank Deposit Program
5,074.28 SB Capital & Inc. A
SB Capital & Inc. B
2,671.21 SB High Income A
294.11 SB Muni High Inc A
4,450.29 SB Div Strat Inc A
1,126.92
17,000.00
6,284.46
32,444.48
31,472.37
36,834.69
7,331.76
73,221.86
8,525.78
18,244.36
4,329.30
29,816.94
1,126.92
17,000.00
248,506.00
-1-
REAL ESTATE/PA:
149 Allendale Way,
Twp.
Upper Allen
162,596.00
TOTAL RECEIPTS OF PRINCIPAL ...............
162,596.00
429,228.92
-2-
TO:
BANGS LAW OFFICE
429 South 18th Street
Camp Hill, PA 1701!
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
BUREAU OF ZNDTVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEMENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCT/ONS AND ASSESSMENT OF TAX
RE¥-1547 EX AFP (01-05)
MZCHAEL L BANGS
qZ9 S 18TH ST
CAMP HILL
'04 24
DATE
ESTATE OF
DATE OF DEATH
F/LE NUMBER
:~UNTY
ACN
05-Zq-2OOq
BUSLER
10-25-2005
21 05-0892
CUMBERLAND
101
Amount Remitted
JANE M
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGTSTER OF NILLS
CUMBERLAND CO COURT HOUSE
CARLTSLE, PA 1701:5
CUT ALONG TH/S LZNE ~"~ RETATN LONER PORTZON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTXCE OF ZNHERXTANCE TAX APPRAZSENENT, ALLONANCE OR D]:SALLOklANCE OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF BUSLER JANE MFXLE NO. 21 0:5-0892 ACN 101 DATE 05-2q-ZOOq
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( } CHANGED
RESERVATZON CONCERNZNG FUTURE TNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
q. Mortgages/Notes Rece/vabla (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jo/ntly Owned Property (Schedule F} (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9)
10. Dabts/Hortgaga Liabilities/Liens (Schedule 1) (10)
11. Total Deductions
12. Nat Valua of Tax Return
162~596.00
Zq8~506.00
.00
.00
18~126.92
.00
.00
(8)
lq,:507.69
11,002.7q
(11)
(12)
15.
lq.
NOTE:
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Nat Value of Estate Subject to Tax (lq)
]:f an assesseent was issued previously, lines 14, 15 and/or 16, 17,
reflect f/gures that /nclude the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of L/ne lq at Spousal rata (15)
16. Amount of Line lq taxable at LLneaZ/CZass A rata (16).
17. Amount of Line lq at Sibling rata (17).
18. Amount of L/ne lq taxable at Collateral/Class B rata (18)
19. Princ1~el Tax Due
RECEIPT
NUMBER
DZSCOUNT (+]
ZNTEREST/PEN PAZD (-)
· O0 x O0 =
qO3,918.q9 x Oq5=
· O0 x 12 =
. O0 x 15 =
(19)=
AMOUNT PAZD
TAX CREDZTS
PAYMENT
DATE
Oq-Og-ZOOq
CD00:5767
.00
18,176.$:5
ZF PAID AFTER DATE /NDZCATED, SEE REVERSE
FOR CALCULATZON OF ADDZTZONAL ZNTEREST.
NOTE: To insure proper
credit to your account,
submit the upper port/on
of this form w/th your
tax payment.
qZ9,ZZS.92
25.~10.~
R05,918.~9
.00
qO:5,918.q9
18 and 19 will
.00
18,176.55
.00
.00
18,176.:5:5
TOTAL TAX CREDIT
BALANCE OF TAX DUE
ZNTEREST AND PEN.
TOTAL DUE
18,176.:53
.00
.00
.00
( XF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUZRED.
ZF TOTAL DUE 1S REFLECTED AS A "CREDZT' (CR), YOU MAY BE DUE
A REFUND· SEE REVERSE SIDE OF TH[S FORM FOR /NSTRUCT/ONS.)
RESERVATION:
PURPOSE OF
NOTICE=
PAYMENT:
REFUND £CR):
OBJECTIONS:
ADMIN-
iSTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decadents dying on or before December 11, 1982 -- if any futura interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class 8 (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (71 P.S.
Sect[on 9140).
Detach the top portion of this Notice and submit with your paywent to the Register of Nills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" [REV-1513). Applications are available at the Office
of the Register of Nills, any of the Z$ Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-800-361-Z050~ services for taxpayers with special hearing and / or
speaking needs: 1-800-447-5010 (TT only).
Any party in interest not satisfied with the appraisement, allowance~ or disallowance of deductions, or assessment
of tax (incIuding discount or interest) as shown on this Notice must object within sixty [60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, 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 be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17118-0601
Phone (717) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SX) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is cowputed 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 sams manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rats
announced by the PA Department of Revenue. The applicable interest rates far 1981 through Z004 are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1982 ZOZ .000548 ~)'~'8 - 1991 11Z .OD0501
1983 161 .000438 1992 91 .000147
1984 llZ ,000501 1993-1994 72 .000191
1985 132 .000556 1995-1998 9Z .000147
1986 101 . 000174 1999 7Z . 00019Z
1987 IOZ . 000174 ZOO0 7Z . 000191
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9Z .000Z47
ZOOZ 61 .000164
2003 5Z .000157
Z004 4Z .000110
X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bm calculated.
REGISTER OF WILLS OF CUMBERLAND COUNTY
REPORT OF STATUS OF ADMINISTRATION
(For Resident Decedents Dying after July 1, 1984)
ESTATE NO. 21 - 03 - 0892
Name of Decedent:
Social Security No.:
JANE M. BUSLER
209-24-4639
Date of Death:
October 23, 2003
Name of Personal Representative:
Capacity Executor
(check one) Administrator
X
DONALD M. BUSLER
Administrator c.t.a.
Administrator d.b.n.
Is the administration of the estate complete? Yes X__ No
If "Yes", how was the administration ended? (check one)
By court accounting
By account stated to parties in interest
Did the parties release the
personal representative? Yes
Other (explain)
X
Total amount paid to date to creditors and for funeral and $45,201.31
administrative expenses
Total value of distributions to date to beneficiaries
$262,294.53
If administration is not complete, estimated value of assets $
still in administration
NOTE: This status report is due no later than the due date for filing of the Pennsylvania
inheritance tax return or, if no inheritance tax return is required, nine (9) months after the
date of death; if the administration of the estate has not been concluded, a summary report
shall be filed annually thereafter until the administration is complete.
I certify under penalty of perjury that the foregoing information is correct to the best of my
knowledge, information and belief.
MICHAI~L L. BANGS v
Attorney for Estate
ESTATE OF
JANE M. BUSLER,
Deceased
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-03-0892
RECEIPT AND RELEASE
'~: ; I, ~ONALD M. BUSLER, the undersigned, being a beneficiary under the Estate of Jane
r,.z~usler,,o:tecea~e~, do hereby:
1. State an acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received all sums of money and personal property to which I
am entitled as a beneficiary of the Estate of Jane M. Busier;
4. To the extent of said distribution, release DONALD M. BUSLER, Executor, of the
Estate of Jane M. Busier, and his heirs and personal representatives, from all liabilities, whether
due to his negligence or otherwise, which he may have by reason of his admirdstration of the
Estate;
5. Agree to refund to the Estate and to the said DONALD M. BUSLER, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
represematives, and assigns.
WITI'qES~S WHEREOF, I have hereunto set my hand and seal this ~day
~~/~.' 2004. ' '~/~ ~ (SEAL)
DONALD 19I. BUSLER
of
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
On this, the ~ day of ~[~~ ,2004, before me, the
undersigned officer, personally appe~ed'l~0..N_A~LD M. BUSLER, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that (s)he executed same for the purposes therei~ contained.
1
IN WITNESS WHEREOF,J-~ l~repto sci m~ h~t and official seal.
y :c