HomeMy WebLinkAbout02-0081PETITION FOR PROBATE and GRANT OF LETTERS
also known as To:
21-02-81
Deceased.
Social Security No. c~ / / ~ / f -' ff ~ ~ ~z
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the e3ecut
in the last will of the above c}ec,qdent, dated ~
and codicil(s) dated ~///./~
Register of W,);l, ls for .the .~ /
County of (Zc.c-r,.~~in the
Commonwealth of Pennsylvania
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~)~_..(/~4-~-~ _ CountyvPe. e.nnsylvz~ma, with
h .,6~ last family or principal residence.at '7/~--
(list stC~et, ~umber and mu~cipality)
De.ce13dent, then ~7 ~ , ,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 will. offered for probate; was not the victim of a killing and was never adjudicated
incompetent: /~¥//./L .
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 P~,~syz)/~nia $
situated as follows:
WHEREFORE, petitioner(s) respectfully r. equest(s) th¢~probate of the last will and codicil(s)
and the grant of letters _~'~-'9~
presented
herewith
(testamentary;~' 'administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF Cmm~.RLA~D
Thc petitioner(s) above-named swear(s) or affirm(s) that the statements in thc foregoing petition are
truc and correct to the best of thc knowledge and belief of petitioner(s) and that as personal represen-
tativc(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
wor. or
before me this 22nd day of
NO. 21-02-81
Estate of
CLARENCE KERLIN
,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 2.4 ....... :~211f12_, in consideration c
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JANUARY 3~ 2002
described therein be admitted to probate and filed of record as the last will of
CLARENCE KERLIN .
and Letters TESTAMENTARy
are hereby granted to BETTY J FREEBURN
FEES
Probate, Letters, Etc .......... $ 18.00
Short Certificates( ) .......... $ 3.00
x-pages 3.00
Renunciation ................
JCP FEE $. 5.00
TOTAL __ $ 29.00
Filed .. JAN. U. ARY. 24,. 2.0.02 ..............
ATTORNEY (Sup. C:. I.D. No.)
ADDRESS
PHONE
z
21-02-81
I do hereby make, constit~de and appoint
to be Execut.~/~ of this my last Will and Testament
IN WITNESS WHEREOF, I, ~9~ ~1~ ~ [4]~.~ , the
Testat above named, have hereunto subscribed my name and affixed my seal, the
in the year of our Lord ~n~ thousand
Signed, se~aled, p?~blished and declared by the the above named
as a~d for ~/~..last Will and Testam~ent, in the presence of us, wh.o have hereunto
s~tbscribed o?tr names a~'~ tO~~q~test as witnesses thereto in the presence of
said testat and of each other. ! / ~ '
...........................................
Z
21-02-81
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat
request of testat__
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19__
, sign the same and that signed as a witness at the
in h__ presence and (in the presence of each other) (in the presence of the
Register
(Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
she is familiar with the signature of CLARENCE KARl. TN ,
testat or of (a:~exx~xxqavrxa~aa~&41~gx~xK}t the will presented herewith and
~z~li~lrx
that she believes the signature on the will is in the handwriting of
CLARENCE KARLIN
to the best of. her knowledge and belief.
Sworn to or affirmed and subscribed before
me this 22nd day of
JANUARY :1~ 2002
//-- / ~/] ........ Register,
, Name)
(Address) [ 70 ~.~
(Name)
(Address)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
1.ocat Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee £or this certificate, $2.00
Local Registrar
No. Date
21-02-81
Rev. 2/87
NAME OF DECEDENT (First. M<klle. Last)
Clarence S. Kerlin
AGE (Last Birthday) UNDER 1 YEAR
74 Y~,.
COUNTY OF DEATH
Cumberland
DI=~I:uI;r4T'S USUAL OCCUPATION
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
SEX SOCIAL SECURITY NUMBER I DATE OF DEATH (Mo~lh. Day. Year)
,.male 1=.211 -- 18 -- 3224 14.Jan.9,2002
UNDER 1 DAY DATE OF RIRTH BIRTHPLACE (City and I PLACE OF DEATH (Check o~Jy o~e -- see instructions o~ other rode)
East Pennsboro ,,. Shore Health & Rehab. Ctr. 12"~'~,F""oR~'",'~=. I,,.white
I U.S. AR~M~DFORCES? IISmc~vo~vh~h~adac~m~e~ Ncv~rManm~.W~o~. (ll~e. givem~de, name)
,~.ransportation ~ ~--~ ~ 9 (~,2)
It~. I'~. t4.divOrced
DEo~.=~'s Pennsylvania ,~.~ ~ ~,,~ ~
(Give kind Ct work ~)ne du~ing mom
of v,o~kbtg life; ~o not use re, red )
,~. ruck driver
DECEDENT'S MAILING ADDRESS {streel. City/Town. State. Zip Code)
712 Ayres Ave. ~ teac
t~.[~mo:y~eF PA 17043
FATHER'S NAME (FirSi. M,:ldie. Laud)
Kerlin
INFORMANT'S NAME (Type/P,inl)
David S. Kerlin
METHOD OF DISPOSITION
[] ,,B.aan. 14,2002
MOTHER'S NAIdE (F,'sl. M~dle. Maiden Surname)
t~. Caro].±~e Ste~a_r~
INFORMANT'S MAILING ADDRES~ (~ree~. Cily/Town. State. Z~ Code
~.7 Spruce St. ,Mont Alto, PA17237
c .....
Indiantown Gap Nat. Cem. Annville,PA17003
I~tc.
NAME ~D AD.ESE OF E~,L,~
~D-013163-L ~ FH & (~,324 B3mel Av~m%me, P~17043
DATE PRONOUNCED DEAD (Momh. Day. Yeal) W~S CASE REFERRED TO MEDICAL EXAMINEPJCORONER?
~IAME AND ADORESS OF pE: PEE~SO~ SON WHO COMPLETED CAUSE OF DEATH
'.Item 27) Type or Print
~ATEFILED(Monlh. Day. Year) r 'r~-~ ~'~'~' ~'~ ,~ ~//~'
'MEDICAL EXAMINER/CORONER
On the buell, o.f a.xaminatlon and/or InvamtlgaUon, In my opinion, death o¢~urred mt the time, data, and place, and due to the cause(a) and
WAS AN AUTOPSY I MANNER OF DEATH DATE OF INJURY TiME OF INJURY INJURY AT WORK? DESCRIBE HOrN INJURY OCCURRED.
PERFORMED? I I(Month. Day. Year)
COMPLETION OF CAUSE
OF DEATH? Natural ~ Homicide []
· . . /~/building. otc (Specify)
*CERTIFYING PHYSICIAN (phys4cia~ ce~tdying cause o~ Oealh when another phySiCian has p~ono~nced deaih and c~np~eted Ilea 23)
TO the be~t of my know~dge, death oc~ur~d due to the caught) ind ........ tilted ........................................ LJ
LICENSE NUMBER DATE SIGNED (Monlh, Da',', Year)
* PRONOUNCIMO AND CERTII~flNG PHYBICtAN (Physician b°t~ I:~°°'J~c*~g dealh and certifying I0 cause ~ d~lh) 31d.
21-02-81
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing witness to the will presented herewith, (each) being duly qualified according to
law, depose(s) and say(s) that present and saw
the testat. , sign the same and that signed as a witness at the
request of testat.__ in h__ presence and (in the presence of each other) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this day of
19.__
(Name)
(Address)
(Name)
(Address)
Register
.I~GISTER OF WILLS OF Cm4~E~nA~p COUNTY
~TH OF NON-SUBSCRIBING WITNESS
~ a subscriber hereto, (each) being duly qualified according to, law, deposes) aod say(9 that
~ ~ familiar with the signature of ~/~e~m < ~ ~e.~'l~ ,
codicil
testat a~ of (one of the subscribing witnesses to) the ~ presented herewith and
codicil
that .~ believe~ the signature on the ~is in the handwriting of
to the best of_.~ ~/ knowledge and belief. A ~
Sworn to or affirmed and Subscribed before
me this 23rd day of
~. /Name)
(Address)
(Name)
(Address)
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent:
Date of Death:
Will No.
21-02-0081
Admin. No. 2002-00081
To the Register:
I certify that Notice of 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,=:~~ ~ ,2002.
Name Address
/~x z~Tq
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Capacity:
X Personal Representative
Counsel for Personal
Representative
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent:
Date of Death:
Will No.
21-02-0081
Admin. No. 2002-00081
To the Register:
I certify that Notice of 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 ~'~ /zz ,2002.
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Capacity:
X Personal Representative
Counsel for Personal
Representative
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
COUN~ CODE YEAR NUMBER
X
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DO-YEAR) t DATE'OF BIRTH (MM-DO-YEAR)
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. ANO MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
- Y.
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~-]1. Odginal Return
[--~4. Limited Estate
r--] 6. Decedent Died Testate (A~tacfl copy of Wdl)
[~9. Litigation Proceeds Received
E~]2. Supplemental Return
~--] 4a. Future Interest Compromise (date o{ deem a~te~ ~2-12`82)
E~]7. Decedent Maintained a Uving Trust (A~ch c~py olTn~sq
[----~ 10. Spousal PoverbJ Credit (date of deem be~,~een 12-31.91 and 1.1-9§)
E~]3. Remainder Return (dam of deem pc,~'to 12-13-82)
E~5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D'11. Election to tax under Sec. 9113(A) (Attach Sc~ O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
birr~
FIRM NAME (IfA~icable)
TELEPHONE NUMBER 7/~ ' 7 (~ 3 - ~ ~ '7 ~'.
COMPLETE MAILING ADDRESS
?1 ~. /~ y,c~z ..<'
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 PersonaE Property (5)
(Schedule E)
6. Jointly Owned Propert7 (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 & AdministralNe 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. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
¢$¢: °/.
(8)
(11)
(12)
(13)
(14)
OFFICIAL USE ONLY
15.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, o~ transfers under Sec. 9116 (a)(1.2)
x .0_ (15)
16. Amount of Line 14 taxable at lineal rate x .0 __ (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at c~llateral rate x .15 (18)
19. Tax Due (19)
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
ISTREETAOORESS .~[ j.. ~Fy,~/x~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credit~Payments
A. Spousal Pove~ Credit
B. Pdor Payments
C. Discount
(1)
ZIP
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E ) (3)
4. 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)
5. 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. (5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (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
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; ............................................ []
retain a reversionary interest; or .......................................................................................................................... []
c.
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 pedur'/, I declare ~hat I have examined this return, including accompanying sch~ules and statements, and to the best of my knowledge and belief, it is true, con,ct and complete.
Declare~n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE.,OF PERSON_RESPONSIBLE FOR FILING RETURN/'~"
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
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 twen¥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 benefictades is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 5, Recapitulation) $ ~..,~ ~,, ~----~1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1.
5.
6.
7.
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) ~ £ 7-7' ~ ~' /c"/'?t'~E/'~C//9/V.
Social Security Number(s) / EtN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
c~
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparers Fees
State Zip
,. C
0
TOTAL (Also enter on line 9, Recapitulation) $ 2 ~'~ ~ ~'- 0 cC
more space is needed, insert additional sheets of the same size)
BUREAU OF 'rND'rVZDUAL TAXES
ZNHERTTANCE TAX DI*VI'S]'ON
DEPT. 280601
HARRISBURG, PA 171Z8-0601
COMHONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLOWANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
BETTY J FREEBURN
717 AVFR~ AV~
DATE
ESTATE OF
DATE OF DEATH
FZLE NUMBER
~COUNTY
ACN
11-11-2002
KERLIN
01-09-2002
Z10Z-O08!
CUMBERLAND
101
REV-15gi7 EX AFP (81-g2)
CLARENCE
STATUS REPORT UNDE.R..RULE 6.12
Name of Decedent: G'/7~~'~
DateofDeath: ~ q7 ~00
Will No.: ~ ] --- o~ e O'2 -' J>/ 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:
1. State whether administration of the estate is complete:
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the angwer to No. 1 is Yes, state the following:
bo
Did the personal representative file a final account with the Court?
Yes _ No
The separate Orphans' Court No. (if any) for the Personal representative's
account is: ~
c. Did the personal r.[..~resentative state an account informally to the parties
in interest? Yes ~ No [--]
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Signature
Capacity:
Nallle
Betty J. Freeburn 1
712 Ayers Ave.
Lemoyne, PA 17043-1710
Address
Telephone No.
Personal Representative
Counsel for personal representative