HomeMy WebLinkAbout04-0369 PETITION FOR PROBATE and GRANT OF LETTERS
state o: Jewell S. retz No. ?
also known as Jewell Sprenkle Bretz To:
Register of Wills for the
Social Security No. 182-/40-8025' Deceased. County of Cumberland
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who ix/are 18 years of age or older an the executrices
in the last will of the above decedent, dated October 5, 2001
and codicil(s) dated
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland Cqpnty, Pe~Rr~sylva~ia, with
h er last family or principal residence at 105lB Allendale Rd., upper At.ten 'x'wp.,
Cumberland County, PA
(list street, number and muncipality)
Decendent, then 90 years of age, died March 31, 2004
at Holy Spirit HospiCe--i, E. Pennsboro Twp., Cumberland County, P/~ "
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:
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:
70,000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary '
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
~, ~ ~---Carol Br,etz~/Bax~d'~ Judith B. Wertz
~:~ 30 N. 41s~ St., Camp Hill, PA 17011 900 Cocklin St., Mechanicsburg, PA
17055
tative(s) of the above decedent petitioner(s) will well and truly adm_inister tb, e estate
Sworn to or affir.med and subscribed
befor~ me t~is /~ ~ day of ~, CA~L ~ ~, ,
--~ ~egtster t
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF CUMBERLAND ; Se3
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 of petitioner(s) and that as personal represen-
according to law.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21
COUNTY CODE
-- 2004 00369
yEAR NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~ Bretz, Jewell S 182-40-8025
z
LU DATE OF DEATH (MM DD YEAR) DATE OF BIRTH (MM DD YEAR) THIS RETURN MUST SE F~LED IN [3UpUCATE WiTH THE
~ 03/24/1914
LB 03/31/2004 REGISTER OF WILLS
LB IE APPLICABLE) SURVIVING SPOUSE'S NAME(LAST FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I--I'd [~ 10riginalReturn E~ 2 SupplementalReturn [~ 3 RemainderReturn(dateoldeampriorto121382)
~ 4 Umited Estate ~ 4a Future Interest Compromise (Date of death, afier ~2-12-82) ~ 5 Federal Estate Tax Return Required
~O~O E~ 6 DecedentDiedTestate(Attachco~yofWill) [~ 7 Decedent Maintained a Livir~g Trust (AttachcopyofT,usb ~ 8 TotalNumberofSafeDepositBoxes
~ 9 L,tigation Proceeds Received b~ 10 Spousal Poverty C ed /dated deamb.t,*ee. 1Z3~.91a.d1195) ~ 11 Election totaxunderSec 9113(A)(A~ta~hSChO)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Z
NAME
Gerald J. Shekletski, Esq.
FIRM NAME(ffApplicable)
Stone, Lafaver & Shekletski
~LEPHONENUMBER
(717) 774-7435
ICOMPLE~ MAIL[NGADDRESS
~414 Bridge St.
P.O. Box E
New Cumberland, PA 17070
1 Rea] Estate (Schedule A) (1)
2 Stocks and Bonds (Schedule B) (2)
3 Closely Held Corporation Paflnership or Sole-Proprietorship (3)
4 Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6 Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
7 Inter-Vivos Transfers & Miscellaneous Non-Probate Properiy (7)
(Schedule G or L)
8 Total Gross Assets (total Lines 1 7)
9 Funeral Expenses & Administrative Costs (Schedule R) (9)
10 Debts of Decedent, Modgage Liabilities, & Liens (S~edu~e I) (10)
11 Total Deductions (totat Lines 9 & 10)
12.Net Value of Estate (Line 8 minus Line 11 )
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an etection to tax has no~ been
made (Schedule J)
14 Net Value SubjecttoTax(Line 12 minus Line13)
o .iQ0
51,981 .~9
0.00
(8)
OFFICIAL U ~)NLy
88,032.79
14,104.34
0.00
14,104.34
73,928.45
0.00
73,928.45
(12)
(13)
(14)
BEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15 Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec 9116 (a}(1 2)
16 Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18 Amount of Line 14 taxable at collateral rate.
19 Tax Due
0. O0 x .o0 (15)
73,928.45 xo4~ (16)
0.00 x 12 (17)
0 . 00 x 15 (18)
(19)
0.00
3,326.78
0.00
0.00
3,326.78
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
2W4645 1000
Decedent's Complete Address:
! STREET ADDRESS
!1057B Allendale Road
Mechanicsburg
Tax Payments and Credits:
1 Tax Due (Page 1 Line 19)
2 Credits/Payments
A Spousal Poverty Credit 0.00
B Prior Payments 3,000.00
C Discount 150.00
3 Interest/Penalty if applicable
D Interest 0.00
E Penalty 0,00
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
(1) 3,326.78
3,150.00
0.00
4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I 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) 176.78
A. Enter the interest on the taxdue
(5A) O, O0
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(5B) 176.78
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and:
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 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 ha',~ examined this return including accompanying schedules a~d statements, and to the best of my knowledge and belief, it is true, correct and complete
SIGNATURE OF PERSON RESPONSIBI~;OR FILING RE3~
AD~/P>F~S 30 North 4~,st3t.~ , 2
gSS 414 Brid~reg '
New C~and, PA 17070
DATE
For dates of death on or after July 1, 1994 and before Jan uary 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 § 9916 (a) (1.1) (0]
For dates of death on or after Jan uaw 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 su~iving 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 PS. § 9116(a){1.2)].
The tax rate imposed on the net value of transfers to or for the use of the deced ent's lineal beneficiaries is 4 5a/~, except as noted in 72 PS. § 9116(1 2 ) [72 PS § 9116(a)(t )]
The tax rate imposed on the net value of transfers to o~ for the use of the decedenPs siblings is 12% {72 PS § 911S(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.
2W4646 1 000
Estate of: Jewell S Bretz
Judith B Wertz
900 Cocklin St.
Mechanicsburg, PA 17055
182-40-8025
Co- Executrix
LAST WILL AND TESTAMENT
OF
JEWELL S. BRETZ
I, JEWELL S. BRETZ, of 1057 Allendale Road, Apt. B,
Mechanicsburg, Cumberland County, Pennsylvania, declare this
last will and revoke any will previously m~e by me.
ITEM I: I devise and bequeath all of ny estate of every nature
and wherever situate, in equal shares to such of my daughters, CAROL
BRETZ BURD, JUDITH B. WERTZ, and JACQUELINE L. BAKER, who survive me.
Should any of my children predecease me, I devise and bequeath the
share of such child to her issue, per stirpes; and should any such
child of mine leave no such issue living at the time of my death, I
devise and bequeath the share of such child to my issue, per stirpes,
living at the
ITEM II:
WERTZ,
to be my
time of my death.
I appoint my daughters, CAROL BRETZ BURD and JUDITH B.
Co-Executrices of this my last will.
Page 1 of 4
ITEM III:
post bond or enter security for the faithful performance
No fiduciary acting hereunder shall be required to
of her duties
in any jurisdiction.
IN WITNESS W~EREOF, I,
and seal this ~'~v./ day of
JEWELL S. BRETZ, have hereunto set my hand
,
~/~ ~ JEWELL S. BRETZ ~
SIGNED, SEALED, PUBLISHED and DECLARED by JEWELL S. BRETZ, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other,
Witness
Witness
have subscribed our names as witnesses.
Address
Address
Page 1 of 4
COMMONWEALTH OF PENNSYLVANIA)
)
COUNTY OF CUMBERLAND )
SS.
I, JEWELL S. BRETZ, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed this instru-
ment as my Last Will; that I
as my free and voluntary act
Sworn to or affirmed
BRETZ, the Testatrix, this
NOTARIAL SEAL
R. LUCI<,KY, Not,r/Public
O' ,~.,,~-I~,d Boro. Cu,mberi~nd
signed it willingly and that I signed it
for the purposes therein contained.
ELL S. BRET~ ~
to and acknowledged before me by JEWELL S.
day of (~P~m-~ , 2001.
Notary Pu~-~c
COMMONWEALTH OF PENNSYLVANIA)
) SS.
COUNTY OF CUMBERLJ%ND )
we,
the witnesses, whose names are signed
to the attached or foregoing
instrument being duly qualified according to law, do depose and say
Page 1 of 4
that we were present and saw Testatrix sign and execute the instrument
as her Last Will; that Testatrix signed willingly and that she exe-
cuted 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; that to the best of our knowledge, the
Testatrix was at the time eighteen years of age or more, of sound mind
and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by
~S ~. ~ and
witnesses, this ~ day of ~d~-~ , 2001,
- ~qot ary ~ic
Page 1 of 4
REV-1508 EX + (1 97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Bretz, Jewell S 21-2004-00369
Include the proceed s of litigation and the date the proceeds were received by the estate All prope~ joingy-owned with the right of su~ivorship must be disclosed on Schedule F,
iTEM i VALUE AT DATE
NUMBERi DESCRIPTION OF D~TH
1i PNC Bank Savings Account #5000882843 51,074.75
2 Apartment Rent Rebate 289.38
3 !Apartment lease security deposit refund 102.00
4 iErie Insurance refund/renter's insurance 154.00
5 !Highmark Blue Shield Insurance refund 197.16
6 Patriot News refund check 164.30
TOTAL (Also enter on line 5. Recapitulation) $ 5 1,981 . 5 9
2W46AD 2 000 (If more space is needed, insert additional sheets of the same size)
PN CBAN<
June 23, 2004
Gerald J. Shekletskt
414 Bridge Street
P.O. Box E
New Cumberland, PA 17070
Estate of Jewel S. Bretz. deceased
SSN: 182-40 802>
DOD: 3/31/2004
Dear Mr Shekletski:
in response to your request for Date o f Deal balances tut the customer noted above, our
records show the following:
Savings Account
Account #5000882843
JEW'ELL S BR_ETZ
DOD balance: S51,060.$8 + $13.87 accrued interest
Established 10/20/1998
Please note that this office ordy provides date of death balances for deposit accounts
(LKAs, CDs, Chee -king and Savings accounts), We do not process any tinancial
transactions or provide statements. If you need assistance with any of these items,
please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
Rachelle Wells
1-800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
M,tuber FDIC
TOTAL
REV 1509 EX + {1 97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Bretz, Jewell S 21-2004-00369
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G,
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A Bretz Burd, Carol Daughter
B Wertz, Judith B
C Baker, Jacqueline L
30 North 41st St.
Ca~p Hill, PA 17011
900 Cocklin St.
Mechanicsburg, PA 17055
687 Ports Bill Road
Etters, PA 17319
Daughter
Daughter
JOiNTLY-OWNED PROPERTY:
L~Tn- R DATE DESCRIP~ON OF PROPER~ %OF DA~ OF DEATH
ITEM FO~ JO'~ MADE Include name of financial instit ut[on and bank account number o¢ DA~ OF DEATH DECD'S VALUE OF
NUMBER TE~ JOINT similar identif?ng numbe¢ ~tach deed far jointly.held real estate VALUE OE ASSET INTEREST DECEDENTS IN.REST
1 ~ 12/22/1984 Waypoint Bank Checking 5,116.11 33.33 1,705.20
Account #90349523
2 s 02/01/2001 United States Series EE 45,420.00 50.00 22,710.00
Savings Bonds, X5601883EE,
X5601882EE, X5601884EE,
X5601885EE, X5601886EE and
X5601887EE, and United
States Series I Savings
Bond X001118802I (Copies of
Bonds attached hereto).
3 A 04/01/2001 United States Series I 11,636.00 50.00 5,818.00
Savings Bond X001133461I
(Copy of Bond attached
hereto).
4 c 04/01/2001 United States Series I 11,636.00 50.00 5,818.00
Savings Bond X001133462I
(Copy of Bond attached
hereto).
TOTAL(Alsoenteronline6, Recapitulation) $ 36,051.20
2W46AE 2000 (If more space is needed, insed additional sheets of same size)
LOO]( FOIR US. ¥~/E'LI. TET YOU TI-JERE.
612812004
STONE LAFAVER & SHEKLETSKI
414 BRIDGE ST PO BOX E
NEW CUMBERLAND PA 17070
The information which you requested on the account(s) of JEWELL S BRETZ
(Social Security Number 182-40-8025 ) is/are as £ollows:
Account Nnmber
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
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
90349523
CHECKING
122284
5115.97
.14
5116.11
JTO
JUDITH
WERTZ OR
122284
Additional
Information
Requested
SENIOR SERVICES REP.
P.O. Box 171 I, HARRISBURG. PENNSYLVANIA 17105-1711
Toll FrE~ 1-866-WAYPOIN? (I-1~66-9~9-7646) · IN YORK ARC. A 717/815-4500 · www. wagpointbank.com
Savings Bond Calculator Page
03/2004
Ui)date
Help
Savinc
Series
Bonds
Denomination
$10,000
Serial Number
Issue Date
# Bunds
9
Serial Number
X00I 118802I
X0011334621
X001133461I
×5601887EE
XS601886EE
X5601885EE
X5601884EE
X5601882EE
X5601883EE
Total Price Total Interest Total Value
S60,000.00 $8,692.00 $68,692.00
Issue Issue Interest
Date Series Denom Price Interest Value Rate
02/2001 I $10,000 S10~000.00 $1,772.00 $11,772.00 4.50%
04/2001 I 10,000 10,000.00 1,636.00 11,636.00 7.00%
04/2001 I 10,000 10,000.00 1,636.00 11,636.00 7.00%
02/2001 EE 10,000 5,000.00 608.00 5,608.00 2.61%
02/2001 EE 10,000 5,000.00 608.00 5,608.00 2.61%
02/2001 EE 10,000 5,000.00 608.00 5,608.00 2.61%
02/2001 EE 10,000 5,000.00 608.00 5,608.00 2.61%
02/2001 EE 10,000 5,000.00 608.00 5,608.00 2.61%
02/2001 EE 10,000 5,000.00 608.00 5,608.00 2.61%
YTD In
$784.
Next Final
Accrual Maturil:
04/2004 02/203 ~
04/2004 04/2031
04/2004 04/203 I
04/2004 02/203~
04/2004 02/203 i
04/2004 02/203
04/2004 02/203 ~
04/2004 02/203 [
04/2004 02/203 l
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
ME Matured (Exchangeable for HH)
MN Matured (Not Exchangeable for HH)
Please rate this service.
(Please print and/or save this page before submitting your survey)
Service Excellent Good Fair
Savings Bond Calculator
Submit Survey I . Reset
Poor
http://wwws.publicdebt.tmas.gov/BC/SBCPrice 5/4/2004
3HANICSBURG
17055-4461
iX,SG0188SF'
182 40 8025 02 200~
~ -~.; ~l;"[ 7}, JEWELL S BRETZ .. ..... '-.
~'~-¢,., ]~.~ ~. ,FRB P ITT
~2~' ~ : 1061 I ALLENDALE RD " ~ '
INX~[ ~ .... MECHAN~CSBURG PA 17055-~&1 "
~"~/ I',lll,,,lll,,,,I,h,l,l,,h,l,l,,I,Ih,,,,lll,,I,,,,lll,,hl ', ..........,"
: RDS-H ~31000053-0~00 07qqZqZ OE0901 099 ~6~
.~... ~ .: ::.: ~ . ~ - ~.~
182 40 8025
JEWELL S BRETZ
SERIES EE
02 2001
F'RB PITT,
/02-25-01'
: .... ~ ....., ,
182
~2JE~ELL
061 I
40 8025
S BRETZ
ALLENDALE RD.
RDS-M 051000055-0000 0744242 020901 099
SERIES EE
02 2001
,F'~B P I~T.
, o~-2~-o1',
XSG01883EI
182 qO 8025 02 200
S BRETZ
1061 I ALLENDALE RD
MECHANICSBURG PA 17055-4461
I,,:lll,,,ll!,,,,I,l,,ld,,I,,lll,,l,II ..... Ill.l,,.lll,,l,I
OR JUDITH WERTZ
RDS-M 051000055-0000 0744242 020901 ,099
FRB PITT
,'02-25-01
00056016
182 40 8025 02 200]
1061 I ALLENDALE RD
MECHANICSBURG PA
,...,,,.,.,,,....,.,..,.,..,..,.,.,,.,,.....,,,..,....,,,..,., ,,,
RDS-M 051800053-0800 07442~2 020981 099 ~096018
a:OOOOqOOO ?l:O ~ ~0005~0
Spark M* Matsunaga
182 40 8025 02 2001
~ JENELL S BRETZ
lOG1 I ALLENDALE RD
MECHANCSBRG PA 17055-qq61
I,,,lll,,,lll,,,,I,l,,I,l,,I,,hh,hlh,,,,llh,h,,,llh,hl
OR JUDITH B WERTZ
RDS-M 031000053-0000 0775931 022701 636
I:O000qO00 ?l'. 2q
FRB PITT
03-09-01
1
0001118802
X001118802I
~000 ~ ~ 1,880 2"'
REV 1511 EX + [1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Bretz, Jewell S
FILE NUMBER
21-2004-00369
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A
B
5
6
8
9
10
12
DESCRfPTION
FUNERAL EXPENSES:
Parthemore Funeral Home and Cremation Services,
1303 Bridge St.
New Cumberland, PA 17070
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 Fees Na.~e: ~erald J. Shekletski, Esq.
Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant
Street Address
RelationshipofClaimanttoD~edent
Accountant'sFees
Legal Advertising - Patriot News
Legal Advertising - Cumberland Law Journal
George K. Shahinian, M.D.
Crumay Parnes Assoc., Inc.
PPL
Verizon
1 from continuation pages ....
Zip
AMOUNT
8,609.00
0.00
4,400.00
0.00
149.00
0.00
0.00
146.20
75.00
74.75
100.00
109.31
28.76
412.32
14,104.34
TOTAL (Also enter on line 9, Recapitulation) $
2W46AG 2.000 (If more space is needed, insert additional sheets of same size)
Page 2
Estate of: Bretz, Jewell S 21-2004-00369
Schedule H, Part B -- Administrative Costs
Item
No. Description
13
14
15
16
Brachendorf Memorials, Inc.
Comcast Cablevision
Patriot News - advertising
Filing Fees - Personal Inventory and PA Inheritance
Tax Return
Amount
295.00
6.72
85.60
25.00
TOTAL. (Carry forward to main schedule) ...... 412.32
REV.15~3 EX+ (9-(]0)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Bretz, Jewell S 21-2004-00369
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
2
3
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec 9116(a)(1.2)]
Bretz Burd, Carol
30 North 41st St.
Camp Hill, PA 17011
Wertz, Judith B
900 Cocklin St.
Mechanicsburg, PA 17055
Baker, Jacqueline L
687 Potts Hill Road
Etters, PA 17319
Daughter
Daughter
Daughter
19,960.06
34,746.36
19,222.03
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II.
NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0
2W46AI 1.000 (If more space is needed, insert additional sheets of the same size)
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local 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.
~7_! Local Registrar
!*
No.
Date
H105.143 Rev. 2/87
RINT
NAME OF DECEDENT (FirsL Middle, Last)
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
AGE (Last
90
S.
COUNTY OF DEATH
~. Cumberland
'.s. Homemaker
1057B Allendale Road
Mechanicsburg, PA 17055
FATHER'S NAME (First, ~;GG;~, Last)
~L Jacob Webster )renkle
20,. Judith B. Wertz
21a.
I sex I SOC*AL SECUR,TY NUMEER
Jewell Sprenkle Bretz ' BIRTHP I~.female iS. 182 -- 40 -- OATEOFOEATH(Monfl%Day. Yeer)
(Month, Day, Year) . __ . ~m-~ ,._' . )
CITY, BORO, 'FWP OF DEATH I FACILITY NAME (If nol i~sUtufio~, give street and number) [WAS DECEDENT OF HISPANIC ORIGIN'
i / iNDUSTRY~vv~j ENTliVER iN [ DEO-ut~T'S EDUCATION ' ] MARITAL STATUS - Married,
[I .S, ARMED FORCES? [{sf~di~enl~fli~t~e~.a~e} NeverMail'ied VVIdowed
DECEDENVS ',-St.e Pennsylvania m~ Upper Allen
ACTUAL ., 17C. [~ Yes, decedenl lived in
RESIDENCE danedenl
(See instructions live in a
MOTHER'S NAME (Firm. Mi(Idle. Maidan Surname)
Bessie Hoover
INFORMANTS MAIUNG ADDRESS (Street. ~¥Town, $t~8, ~i~ Co~o)
20~. 900 Cocklin Street, Mechanicsbur~, PA 17055
PLACE OF DISPOSITION- Nmme ~ Ceme~. Crofl~to~ LOCATION - Ci~/Tow~, Sla~. Zip Code
DATE OF DISPOSITION
(kl~h, I~/, Year)
[] 2004
DR PERSON ACTING AS SUCH LICENSE NUMBER
FD 0'1.2 848 L
(Signature ~ Title)
TIME OF DEATH
DATE PRONOUNCED DEAD (MD. bb, Day, Year)
t c. o (oR AS A CONSEQUENCE O~):
DUE TO (OR AS A CONSEOL~NCE OF):
) LAST d.,
WERE AUTOPSY FINDINGS MANNER OF DEATH
~vp.
c~ty/bon3
~.wer Paxton Twp., PA 1710
NAME AND ADORESS OF FACILITY Parthemore FH & CS Inc.
LICENSE NUMBER
23b. 23c.
WAS CASE REFERRED TO A MEDICAL EXAM NER/CORONER~
Y-• No~
I DATE OF INJURY I TIME OF N JURY
PERFORMED? AVAILABLE PRIOR TO &4e.l~, Day. Yea')
~ D~TH?
DTM
1~.
INJURY AT WORK? J DESCRIBE HOW INJURY OCCURRED
Y.r-I No E! J~.
.~.~ . State)
SIGNATURE AND TITLE OF (
LICENSE NUMBER DATE SIGNED (Mo~th, Day. Year)
NAME AND ADDRESS OF PERSQN V~HO COMPLETED CAUSE OF DEATH .
(Item 27) Type or print
DATE FILED (M~th,
ep\wills\bretz.js\7-97
'04
LAST WILL AND TESTAMENT
OF ,-., ....
JEWELL S. BRETZ
I, JEWELL S. BRETZ, of 1057 Allendale Road, Apt. B,
Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my
last will and revoke any will previously made by me.
ITEM I: I devise and bequeath all of my estate of every nature
and wherever situate, in equal shares to such of my daughters, CAROL
BRETZ BURD, JUDITH B. WERTZ, and JACQUELINE L. BAKER, who survive me.
Should any of my children predecease me, I devise and bequeath the
share of such child to her issue, per stirpes; and should any such
child of mine leave no such issue living at the time of my death, I
devise and bequeath the share of such child to my issue, per stirpes,
living at the time of my death.
ITEM II: I appoint my daughters, CAROL BRETZ BURD and JUDITH B.
WERTZ, Co-Executrices of this my last will.
Page 1 of 4
ITEM III: No fiduciary acting hereunder shall be required to
post bond or enter security for the faithful performance of her duties
in any jurisdiction.
IN WITNESS Wq{EREOF, I, JEWELL S. BRETZ, have hereunto set my hand
and seal this ~ ~ day of ~ ~/~_~r.,~-~ , 2001.
SIGNED, SEALED, PUBLISHED and DECLARED by JEWELL S. BRETZ, the
Testatrix above named, as and for her Last Will and Testament, and 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.
Witness Address
Witness
Addre s s
Page 1 of 4
COMMONWEALTH OF PENNSYLVANIA)
) SS.
COUNTY OF CIIMBERLAND )
I, JEWELL S. BRETZ, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed this instru-
ment as my Last Will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
[~WELL S. BRET~ - -' ~
Sworn to or affirmed to and acknowledged before me by JEWELL S.
BRETZ, the Testatrix, this ~ day of ~7C~ , 2001.
i NOTARIAL SEAL
i
K~'~ ~. LUCKEY, Nolary Public I
~ C~i~'land Bom. C~l~land Co. I
~ No[/ary Pu~i c
COMMONWEALTH OF PENNSYLVANIA)
) SS.
COUNTY OF CUMBERLAND )
the witnesses, whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and say
Page 1 of 4
that we were present and saw Testatrix sign and execute the instrument
as her Last Will; that Testatrix signed willingly and that she exe-
cuted 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; that to the best of our knowledge, the
Testatrix was at the time eighteen years of age or more, of sound mind
and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by
witnesses, this ~ day of ~~. , 2001.
- ~ota~ ~iC
Page 1 of 4
STONE, LAFAVER & SHEKLETSKI
A PROFESSIONAL CORPORATION
ATTORN~ LAW
414 BRIDGE STREET
NEW CI. TM. BERI.~qD, PA 17070
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Jewell S. Bretz, a/k/a Jewell Sprenkle Bretz
Date of Death: March 31, 2004
Will No. 21-04-0369
To the Register:
I certify that notice of beneficial interest required by
Rule 5.6(a) ef the Orphans' Court rules was served on or mailed
to the following beneficiaries of the above captioned estate on
May 6, 2004.
Carol Bretz Burd
30 North 41st Street
Camp Hill, PA 17011
Judith B. Wertz
900 Cocklin Street
Mechanicsburg, PA
17055
Jacqueline L. Baker
687 Potts Hill Road
Etters, PA 17319
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) .
Date:
Capacity:
' Gerald J. kletski, Esquire
414 Bridge Street
New Cumberland, PA 17070
717-774-7435
Personal Representative
170.
X
Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 0O4095
SHEKLETSKI GERALD J
414 BRIDGE STREET
NEW CUMBERLAND, PA
17070
........ fold
ESTATE INFORMATION: SSN: 182-40-8025
FILE NUMBER: 2104-0369
DECEDENT NAME: BRETZ JEWELL S
DATE OF PAYMENT: 06/29/2004
POSTMARK DATE: 06/29/2004
COUNTY: CUM BE RLAN D
DATE OF DEATH: 03/31/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $3,000.00
REMARKS'
CHECK#103
"SEAL
TOTAL AMOUNT PAID:
$3,000.00
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OFINDIVIDUAL TAXES
DEPTE80601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11 96)
NO. CD 004306
SHEKLETSKI GERALD J
414 BRIDGE STREET
NEW CUMBERLAND, PA
17070
fold
ESTATE INFORMATION: SSN:
FILE NUMBER: 2104-0369
182-40-8025
DECEDENT NAME: BRETZ JEWELL S
DATE OF PAYMENT: 08/26/2004
POSTMARK DATE: 08/26/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 03/31/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $176.78
REMARKS:
TOTAL AMOUNT PAID:
9176.78
'SEAL
CHECK# 104
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Inventory of the real and personal estate of
Jewell S. Bretz a/k/a Jewell Sprenkle Bretz
deceased
PERSONAL PROPERTY
l. PNC Bank Savings Account #5000882843
2. Apartment Rent Rebate
3. Apartment lease security deposit refund
4. Erie Insurance refund/renter's insurance
5. Highmark Blue Shield Insuramce refund
6. Patriot News RefUnd check
TOTAL PERSONAL PROPERTY
REAL ESTATE
NONE
TOTAL REAL ESTATE AND PERSONAL PROPERTY
074. !5
154.00
164.30
$51,981.59
$51,981.~9
COM~'~JONWF. AL?~ C~ ?ENHSYLVAJqI~
COUHTY O~:
Carol Bretz Burd and Judith B. Wertz
being duly _ ~nrq ..... according to [aw, depose~ and says thatt hey
are Co-Executr~ces of fha Estate of Jewell Sprenkle~retz ~/k/a Jewell S. Bretz
[ate of _~pper Allen To~cnship . , Cumberland County, Pa., deceased and fhaf
w;fh;n ~ a~ ~nvenfory m~de by Carol Bretz Burd and Judi~ B~ Wertz , the s~idC°-Executrices
o¢ +~e entire eCate o¢ saSH 8ecedenL con~st~mg o¢ a;I ~ke per~ona~ property ~nH rea~ e~a~e, ex6ep~ real e~+a~e
' ~ ~' o~ ~e~nsy~v~ia, end fhaf fha figures opposite e~ch ff~m cf +he Inventory represen~ ff's fair va~ue
fne
8s of fha date of ~eced~nf's death.
and '.ubscribed before me,
.ar rol Bretz Burd Judith B. Wertz
30 North 41st St. 900 Cocklin St.
Camt~Si!!, o^ ~7~14_A~r~.~_.~_~ .... ~A 17055
Date of Death
31 March
2OO4
INSTR UCT!O,~4$
~. An inventor7 ,must be fi'ed within three months after appointment 9f personal represen+afive.
?. A ;uppiemen+ inventory must be flied w~fh;n thirty days of disccvery of edd[f[ona[ assets.
:. Adapt,one ~e?s may be ~,+acned es fo personeJfy or realiy
4. See ArHcle ~V. ~iduc[nr[es Act of 1949.
0
BUREAU OF TNDTVZDUAL TAXES
TNHER/TANCE TAX DZVZSZOH
DEPT. 18060!
HARRISBURG, PA 17118-0601
COHHONNEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTZCE OF ZNHERZTANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
REV-16~i? EX AFP
GERALD J SHEKLETSK~L~S~'f 22
STONE ETAL
PO BOX E
NEN CUMBERLAND ~,,~.7070
DATE
ESTATE OF
DATE OF DEATH
FZLE NUMBER
COUNTY
ACN
10-25-200q
BRETZ
05-$1-200q
21 0q-0569
CUMBERLAND
101
Amount: Rem l'l:~:ed
JENELL S
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~
REV-15q7 EX AFP (01-033 NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT; ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX
ESTATE OF BRETZ JENELL S FZLE NO. 21 0q-0569 ACM 101 DATE 10-25-200q
TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORZGZNAL RETURN
1. Real Es~a~e (Schedule A) {1)
2. S~ocks and Bonds (Schedule B)
3. Closely Held S~ock/Par~narsh/p Zn~ares~ (Schedule C) ($)
q. Hor~gages/No~as Receivable (Schedule D) (q)
5. Cash/Bank Deposits~Misc. Personal Propar~y (Schedule E) (5)
6. Jointly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al Assa~s
APPROVED DEDUCTZONS AND EXENPTZONS:
9. Funeral Expanses/Ada. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10)
11. To,al Deductions
12. Na~ Value of Tax Re~urn
15.
lq.
.00
.00
.00
.00
51z981.59
$6z051.20
.00
(8)
lq,lOq.$q
Chari~able/govern,en~al Bequests; Non-elected 9113 Trusts (Schedule J)
Na~ Value of Es~a~e Sub~ac~ ~o Tax
NOTE: To insure proper
cradi~ *o your account,
submi~ ~ha upper pot*ion
of ~his fore wi~h your
~ax payment.
88,031.79
.00
(11) 1~. lot. S~
(12) 75,928.q5
(13) . O0
(1~) 73,928. q5
NOTE:
]:f an assessment was lssued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect ~igures that include the total of ALL returns assessed to date.
(15) .00 X O0 : .00
(16) 75,928.q5 X Oq5= 3,326.78
(17) . O0 X 12 = . O0
(18) .00 x 15 = .00
(19)= 3,326.78
AMOUNT PAZD
$,000.00
176.78
TOTAL TAX CREDZT
BALANCE OF TAX DUEI
ZNTEREST AND PEN.
TOTAL DUE
ASSESSMENT OF TAX:
1E. Amoun~ of Line lq at Spousal rata
16. Amoun* of Line lq ~axable a~ Lineal/Class A ra~e
17. Aaoun~ of Line lq a* Sibling ra~a
18. Aaoun~ of LAne lq ~axable a~ Collateral/Class B ra~e
19. Principal Tax Due
TAX CREDZTS:
PAYMENT RECEIPT DTSCOUNT
DATE NUMBER TNTEREST/PEN PAZD (-)
06-Z9-ZOOq CDOOq095 157.89
08-26-200q CDOOq$06 . O0
ZF PAID AFTER DATE ZND/CATED, SEE REVERSE
FOR CALCULATZON OF ADD/TIONAL ZNTEREST.
$,35q.67
7.89CR
.00
7.89CR
( TF TOTAL DUE TS LESS THAN $1, NO PAYMENT TS REQUTRED.
TF TOTAL DUE TS REFLECTED AS A 'CREDZT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SZDE OF THTS FORM FOR TNSTRUCTTONS.}
RESERVATZON:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 1982 -- if any future 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 Comaoneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laaful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TZ P.S.
Section 91q0).
Detach the top portion of this Notice and submit aith your payment to the Register of Mills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NXLLS, AGENT
A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at tho Office
of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Zq-hour
answering service for forms ordering: I-B00-36Z-Z050; services for taxpayers with special hearing and / or
speaking needs: Z-&OO-447-30ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including 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-lOZ1, 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. Z80601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See 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 (33 calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the sams manner and in the the same tiaa 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, 198Z bear interest at the rate of
six (6X) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 ara:
Interest Daily Interest Daily Interest
Year Rate Factor Year Rate Factor
~ ZOZ .000548 ~'~-1991 llX .000301
1983 16Z ,000438 199Z 9Z .000Z47
1984 11Z .000301 1993-1994 7X .00019Z
1985 132 .000356 1995-1998 92 .000Z47
1986 lOZ .000274 1999 7Z .00019Z
1987 IOZ .000Z74 2000 7Z .00019Z
--/nterast is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Daily
Year Rate Factor
~ 9Z .OOOZ47
Z002 6Z .000164
2005 SZ .000137
2004 4Z .000110
X NUHBBR OF DAYS DELTNI~UENT 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 be calculated.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF TNDZVZDUAL
INHERITANCE TAX DIVISION
po BOX 28060~
HARRISBURG, PA
INHERITANCE TAX
STATEHENT OF ACCOUNT
REV-16D7 EX &FP (09-04)
200qDEC 29 AH 9:1 2
CLERK OF
ORPHAN'S COURT
GERALD J SH~-~'~ E~I~L.., PA
STONE ETAL
PO BOX E
NEW CUMBERLAND PA 17070
DATE 12-06-200q
ESTATE OF BRETZ
DATE OF DEATH 03-$1-200~
FILE NUMBER 21 0q-0569
COUNTY CUMBERLAND
ACN 101
I Amoun~ Remi~ed
JEWELL S
HAKE CHECK PAYABLE AND REHZT PAYNENT TO:
REGISTER OF WILLS
CUMBERLAND C0 COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper cred&~ ~o your account, submi~ ~he upper por~/on of ~h/s form wi~ch your ~cex payment:.
CUT ALONG TH'rS L'rNE I~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ESTATE OF BRETZ JEWELL S FILE NO. 21 0q-0369 ACN 101 DATE 1Z-06-Z00q
THIS STATEMENT 1S PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHO#N BELO#
1S A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE., AND, ZF APPLICABLE,
A PROJECTED TNTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 10-18-Z00q
PRINCIPAL TAX DUE: ............................................................................................
PAYMENTS (TAX CREDITS):
3,326.78
PAYMENT
DATE
06-29-200~
08-Z6-200~
ll-ZZ-ZO0~
RECEIPT
NUMBER
~CD00~095
~CD00~306
REFUND
DISCOUNT (+)
INTEREST/PEN PAID (-)
157.89
.00
.00
AMOUNT PAID
3,000.00
176.78
7.89-
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT"
TOTAL TAX CRED'rT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
3,$Z6.78
.00
.00
.00
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
II
I
i
I
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Jewell S. Bretz a/k/a Jewell Sprenkle Bretz
Date of Death: March 31, 2004
Will No.
2004-00369
To the Register:
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.
Yes ~
State whether administration of the estate
No
complete:
lS
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 representative file a final
account with the Court? Yes No X
(b) The separate Orphans I Court No. (if any) for the
personal representative's account is: N/A
(c) Did the personal representative state an account
informally to the parties in interest? Yes~ No
Dat~:
(d) Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with
~~~o;~~rk of the Orphans' Court and m e att~~~
///~~'-I ~
.
Gerald Shekletski, Esquire
414 Bridge Street
New Cumberland, PA 17070
717-774-7435
Capacity:
Personal Representative
X
Counsel for Personal
Representative
uR
est\rel\lform.rel
IN RE: ESTATE OF
JEWELL S. BRETZ, A/K/A
JEWELL SPRENKLE BRETZ
LATE OF UPPER ALLEN
TOWNSHIP, CUMBERLAND
COUNTY, PENNSYLVANIA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
00369 OF 2004
RECEIPT, RELEASE AND WAIVER OF ACCOUNTING
KNOW ALL MEN BY THESE PRESENTS, that I, Carol Bretz Burd, being
one of the beneficiaries under the will of Jewell S. Bretz, a/k/a
Jewell Sprenkle Bretz, do hereby acknowledge that I have received all
sums of money and property due me by virtue of the death of Jewell S.
Bretz, a/k/a Jewell Sprenkle Bretz, in full satisfaction and settle-
ment of all of my rights and claims under her estate.
I further declare, intending to be legally bound, that I hereby
waive my right to require the filing of a First and Final Account and
Proposed Schedule of Distribution in any Court of Common Pleas having
jurisdiction over the same, and I acknowledge that I have had an
opportunity to examine copies of the books and records of the said
estate, and I agree to the final distribution of the estate without
further formalities, and with the same force and effect as if a First
and Final Account and Proposed Distribution had been filed in a Court
of Common Pleas of Pennsylvania having jurisdiction over the same and
duly audited and confirmed.
AND THEREFORE, I, Carol Bretz Burd, do by these presents, remise,
release, quitclaim and forever discharge the Co-Executrices, their
heirs, successors and assigns, from the acts of the Co-Executrices as
aforesaid, and of and from all actions, suits, payments, accounts,
reckonings, claims, and demands whatsoever, for or by reason thereof,
or any other act, matter, cause or thing whatsoever, and I do hereby
consent to the discharge of the said Co-Executrices.
day o~N Wfl~~OF, ~ ~~~: hereunt,: set my;;and a~ seal the 8?7.-
Witness /~~~~~:y~
"-_m ...---.---/'~
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
On this, the {"q /A- day of .~~r , 2004, before
me a Notary Public, the undersigned officer, personally appeared
Carol Bretz Burd, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and acknowl-
edged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have he~eunto . hand and s b~ day
and year first above written. C~~ _
.--
COMMONWEALTH OF PENNSYlVANIA No y Pub 1 i c
NOTAR!AL SEAL
GERALD J. SHEf{L.ETSKI. Notary Public
New Cumberland Bora. Cumberland Co.
My Commission Expires Nov. 9, 2006
est\rel\lform.rel
IN RE: ESTATE OF
JEWELL S. BRETZ, A/K/A
JEWELL SPRENKLE BRETZ
LATE OF UPPER ALLEN
TOWNSHIP, CUMBERLAND
COUNTY, PENNSYLVANIA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
00369 OF 2004
RECEIPT , RELEASE AND WAIVER OF ACCOUNTING
KNOW ALL MEN BY THESE PRESENTS, that I, Jacqueline L. Baker,
being one of the beneficiaries under the will of Jewell S. Bretz,
a/k/a Jewell Sprenkle Bretz, do hereby acknowledge that I have re-
ceived all sums of money and property due me by virtue of the death of
Jewell S. Bretz, a/k/a Jewell Sprenkle Bretz, in full satisfaction and
settlement of all of my rights and claims under her estate.
I further declare, intending to be legally bound, that I hereby
waive my right to require the filing of a First and Final Account and
Proposed Schedule of Distribution in any Court of Common Pleas having
jurisdiction over the same, and I acknowledge that I have had an
opportunity to examine copies of the books and records of the said
estate, and I agree to the final distribution of the estate without
further formalities, and with the same force and effect as if a First
and Final Account and Proposed Distribution had been filed in a Court
of Common Pleas of Pennsylvania having jurisdiction over the same and
duly audited and confirmed.
AND THEREFORE, I, Jacqueline L. Baker, do by these presents,
remise, release, quitclaim and forever discharge the Co-Executrices,
their heirs, successors and assigns, from the acts of the Co-Execu-
trices as aforesaid, and of and from all actions, suits, payments,
accounts, reckonings, claims, and demands whatsoever, for or by reason
thereof, or any other act, matter, cause or thing whatsoever, and I do
hereby consent to the discharge of the said Co-Executrices. d
IN WI~NESS WHEREOF, I have hereunto set my hand and seal the~
day of ~1;e~.u~ ,2004.
.,) {) o;?-uaa ftp tJ 6rP I:'Q/L
C:;/JacRyeline L. Baker
Witness
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
On this, the Z1~ day of ~~~~ , 2004, before
me a Notary Public, the undersigned officer, personally appeared
Jacqueline L. Baker, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and acknowl-
edged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto~..~.... ha.. .and..._~ s~. _~~..e d. ay
and year first above written. ~C~ : ~~:-:::_
COMMONWEALTH OF PENNSYLVANIA Notary Public
NOTARIAL SEAL
GEPlALD J. SHEKLETSKI. Notary Public
New Cumberland Bora. Cumberland Co.
My Commission Expires Nov. 9, 2006
Ii est\rel \lform. rel
IN RE: ESTATE OF
JEWELL S. BRETZ, A/K/A
JEWELL SPRENKLE BRETZ
LATE OF UPPER ALLEN
TOWNSHIP, CUMBERLAND
COUNTY, PENNSYLVANIA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
00369 OF 2004
RECEIPT, RELEASE AND WAIVER OF ACCOUNTING
KNOW ALL MEN BY THESE PRESENTS, that I, Judith B. Wertz, being
one of the beneficiaries under the will of Jewell S. Bretz, a/k/a
Jewell Sprenkle Bretz, do hereby acknowledge that I have received all
sums of money and property due me by virtue of the death of Jewell S.
Bretz, a/k/a Jewell Sprenkle Bretz, in full satisfaction and settle-
ment of all of my rights and claims under her estate.
I further declare, intending to be legally bound, that I hereby
waive my right to require the filing of a First and Final Account and
Proposed Schedule of Distribution in any Court of Common Pleas having
jurisdiction over the same, and I acknowledge that I have had an
opportunity to examine copies of the books and records of the said
estate, and I agree to the final distribution of the estate without
further formalities, and with the same force and effect as if a First
and Final Account and Proposed Distribution had been filed in a Court
of Common Pleas of Pennsylvania having jurisdiction over the same and
duly audited and confirmed.
AND THEREFORE, I, Judith B. Wertz, do by these presents, remise,
release, quitclaim and forever discharge the Co-Executrices, their
heirs, successors and assigns, from the acts of the Co-Executrices as
aforesaid, and of and from all actions, suits, payments, accounts,
reckonings, claims, and demands whatsoever, for or by reason thereof,
or any other act, matter, cause or thing whatsoever, and I do hereby
consent to the discharge of the said Co-Executrices.
and seal the ~4A
IN WITNESS WHEREOF, I have hereunto set my hand v/~
day of /11~ ' 2004.
Witness
(2~ 135 (:{J~
J~~~h th B. Wertz .
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND
On this, the 1ft- day Of~rr:'..vo.-~-r;:;-- , 2004, before
me a Notary Public, the undersigned officer, personally appeared
Judith B. Wertz, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and acknowl-
edged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto se and d se the ay
and year first above written. ~
COMMONWEALTH OF PENNSYlVANIA
NOTARIAL SEAL
GERALD J. SHEKLFTSI<I. Notary Public
New CurntllJrlancl 80ro. Cumberland Co.
My Commission Expires Nov. 9. 2006