HomeMy WebLinkAbout02-1161PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~ r~ „r~i7
~V .t~ U 1 J l 1 i~. 1'i . ~Ui ~ i..~
also known as
Deceased.
Social Security No. 1~~7-7.. ~.-~~ r>?1d_
No. ~~ G~~~N~
To:
Register of Wills for the
County of Curaberlct:nd in the
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 ox named
in the last will of the above decedent, dated 0 C t ob ° r 1 ~ ~ , ~ "2 / 9f~y
and codicil(s) dated
v
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cu'~aberland County, Pennsylvania, with
hez' last family or principal residence at 32E, G1Endale Dra_ve , Shix'e~na.ns town,
P.~, 17011-Lot•~er ~l.len TottiTnsyiLp-
(list street, number and muneipality)
Decendent, then ~ 1 years of age, died Tj o ve rab e r ~ 0 , ~ ~j 2 0 02
at Ca_na~ :[ill, '~'1 7.70.1-,~st I'ennsboro "~~~wnshix~ -
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 $ 500, 0~)0, 00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ 1c0, ;;00.00
situat d as follows: 'io~.zse ai:~d Lot of Gr>o~~nr. si_tl~ to at _
~?~ r-~-c:ndale Drive, Shirc;rcarstotrn, ~"~ 17011.
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters 2' e s t a~,~~ c; r t sr ~'
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
!~~'illiai,i C. Range
~,V 3~_'y_ Ga_endale i~r~LV~ e
~~;; Sh-i.rernaristown, T'A l7, 11
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1
COUN'T'Y OF Cum.oerland ~ 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 of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed -c.E~~ ~r G ~` a r„
bef~re me this 23rd _ day of ~~
ece~~~i er. 2002 a
h
~~ ~ - ~ ~
Donna M. Otto, lst Depute Re tr
/7 /i~~ iv
NO. 21-2002-1161
Estate of ''~_i<<a1~~~ i!. '=~i~.<~c~a ,Deceased
DECREE OF PROBATE A ,O~' LEc'IS
AND NOW December 26th, ]~ 200 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 C) C t obey' 1 `; ,l~; 9~~.
described therein be admitted to probate and filed of record as the last will of
-r,
and Letters ~'' e ~> t r~.xne :rt ~ <zY° ~"
are hereby granted to ?`' i l1 i. uxi C . I:i ~ :ni: ~e
FEES
Probate, Letters, Etc. ......... $ 410.00
Short Certificates( 1~.......... $ 30.00
~~ x-pages , (4.)... $ 12.00
JCP $ 10.00
TOTAL g 462.00
Filed . ??~cemher, 26th, 2002...... , .. , , ,
~~ ~~
~r
Register of w~us Donna .Ot~ ,1st Deputy
_ ~+f r n. ~,• ~
c • 1{.J:)'°Y'~ AJ {_~1.Uf'.~'P,A .."(~.i '^ _i.J,)l.'•,
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
%1.7-766-?1?~..
71 1 "' l i~~;"'~6~i 3
PHONE
MAILED LETTERS `PO A`I"I'ORI~TEY ON DECEMBER 26TH, 2002.
Y
' , , ' ~ • ~ ~
LAST Z~~ILL AND TESTAT~~IEIJT OF VIRGINIA I'T. KiJRTZ
I, VTR GI NIA i~~T.
County of Cumberlan
and disposing mind,
and declare this my
making void any and
made.
I~URTZ, of the Township of Lower Allen,
3 a.nd State of Pennsylvania, being of sound
memory and understanding, do make, publish
Last Will and Testament, hereby revoking and
all prior Wills b y me at any time heretofore
1.
T direct the payment of all my dust debts a.nd funeral
expenses as soon after my decease as the same can be conveniently
done, and in this respect, I direct that all estate, inheritance
and succession taxes that may be assessed in consequence of my dean
of whatever nature and by whatever jurisdiction imposed, shall be
paid out of the principal of my general estate to the same effect
as if said taxes were expenses of administration, and that all
property includable in my taxable estate, whether or not passing
under tl~~.s Will, shall be free and clear trereof.
2.
I give and bequeath the sum of Thirty Thousand 030,000.00)
Dollars to my good friend, WILP•2A BOSSERP+TAN.
-1-
3•
I give and bequeath the sum of Thirty Thousand ($30,000.00)
Dollars to my nephew, P~IEIG KURTZ .
4•
I give and bequeath the sum of Twenty Thousand ($20,000.00)
Dollars to my good friend, ~~JILLIAP~7 C. RANGE.
5.
I give and bequeath all the rest, residue and remainder of
my estate, of whatsoever nature and wheresoever the same may be
situate, to my cousins, immediately hereinafter named, who shall
survive me, to wit,
ELWOOD FRIEDLINE
KENTdETIi FRIEDLINE
WAYNE FRIEDLINE
ROT~TALD FRIEDLINE
Gi~RALD FRIEDLINE
I'2. JOAN KIT~II~ZEI,
DOLORES SIL'IEFER
LOIS JEAN DAVIS
CHARLES FRIEDLINE
RAY Z^JOOLLEY
CAROL FRIEDLINE
-2-
6.
I authorize, empower and direct my Executor, hereinafter
named, to se11 any and all real estate which I may own at the
time of my decease, as well as my personal property, at either
public or private sale or sales.
LASTLX, I nominate, constitute and appoint my good friend,
T~TILLIAI,g C. RATdGE, .Executor of this my Last uJill and Testament,
and direct that he be excused from posting bond or other security
for the faithful performance of his duties in any ,jurisdiction.
IP1 ti~JITNESS GTHERFOF, I have hereunto set my hand and seal
this _~ day of October, A. D., 1991.{..
V
~v~
a INT. Kurt z
( SEAL
_~_
Signed, sealed, published and declared by the above
named, VIRGITdIA T~T. I~URTZ, as and for her Last Will and Testament,
in the presence of us, who have subscribed our names hereto as
witnesses, at the request of said testatrix, in her presence and
in the presence of each other.
-4-
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, VIRGINIA l°~, ~iUPTZ the testat rix
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 the instrument as my Last Will and Testament;
that I signed it willingly; and that I signed it as my free and volun-
tary act and deed, for the purposes therein contained.
Sworn and affirmed to and acknowledged before me by u,--
VIRG_~.i,'IA T~i. f`=UF~TZ the testatrix this _ i
day of: October A. D. ~ 7-~9L{..
~~_
'__. ,~~.
No!ariai veal
Marilyn Kay Eakin, Rotary Public
Mechanicsburg Boro, Cun•~beriand Courriy
My Commission E~ires Nov. 6,1997
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
~~++ ~ ~.P6[Iri
SJ. ~ ~ti C,:~i~ jti 'GV
~~ ~aa®fNak~a
We, the undersigned, J• R0~3;PT S'TAUFFFR
and SRI T~ T • L-~-`~1~'T'l"r=.~`zCE~~i the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the
testatrix VIRGII~ITA T~i. ~k _~TZ sign and exe-
cute the instrument as7~~it16/her Last Will and Testament; that the
said testal~ix ~ VIRGIi1iA t~'i. FL ~RT , executed it as
f?<i~/her free and voluntary act for the purposes therein expressed;
that each of us, in t'rie I--ear:ing a.id sight of the testat rlX signed
the Wil]_ as witnesses; and that to the best of our knowledge, the
testatr'iX was, at the time, eighteen (18) or more years of age,
of soucid mind, and under no constraint, duress or undue influence.
Sworn and su)~sc.~ibed to before
me this r,~ , i day of
October 1y9~,
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
In the )
).
Estate of )
VIRGINIA M. KURTZ, unremarried ) No. 1161
widow, deceased, late of Shiremanstown )
Borough, Cumberland County, )
Pennsylvania )
Estate 2002
APPEARANCE
TO MARY C. LEWIS, REGISTER OF WILLS:
Please enter my Appearance as Attorney for the above captioned Estate.
• BY i~
William L. Kimn~iel, Esq.
January, 2003
WILLIAM L. KIMMEL
ATTORNEY AT LAW
166 EAST UNION STREET
P. O. BOX 557
SOMERSET, PENNSYLVANIA 15501
FAX
(814) 445-6362
Mary C. Lewis, Register of WiIIs
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
TELEPHONE
(614) 445-9651
January 9, 2003
Re: Virginia M. Kurtz Estate
No. 1
Dear Ms. Lewis:
Enclosed please find Appearance relative to the above captioned Estate and to be filed
among the records of said Estate. Praecipe to Withdraw on behalf Attorney Stauffer, as well as
Attorney Eakin wiII be forthcoming from my office, or perhaps directly from said Attorneys. Should
you have any questions or in the event there is a Kling fee, please Iet me know.
Thank you for your kind cooperation and indulgence.
Sincerely,
i~
William L. Kimmel
k/s
Enclosure
~/VILLIAM L.. KIMMEL
ATTORNEY AT LAW
- -~ 166 EAST~v?!!(?~! STREET
P. O. BOX 551
SOMERSET. PENNSYLVANIA 15501
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
In the
Estate of )
VIRGII~IIA M. KURTZ, unremarried ) No. 1161
widow, deceased, late of Shiremanstown )
Borough, Cumberland County, )
Pennsylvania )
PRAECIPE TO WITHDRAW
TO MARY C. LEWIS, REGISTER OF WII.,LS:
Estate 2002
The undersigned does hereby withdraw as Attorney for the above captioned
Estate.
-,
~%
~;,
J. RJobert Stauffe q.
January 9, 2003
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~~G/i/!~ ~ ~ kt~~ 7-y No. al ~ - O~ -// /o
also known as To:
Deceased.
Social Security No. l ~- i ~ - 5<S7 ~
The petition of the undersigned respectfully represents that:
the
Your petitioner(s), who is/are 18 years of age or older an the executcE~ named
in the last will of the above d cedent, dated _ [~C?o ~3~ j 9~ , 19_gfL-
and codicil(s) dated ~ _ ~U111 E` iS, oZ 00~
(state relevant cireumsta//n//ces, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in I~UM(3c ~°Zq-.^~O County, Pen sylvania, with
1~_ 1 ~~~~mily or principal residence at ~~L G~ cN,~/f-~~ n,~~ ~~ ~,y~~?~m~~~J~
~J ~ LsJ ~ AtL %Oc•.ln~,;Nir~
(list street, number and muncipality)
Decendent, then I _ years of age, died __ /Vn ~~ ~n,1~~~2 30, 3co .z ,'1~.
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: /V, ~.
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:
WHEREFORE, petitioner(s) respectfully re uest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~EsT.q-~, E/VT~S%
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
v
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~ .~ S kEM RN.S 77J ~J /~- /9CJ//
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COMMONWEA TH OF PENNSYLVANIA
COUNTY OF ~ym(E2~.~4n/.D
Register of ills for the
County of _ ,~It3c~2L,4ND in
Commonwealth of Pennsylvania
ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correc~i to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~-~~~~za~~~ =~~~s~_
before me this ~ ~ t"
v~ ~ day of ~•
~~ ~ _
/~~-jj~_~~,
OATH OF PERSONAL REPRESENTATIVE
No. '~ ~ it ~ - ~
Estate of ~'r ~-' ~ ~ ~ ~~ ~ ~~ `' ~~ .~; ~ ~ _~ - ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~DRi ~ ~ ~ ~~~'~, ~ in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) date
described therein be admitted to probate and filed of record as the last will of
and Letters - ` ~ ~ ~ -
are hereby granted to ~' ~' C ' ~`? '
FEES
Prolate, Letters, Etc. ......... ~
c~., '~,~
$~ior ~e{tificates( ) .... • • •
R~~enunciation ................ $
(J-.
TOTAL $ ~ ~~'
Filed :T .~~~~~: H ~? ~.. ~:.....~(.~=.'{ : r
y ~
Register of Wills/:~'it<~-~ %~1~~~~~.~~!~~~: ~~
.ATTORi`JEY (Sup. Ct. I.D. No.)
.ADDRESS
~~'~) ~4~J ~s-/
PHONE
o2/-a ~. - ~ l 6
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) thaf' present and saw
the testat_ ,sign the same and that "~' signed as a witness at the
request of testat in ~`"
~_ presence and (iri`The,presence of each other) (in the presence of the
other subscriibing witness(es)). ~'''~--
..'~.
~`~
Sworn to or affirmed and subscribed before _ ~`a
me this _ day of (Name)
19
(Address)
Register
(Name)
(Address)
REGISTER OF WILLS OF ~l/m~l~r2~.4/~4 COUNTY
OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qualified according to~aw, depose(s) and say(s) that
L---~!¢'~ ~ familiar with the signature of _ /k'G J ~1,~ t /~ /Yl. Y
/7V~TZ
codicil
testat-~~( of (one of the subscribing witnesses to) the -wi•}i~ presented herewith and
codicil
that wtE= believe! the signature on the •wtH is in the handwriting of
i ti~ l fF- M . /~ c/
to the best of ~ U~ _____ knowledge and belief.
Sworn to or affirmed and subscribed before
~~
me this ~ ,day of
~ D
~~~~~ k-~/~ ~ ~ ~ Register
i
~~~..
!Name
esst
(Name)
31 c~ ~< En/~J9- F ,Q2 / /~ SN-ik'E~~i/5 iZ~u/n1,
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(;Al.L (717) ,~40-(D3,~(:(~Ic A-~~Y [NQUIR(ES
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IiROM: _ _::• . ~~.
County of Cumberland
One Courthouse Square
Carlisle, PA 17013-3387
FAX +af (71 ?) - 240-TIg7
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No.
21-2002-1161
Estate of VIRGINIA M. I{URTZ ,Deceased
DECREE OF PROBATE A ,O~' ~,Ti'S
AND NOW DE~~nber 26th. .7~ Z00?, 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 October 19. 1991{.
described therein be admitted to probate and filed of record as the last will of
Virginia TAI. Kurtz
and Letters _ T e s t ame n t arq '
are hereby granted to ti"Tilliam C . Range
FEES
Probate, Letters, Etc. ......... $ 410.00
Short Certificates( 1~.......... $ 30.00
~~ x-gages , { 4.). , , $ 12.00
JCP $ 10.00
TOTAL $ 462.00
Filed .December. 26th, 2002, ... , . , .. , , .
^'~
~~ ~ ~~
~Cf.~~~
Register of Wills Donna .O o, 1st Deputy
John P1. Eakin (No. 06351)
J. Robert Stauffer-(No. 06356)
ATTORNEY (Sup. Ct. I.D. No.)
Alarl~et Square Bldg.
rlechanicsbur~, PA 17055
717-766-317~DRESS
717-766-9673
PHONE
MAILID LETTERS 'PO A'I'Il7I2NEY ON DECEMBER 26TH, 2002.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
OEPT.280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 002230
KIMMEL WILLIAM L ESQUIRE
166 EAST UNION STREET
PO BOX 51
SOMERSET, PA 15501
--- fold
ESTATE INFORMATION: ssrv: 1s7-~4-4574
FILE NUMBER: 2102-1 161
DECEDENT NAME: KURTZ VIRGINIA M
DATE OF PAYMENT: 02/27/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /30/2002
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ S 160, 000.00
REV-1162 EX111-96)
TOTAL AMOUNT PAID:
REMARKS: WILLIAM L KIMMEL ESQUIRE
CHECK# 561
INITIALS: JA
SEAL RECEIVED BY:
S 160, 000.00
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
IN THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of )
VIRGII~IIA M. KURTZ, unremarried widow, ) No. 1161 Estate
deceased, late of Lower Allen Township, )
Cumberland County, Pennsylvania )
CERTIFICATION OF NOTICE UNDER RULE 5.6(a1
Name of Decedent: VIRGINIA M. KURTZ, unremarried widow
Date of Death: November 30, 2002
Will No. No. 1161 Estate 2002
TO THE REGISTER:
2002
I certify that notice of beneficial interest 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 January
24, 2003:
TO: Wilma Bosserman
1001 E. Walton Avenue, Apt. 305
Altoona, PA 16602
Meig Kurtz
3200 Appel Road
Bethel Park, PA 15102
William C. Range
324 Glendale Drive
Shiremanstown, PA 17011
Elwood Friedline
943 Pleasant Hill Road
Somerset., PA 15501
Gerald Friedline
583 Sipesville Road
Sipesville, PA 15561
M. Joan Kimmel, a/k/a Joann Kimmel
2347 Huckleberry Highway
Berlin, PA 15530
Dolores Shaffer
2622 Raymond Avenue
Latrobe, PA 15650
Lois Jean Davis
R. R. 1, Box 200A
Markleysburg, PA A 15459
i
Wayne Friedline
1027 Pleasant Hill Road
Somerset, PA 15501
Ronald Friedline
281 Wildcat Road
Friedens, PA 15541
Elsa Sutherland
61 Moraga Via
Orinda, CA 94563
Michael Kurtz
3200 Appel Road
Bethel Park, PA 15102
Millie Lai, a/k/a Mildred Lai
1816 Kualona Street
Honolulu, HI 96817
Kay Range
324 Glendale Drive
Shiremanstown, PA 17011
Susanne Funk
3773 Derry Street
Harrisburg, PA 17111
Lois J. Davis
R.R.1, Box 220AAA
Markleysburg, PA 15459
John Stephens
308 Pinewood Drive
Shiremanstown, PA 17011
Charles Friedline
195 Friedline Drive
Somerset, PA 15501
Carol Friedline
413 Second Avenue
Meyersdale, PA 15552
Arbutus.. Focht
423 Amaya Avenue
The Villages, FL 32195
Ruth Sicheri
730 Quecreek Road
Quecreek, PA 15555
Virginia Rebert
P. O. Box $8269
Honolulu, HI 96815
Terri Seip
33 South West Avenue
Shiremanstown, PA 17011
Nancy Berkey
173 Top of Hickory Hill Lane
Somerset, PA 15501
Connie Lee Kolesko
55 Vernon Road
Bolton, CT 06043
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
William L. mmel, Esq.,
Attorney for Personal Representative
166 East Union Street
Somerset, PA 15501
Dated: April 7, 2003 (814) 445-9651
THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
JOSEPH A. DENNISON being duly sworn according to law, deposes and says: That he is the Asst.
Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of
Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg,
County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News
newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State
aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September
18th, 1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in
their regular daily and/or Sunday/ Metro editions which appeared on the 7th, 14th and 21st day(s) of February
20v3. T i-idt neither ile nor said Company is interested in the subject matter of said printed notice or advertising, and
that all of the allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and
adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in
the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PUBLICATION
COPY
Estate Notices
ESTA EE OF V G NgA M. K RTL unre-
marrled widow, deceased, late o} Shiremans-
town Borough, Cumberlond County, Pennsyl-
vania.
fate `fwvlno assn proofed to th undersloned,
all persons Indebted tp }he sold Estate are
reausstsd to make payment, and those havlno
clolmsordemandsopolnsttheEstatetomake
the some known, without delay to:
William C. Ranw, Exeeutor
971 GlendpN Drive
Sworn to and subscri e e ore e t s 21st day gf~Feb~ 2003 A.D.
Notarial Seal `~
Terry L. Russell, Notary Public
City Of Harrisburg, Dauphin County
My Commission Expires June 6, 2006
Member. PPnnsvl~~2n~~ ~~sx;ation Qf Notaries
NOTARY PUBLIC
My commission expires June 6, 2006
WILLIAM L. KIMMEL
ATTORNEY-AT-LAW
166 EAST UNION STREET, P.O. BOX 551
SOMERSET, PA. 15501
Statement of Advertising Costs
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication attached
hereto on the above stated dates $ 215.76
Probating same Notary Fee(s) $ 1.75
Total $ 217.51
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have
been duly paid.
By ................................................................
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Curllberland Law
Journal, a legal periodical published in the Boro>>gh of Carlisle in the County and Stag, aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
FEBRUARY 14, 21, 28, 2003
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
i
Kurtz, Virginia M., decd.
Late of Shiremanstown Borough.
Executor: William C. Range, 324
Glendale Drive, Shiremanstown,
PA 17011.
Attorney: William L. Kimmel, Esq.,
166 East Union Street, Somerset,
PA 15501.
isa Marie Coyne, E or
SWORN TO AND SUBSCRIBED before me this
28 day of FEBRUARY, 2003
.... +. :._.',Mt9`~' 1 nm .~'.~:PRA`i.^;::3.79'~FY(LiP
~` ~Y,~
ti]diC:+M~ •. ~p'kf,t~:~Ft; -v xt-.: ; _ ..-: c7.35su
IN THE COMMONPLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the )
Estate of )
VIRGINIA M. KURTZ, unremarried )
widow, deceased, late of Lower Allen ) No. 1161 Estate 2002
Township, Cumberland County, Pennsylvania )
Social Security No. 187-14-4574 )
PETITION FOR PROBATE OF CODICIL AND GRANT OF LETTERS
The petition of the undersigned respectfully represents that:
1. Your petitioner is 18 years of age or older and the Executor named in the Last Will
of the above decedent, dated October 19, 1994 and probated on December 23, 2002, together with
Codicil dated June 15, 2001 submitted for probate on February 5, 2003, all of said documents filed
to the above term and number
2. Decedent was domiciled at death in Lower Allen Township, Cumberland County,
Pennsylvania, with her last family or principal residence at 326 Glendale Drive, Shiremanstown,
Pennsylvania, 17011.
3. Decedent, then 81 years of age, died November 30, 2002 at Camp Hill,
Pennsylvania.
4. Except as follows, decedent did not marry, was not divorced and did not have a
child born or adopted after execution ofthe Codicil offered for probate; was not the victim of a killing
and was never adjudicated incompetent: None.
5. Decedent at death owned property with estimated values as follows:
(If domiciled in Pennsylvania) All personal property under Codicil $22,636.00
WHEREFORE, Petitioner respectfully requests the probate of the Codicil presented
on February 5, 2003 and the grant of Letters Testamentary thereon.
-Zc:-~E~~~~.JGf ` --~z
William C. Range
324 Glendale Drive
Shiremanstown, PA 17011
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA )
ss:
COUNTY OF CUMBERLAND )
The petitioner above named swears or affirms that the statements in the foregoing
Petition are true and correct to the best of the knowledge and belief of Petitioner and that as personal
representative of the above decedent petitioner will well and truly administer the estate according to
law.
William C. Range
Sworn to or affirmed and subscribed
before me this day of April, 2003.
IN THE COMMONPLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of )
VIRGINIA M. KURTZ, unremarried )
widow, deceased, late of Lower Allen ) No. 1161 Estate 2002
Township, Cumberland County, Pennsylvania )
Social Security No. 187-14-4574
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW, this day of , 2003, in consideration of the petition
hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument dated June 15, 2001 described therein be
admitted to probate and filed of record as the Codicil of Virginia M. Kurtz and Letters Testamentary
are hereby granted to William C. Range in accordance with said Codicil and the Last Will and
Testament of Virginia M. Kurtz dated October 19, 1994 duly probated in the office of the Register
of Wills of Cumberland County, Pennsylvania to No. 1161 Estate 2002.
Register of Wills
William L. Kimmel, Esq.
Attorney for the Estate
166 East Union Street
P. O. Box S51
Somerset, PA 15501
I.D. 05632
(814) 445-9651
Ttt,T-152
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF SUBSCRIBING WITNESS
(I/w~c
co ci
(each) a subscribing witness to the ~1~ presented herewith, (each)
being duly qualified according to law, depose(s) and say(s) that 1
present and saw Virginia M. Kurtz ~ ,
the testat: rix sign the same and that 1 signed as a witness at the
request of` testatrix in her presence and (in the presence of each
other) (iri the presence of the other subscribing witness(es),l.
Sworn to or affirmed and ~ `
subscribed before me this ~ aniel R. Giles
day of 32z Gl~:.d~~~ ~-. Sl~~rew~.•s~~~~~ i~ (70!(
2003 ~~ ~c~ress
For t e Register
A ess
RW-151
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
~T) / Cwe) Kav Elaine Range
(each) a subscriber hereto, (each) being duly qualified according to law, de-
pose(s) and say(s) that faimliar with the signature ofVirginia M. Kurtz
testatrix of (one of the subscribing
codicil
witnesses to) the ~~ presentecl herewith and that believes the
codicil
sigpat7~e on the wY~cxis in the handwriting of Virginia M. Kurtz
to the best of ~` knowledge and belief.
Sworn to or affirmed and
subscribed before me this
day of
April, 2003 ~~
For t e Register.
G~r-~,
ame)Kay Elaine ange
324 Glendale Drive Shiremanstown PA 17011
A ess
~Ac~dress
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE INFORMATION NOT I C E
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601 A N D
HARRISBURG, PA 17126-o~sol TAX PAYER R E S P O N S E
REV-1545 EN RFF (09-007
FILE N0. 21 02-1161
ACN 03119430
DATE 05-30-2003
~.'. ,t '- , a ~ l
** JOH TEPHENS
326 EN ~DR
SHIRE TOWN Pgi-,1~011-6~f
TYPE OF ACCOUNT
EST. OF VIRGINIA M KURTZ ^ savlNGs
S.S. N0. 187-14-4574 ^ CHECKING
DATE OF DEATH 11-30-2002 ^ TRUST
COUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CITIZENS BANK OF PA has provided the Oepartnent with the infornation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this infornation is incorrect, please obtain written correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of vennsylvania. questions nay be answered by calling C717) 787-8327.
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
account No. 6240994923 Date 10-07-2002
To insure proper credit to your account, two
Established (2) copies of this notice oust accompany your
Account Balance 70,331.89 Payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent^.
Percent Taxable X 100.00
Amount Subject to Tax 70,331 .89 NOTE: If tax payments are Wade within three
C3) months of the decedent's date of death,
Tax Rate X , 1 rj You may deduct a 5% discount of the tax due.
Potential Tax Due 10,549.78 Any inheritance tax due will become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
_._
A. The above infornation and tax due is correct.
1. You nay choose to remit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you nay check box ^A^ and return this notice to the Register of
0 N E Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK ~ B. ^ The above asset has been ar will be reported and tax paid with the Pennsylvania Inheritance Tax r
0 N L Y to be filed by the decedent's representative. eturn
C. ^ The above infornation is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART If you indicate a different tax rate, please state your
relationship to decedent:
TAX
RETURN - COMPUTATION
OF s::: ::::::::::::::::~ ::::
TAX ON JOINTiTRUST ACCOUNTS ==
LINE 1. Date Established 1 "~~`
:::::::::::
<`!
2. Account Balance p
:::,,::
s€=~['~.
. Percen Taxable 3 X ~'
i€ii€s ~€
4. Amount Subject to Tax 4 ``°°°°'° °°~`°°
.:::.:.:.:.
iiiiiii
5. Debts and Deductions 5 - ~~
s~~€
6. Amount Taxable 6 "°°
iii':€?~l
7. Tax Rate 7 X ~~
s'i~ ~`?
8. Tax Due g ~~
s~~..
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION
AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) $
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
couple tot st of y knowledge and belief . HOME (~ ~ ) ~ ~ ~ `g 3
WORK C ) B S a 3
PAYER SIGNA RE TELEPHONE NUMBER AT
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax become, delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior tc
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions era not being clamed, place an "X^
in block ^A^ of Part 1 of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EXl upon receipt of the return from the Register of Wills.
2. BLDCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response^ section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Departnent of Revenue will issue an official assessment (Form REV-1548 EXl upon receipt
of the return from the Register of Wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originally was established ar titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (*~) appears before your first Wane in the address portion of this notice, the 53,OOD exclusion
already has been deducted fron the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the Wane of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one Year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVDR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance Cline 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 4).
7. Enter the appropriate tax rate (line 7) as determined below.
^The tax rate imposed on the net value of transfers fron a deceased child twenty-one years of age ar younger at
death tc or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0%.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. ^Children" includes natural children
whether or not they have been adopted 6y others, adopted children and step children. "Lineal descendents^ includes all children of the
natural parents and their descendents, whether or mat they have been adopted by others, adopted descendents and their descendants
and step-descendants. ^Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The ^Collateral^ class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. Yau actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2^ x 11". Proof of
oavnent may be requested by the PA Departnent of Revenue.
Date of Death Spouse LineaY Sibling Coiiaterai
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%* 12% 15%
_ _ __ _ _ _
- -
COMMONWEALTH OF PENNSYLVANIA / ~~// `/ /~
DEPARTMENT OF REVENUE INFORMATION NOTICE FILE N0. 21 02-1161
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601 AND ACN 03119431
HARRISBURG, PA 171zs-D(;ol TAXPAYER RESPONSE
DATE 05-30-2003
REV-1543 EX ~FP (09-VY)
TYPE OF ACCOUNT
EST. OF VIRGINIA M KURTZ ^ savINGs
S.S. N0. 187-14-4574 ^ CHECKING
DATE OF DEATH 11-30-2002 ^ TRUST
--- ~~~= ``_' ~' CbUNTY CUMBERLAND ~ CERTIF.
REMIT PAYMENT AND FORMS T0:
JO N STEPHENS REGISTER OF WILLS
32 LE DR t° CUMBERLAND CO COURT HOUSE
S IRE STOI~Ff"' PA 7,Olli-- CARLISLE, PA 17013
~'v~ ~-~ ~z~ ~-~
CITIZENS BANK OF PA has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions nay be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6140830648 Date 09-07-2001 To insure proper credit to your account, two
Established (2) copies of this notice must accompany your
ACCOUnt Balance 33, 115.85 Payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent^.
Percent Taxable X 50.000
Amount Subject to Tax 16,557.93 NOTE: If tax payments are made within three
(31 months of the decedent's date of death,
Tax Rate X .045 You may deduct a 5% discount of the tax due.
745.11 Any inheritance tax due will becoae delinquent
Potential Tax Due nine (9l months after the date of death.
PART TAXPAYER RESPONSE
1 ~:::::::-,:-: ~ :::::::-: ~ :::.:...:.:...:.:.:.:...........................................................................................
::::::::::~ :::::::::::::::::::::::::::::::::::::::::::::.~ ::::::::::::::: ~:::.......... ~....'I'~~....~.~~i~i
~ ... ~i~::;:~t::'~; . ; ;: .:: .::::::
~~. .
A. ^ The above information and tax due is correct.
1. You may choose to resit payment to the Register of Wills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may check box ^A^ and return this notice to the Register of
ONE Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK ~ g. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to he filed by the decedent's representative.
C. ^ The above information is incorrect and/or debts and deductions were paid by ycu.
Ycu oust complete PART 2^ and/or PART 3^ below.
PART y sndscate a dsfferent tax rate, please state your ~~~ ~~~~==:::::_:::<:::: ~! trrr~~ ~: ~~ ~~::- ~~~.:s;:;; :~ ••~:~~ _= °::~: ~: ~~;
~
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TAX RE -
TURN COMPUTATION OF TAX ON JOINT~TRUST ACCOUNTS :::- ..:..:....:::::::::::::~:::::::::::::::_:::::::::::~:~:~::::~::~;:;:::~::::::~:::::;:;:;:;:;_~::::::::::::~:::::::::::::~:,::::::::~;:~::::
~ ~ ::~::::::::::~ :::::::::::::~:::~::;:;:;:;:;~:~;:;:;:;:::;:::;,::::::::::::~::::::::::::~:;~::::::~::~:;:::;::::::::;:;:;:;:::;:,,::
PIES
LINE 1. Date Establsshed
1 ...................................................................................:..........
€:~ €:~ €:~ :::::::::::::~:;:::::~ ::::~ ::~ ::~ ::::::~:;:: ~:;:;:;:;:;:; ~:::::::::::::::~::::::::::::::~ ::~ ::::~;:~;;:~~::::~ :~ ;:;:;:;:::;:;:;:~:
2. Acco
unt Balance 2 €i€€~°;ii:isi:-~;:;:~:~~€;;::~::::~s:t:::t;s:::::s::::::::=:;s:;::t::::::€:::::::::::: ~ :::::::::::::::::::::~::::::::~:::::::::::::::
....... .........................................
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Percen Taxable 3 X .
.~;:;:;.::.:;:;:;;;:;:
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4 . Anou
nt Sub]ect to Tax 4 =E~ifi~ii=`€s~ ~~ ~~;:~ si€'=siiii~itiEsiiii~ iEiEs~ ~ €~ iii€€=Ei;?€~ ~~ ~~ ~ ii ~€i=€~ iiii=i€s iii €~i;i'i€s_ isi
:.::............:. ::,,:,:,:;:,:,: ~:;:;:;:::;:~::,:;:;:;:;:;~:;::::::::::::::~:::::::::::~::::~::::~~:~::::::~::~::,:~:::,:_::::::::::::::~::
Deb sand Deductsons 5 - ~~~ ~~ ~'
6 . Anoun
t Tax
able 6 ::::::::: ~ s:::::::~:• ::::::::::::::::::::::::: ~::::::::::-:::.:.::-:::::.:::::::-::.:::-:::::.::::::::::::-:::::.:::::::.::
:.......:.....:......._:.,.,.,.,.,.,.,. ,.;.,.,.,.,...,,,.,.,...,.:.,:,:,.,:,:,:,:;:;:,:.:,:;:.::,::::::,:,:;:,:,:,:,...,.,.,.,.,.,.,.,.,.;.;.,.,.:.:.:.:.,
~ .~ :.:.:::::::.::
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. Tax Rae 7 X .
.
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ax Due g
ii?i€i€iEi€sii~i€i€::::::s::~ ~ ::~ :::::::::::::a:s:::t:::`:::€:::::i::::s::_ : :::::::~::::::::::~ ~ :;:<::::;€:~:?:;:;:;:;:;:=;:;:::::::::~ ::~ ::::
PART RESTS AND DEDUCTIONS CLAIMED
0
Under penalties of perj y, I declare that the facts I have reported above are true, correct and
conpl to he bes n wledge and belief. HOME (~ ~ ~) `7 ~ '~]
WORK ( ) 845- a3
TAXP R SIGN URE T LEPHONE NUMBER DA E
DATE PAID PAYEE DESCRIPTION nMni(uT peTn
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax be~:omes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one Year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for^ another or others are taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are net being claimed, place an "X^
in block ^A^ of Part 1 of the ^Taxpayer Response" section. Sign two copies and submit then with your check for the amount of
tax to the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will he reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in black ^B" of Part 1 of the ^Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions are being claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment (Form REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint Hanes within one C1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (~*) appears hefore your first name in the address portion of this notice, the 53,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS DR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2l by the percent taxable Cline 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax Cline 47.
7. Enter the appropriate tax rate (line 7] as determined below.
^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 D%.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. "Children" includes natural children
whether ar not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendants and their descendants
and step-descendants. "Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Proof of
payment may be requested by the PA Department of Revenue.
Date cfi Dsath Spouse Liiresl Sibling Coilaterai
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% 4.5%^ 12% 15%
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-060 1
RECEIVED FROM:
STEPHENS JOHN
308 PINEWOOD DRIVE
SHIREMANSTOWN, PA 17011
foltl
ESTATE INFORMATION: ssN: X87-i4-4574
FILE NUMBER: 2102-1 161
DECEDENT NAME: KURTZ VIRGINIA M
DATE OF PAYMENT: 08/05/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1 /30/2002
REMARKS: JOHN STEPHENS
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DUPLICATE
REV-1162 EXI11-96)
NO. CD 002870
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
03119431 ~ 5745.11
031 19430 ~ 510, 549.78
TOTAL AMOUNT PAID:
51 1,294.89
CHECK#509
INITIALS: CW
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28D601
HARRISBURG, PA 17128-Dti01
A
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
* * REVISED NOTICE * ~
REY-1545 EX ~FP (09-007
L:.~
FILE N0. 21 02-1161
ACN 03119431
DATE 08-13-2003
JOHN STEPHENS
308 PINE WOOD DR ;
SHIREMANSTOWN P-A 17011-6527
TYPE OF ACCOUNT
EST. OF VIRGINIA M KURTZ ^ savlNGs
S.S. N0. 187-14-4574 ~ CHECKING
DATE OF DEATH 11-30-2002 ~ TRUST
COUNTY CUMBERLAND O CERTIF.
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
„... __~ -._. ,.. ... _J
s.~... '~.J ~ _'
CITIZENS BANK OF PA has provided the Department with the inforwation listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Cowwonwealth
Of PRnnSY).Vania, QU9e-i~.qe ,.ay hg answered by calling LT_7) 78?-8327..
COMPLETE PART 1 BELOW ~ ~ ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 6140830648 Date 09-07-2001
Tc insure proper credit to your account, two
Established (2) copies of this notice oust accompany your
Account Balance 33, 115.85 Payment to the Register of Wills. Make check
payable to: ^Register of Wills, Agent^.
Percent Taxable X 50.000
Amount Subject to Tax 16,557.93 NOTE: If tex payments era made within three
(3) months of the decedent's date of death,
Tax Rate X . 1 5 you nay deduct a 5% discount of the tax due.
Potential Tax Due 2, 483.69 Any inheritance tax due will become delinquent
nine C97 months after the date of death.
PART TAXPAYER RESPO
::::~*A!f€tf::t;l~#i:::::«rw: ~:~~~rcw.r~,x:::~;fw~.:::;:;::,:.:~~~~~..::~:::::..~.:,:::.~:~~..,.u.s..._.
A. ~ The above inforwation and tax due is correct.
1. You nay choose to remit payment to the Register of Nills with two copies of this notice tc obtai
CHECK
a discount or avoid interest, or you may check n
box ^A^ and return this notice tc the Register of
0 N E
~ Wills and an official assessment will be issued by the PA Department of Revenue.
BLOCK
0 N L Y B. ~ The above asset has been or will be re orted and tax
P paid with the Pennsylvania Inheritan
T
to be filed by the decedent's representative. ce
ax return
C. ~ The above inforwation is incorrect and/or debts and deductions were paid by you
You
roust cowplete PART 2^ and/or PART 3^ below. .
PART If you indicate a different tax rate, please state your
relationship to decedent:. r= R.1E'n17]
TAX RETURN - COMPUTATION OF TAX ON J077NT/TRUST ACCOUNTS •~~.••••.....••••~..~~
`I~'~4!
LINE 1. Date Established 1 _~ '7/ 2db j
~~
`~i
2. Account Balance 2_ 3 3 ~ l 5.
r
`~s~'
3. Percent Taxable 3 __ X ~d .~I)Q D
`'ti€
4. Amount Subject to Tax 4 557 ~3
f x ~~'
_
. "`~#~s
5. Debts and Deductions 5_ - ~5 , j )
6. Amount Taxable 6 ~S ' , ~
~ ~°'~'
~_ €s
7. Tax Rate 7 X ~ ~5
:::~::
...:.:.:.:.
'!
8. Tax Due 8 _ 'Z, ~ ~ t
~~s'€€
PART
0 DEBTS AND DEDUCTIONS CLAIMED
DATE. PAID PAYEE DESCRIPTION
- ~
on Line 5 of Tax
AMOUNT PAID
Under penalties of p "ury, I Clare that the facts I have reported above are true, correct and
couple to he bes•E of n wl and belief. HOME ( 7~7 ) ~]~ ~ ~` ~ 3
~/ WORK ( )
TAXP SIGNATURE TELEPHONE NUM ER DATE
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT with applicable interest based on information
submitted by the financial institution.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decedent's name was added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death are fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent ^in trust for^ another or others are taxable fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions are not being claimed, place an "X"
in block ^A" of Part 1 of the ^Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax tc the Register of Wills of the county indicated. The PA Department of Revenue will issue an official assessment
(Form REV-1548 EX) upon receipt of the return from the Register of Wills.
2. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an ^X" in block "B" of Part 1 of the ^Taxpayer Response" section. Sign one
copy and return tc the PA Department of Revenue, Bureau of Individual Taxes, Dept 280601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/ar deductions are being claimed, check block "C" and complete Parts 2 and 3
according to the instructions below. Sign two copies and submit them with your check for the amount of tax payable to the Register
of Wills of the county indicated. The PA Department of Revenue will issue an official assessment CForm REV-1548 EX) upon receipt
of the return from the Register of Wills.
TAX RETURN - PART 2 - TAX COMPUTATION
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. However, there is an exclusion not to exceed 53,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (*~) appears before your first name in the address portion of this notice, the 53,D00 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxable for each survivor is determined as follows:
A. The percent taxable for joint assets established more than one year prior to the decedent's death:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED 8Y TOTAL NUMBER OF X 100 = PERCENT TAXABLE
JOINT OWNERS SURVIVING JOINT OWNERS
Example: A Joint asset registered in the name of the decedent and two other persons.
1 DIVIDED BY 3 (JOINT OWNERS) DIVIDED BY 2 (SURVIVORS) _ .167 X 100 = 16.7% (TAXABLE FOR EACH SURVIVOR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
OWNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the name of the decedent and two other persons and established within one year of death by
the decedent.
1 DIVIDED BY 2 (SURVIVORS) _ .50 X 100 = 50% (TAXABLE FDR EACH SURVIVOR)
4. The amount subject to tax (line 4) is determined by multiplying the account balance (line 2) by the percent taxable (line 3).
5. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (line 47.
7. Enter the appropriate tax rate (line 7) as determined below.
Date of Death Spouse Lineal ~ Sibling ~ Collateral
07/01/94 to 12/31/94 3% 6% 15% 15%
01/01/95 to 06/30/00 0% 6% 15% 15%
07/01/00 to present 0% I 4.5%* I 12% I 15%
^The tax rate imposed on the net value of transfers from a ceceasec cnuo Gwen y y ~ younger at
death to ar for the use of a natural parent, an adoptive parent, ar a stepparent of the child is D%.
The lineal class of heirs includes grandparents, parents, children, and lineal descendents. ^Children" includes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
and step-descendants. "Siblings^ are defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The ^Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED
Allowable debts and deductions are determined as follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. Ycu actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed roust be itemized fully in Part 3. If additional space is needed, use plain paper 8 1/2" x 11". Prcof of
^~~ao^+ nwv he recuested 6Y the PA Department of Revenue.
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. CD 002908
KIMMEL WILLIAM L
166 EAST UNION ST
PO BOX 51
SOMERSET, PA 15501
fold
ESTATE INFORMATION: ssN: is~-~4-4574
FILE NUMBER: 2102-1 161
DECEDENT NAME: KURTZ VIRGINIA M
DATE OF PAYMENT: 08/15/2003
POSTMARK DATE: 08/15/2003
couNTY: CUMBERLAND
DATE OF DEATH: 1 1 /30/2002
REMARKS:
CHECK# 4384
ACN
ASSESSMENT
CONTROL
NUMBER
REV-1162 EX~11-96~
AMOUNT
101 ~ 52,371.92
TOTAL AMOUNT PAID:
52,371.92
INITIALS: SK
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
IN THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of
VIRGINIA. M. KURTZ, deceased No. 1161 Estate 2002
DISCLAIlVIER OF SERIES HH
U. S. SAVINGS BONDS
FILED ON BEHALF OF:
JOHN STEPHENS, DISCLAIMANT
COUNSEL OF RECORD:
William L. Kimmel, Esq.
Attorney for Estate
166 East Union Street
Somerset, PA 15501
(814)445-9651
Pa. I.D. 05632
IN THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of
VIRGINIA M. KURTZ, unremarried widow,
deceased, late of Lower Allen Township,
Cumberland County, Pennsylvania
No. 1161
DISCLAIMER
Estate 2002
WHEREAS, VIRGINIA M. KURTZ (the "Decedent"), an unremarried widow,
became deceased on November 30, 2002 while a resident of Lower Allen Township, Cumberland
County, Pennsylvania; and
WHEREAS, as of the date of her death, Decedent was the owner of four $10,000.00
Series HH United States Savings Bonds, Serial Nos. X1157814HH, X 1157815, X1157816 and
X1157817HH issued June, 2002, and fifteen $10,000.00 Series HH United States Savings Bonds,
Serial Nos. X1157820HH, X1157821H1-I, X1157822HH, X1157823HH, X1157824HH,
X1157825HH, X1157826HH, X1157827HH, X1157828HH, X1157829HH, X1157830HH,
X1157831HH, X1157832HH, X1157833HH, and X1157834HH issued June, 2002 (collectively,
the `Bonds"), the face value of all of said Bonds totaling $190,000.00; and
WHEREAS, each Bond designates the undersigned, JOHN STEPHENS, as "POD"
Beneficiary, with each Bond payable to him upon Decedent's death; and
WHEREAS, the undersigned has not accepted any interest in or benefits of the Bonds;
and
WHEREAS, the undersigned will not receive any consideration in money or money's
worth for making a disclaimer or renunciation of any interest in the proceeds of the Bonds.
NOW, THEREFORE, the undersigned, JOHN STEPHENS, intending to be legally
bound, hereby irrevocably disclaims, renounces and refuses to accept any and all interest of any kind
in the proceeds of said Bonds as Beneficiary.
2
1. The undersigned intends that this Disclaimer shall constitute a "qualified
disclaimer" as defined in Section 2518 of the Internal Revenue Code of 1986, as amended, or the
corresponding provisions of any subsequent federal tax law. This Disclaimer shall be irrevocable.
2. This Disclaimer is not made to prejudice the rights of any creditor of the
undersigned.
IN WITNESS WHEREOF, the undersigned hereby executes this Disclaimer this 20'~
day of August, 2003.
Witness: )
(SEAL)
John Stephe s
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF SOMERSET
SS:
I, JOHN STEPHENS, the Disclaimant, whose name is signed to the foregoing
Disclaimer, being first duly sworn according to law, do depose and say that I signed and executed the
foregoing instrument as my Disclaimer, that I signed willingly, that I executed it as my free and
voluntary act for the purposes therein expressed, and that I am eighteen years of age or older, of
sound mind and under no constraint or undue influence. ~ ,. /1
l/ John Steplienst/
Subscribed, sworn to and acknowledged
before me by John Stephens, the
Disclaimant, this 20~` day of August, 2003.
,~ -
u~
~ ~ J^~~h~rU~~IC
C r c
~_ o~V011.1 2=~,~
4
~7-
,
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
i'7~11O - iO
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
....
z
UJ
Cl
UJ
U
UJ
Cl
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
(.
'-./
PR.E NUMBER
COUNTY CODE
NUMBER
SOCIAL SECURITY NUMBER
DATE OF DEATH
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
TItIS RETURN MUST BE FILED IN DUPLICATE WITH THE
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
7. Decedent Maintained a Living Trust (Ntach. copy of Truet) I) 8. Total Number at Safe Deposit Boxes
10. Spousal Poverty Credit (dIte of_Ill ~ 12-31-91 and 1-1-95) ~~;~~n to tax under Sec. 9113(A)
THIS SECllON MUST BE COMPLETED. ALL CORRESPONDeNCE AND CONFIDENTlAL TAX INFORMAnON SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
!
:>e.!!!ln
O"~
.l!~~
(,,)8:lD
0(
X 1. Original Return
4. Limited Estate
6. Decedent Died Testate (Attach copy afWirl)
9. Litigation Proceeds Received
i
B
FIRM NAME
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
~ 4. Mortgages & Notes Receivable (Schedule 0)
~ 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E)
<(
:5 6. Jointly ONned Property (Schedule F)
~ 1:--::-,::-:'-1 Separate Billing Requested
0-
<( 7. Inter~Vtvos Transfers & Misc. Non..probafe Property
U (Schedule G or L)
W
a::: 8. Total Gross Assets (total Lines 1~7)
9. Funeral Expense. & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line a minus Line 11)
2. Supplemental Return
3. Remainder Return (auofdRlh priorto 12-
,,..,,
4a. Future Interest Comprise (date of d!taIh der 12-12-62)
5. Federal Estate Tax Return Required
(1)
(2)
(3)
(4)
(5)
(6)
$136,000.00 OFFICIAL USE ONLY
$1~,489.61 d
"',,'
$0.00
$0.00
$3}7,747.69
$301,131.67
(7)
$421,654.29
(6)
$1,303,223.46
(9)
(10)
$1116,679.99
$3,503.}7
(11)
(12)
(13)
S1M 183 18
$1,113,040.30
13. Charitable and Governmental8equestafSec 9113 Trusts for which an election to tax !\as not been
made (Schedule J)
14. Net Value SubtecttoTax (line 12 minus Line 13)
$190 000 OD
(14)
$923,040.30
SEE 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)
z
o
;::
~~
f-::J
..
~
o
o
$136,456.05
$0.00
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
2ol~d
x
(15)
(16)
(17)
(16)
(19)
$136,456.05
$0.00
x
x
.12
x
.15
SOOD
, Oece~nt's Complete Address:
STREET ADDRESS
crry
ZIP
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
c. Discount
(1)
$138.456.05
Total Credits (A + B + C)
(2)
$168.922.80
3. InterestlPenatty if applicable
D. Interest
E. Penalty
TotallnterestIPenalty (0 + 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 Une 20 to request a refund (4)
s. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
lIIIL~IIIIBf~1IIJf_'
$0.00
$28,456.75
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
l'~
1. 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 tramsferred or its income;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? tf death occurred
after December 12, 1982, did decedent transfer property within one ~r of death without
receiving adequate consideration?
3. Did decedent own an ~in b'ust 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?
Yes
No
;
E!3
x
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 rerum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct,
and complete.
Declaration of preparer other than the personal representative is baaed on all the information of which preparer has any knowledge.
SIGNATURE
a
ADDRESS
DATE ff-~'1-03
1'''9'1at2t.2~
ADDReSS
Copyright 2000 David James Thorpe, Esq.
COMMONINEAL TH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
21.024IBI
VIRGINIA M. KURTZ
FILE NUMBER
All real property 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
jotntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
I.
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$136,000.00
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER
21021161
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
3.
6.
TOTAL (Also enter on line 2, Recapnulalion)
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 Dwid James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER 21021161
PJI property jolntly-owned with the right or survivorship must be disclosed on
Include the proceeds of litigation and the date the proceeds were received by the estate.
Schedule F.
ITEM
NUMBER
DESCRIPTION
TOTAL (Also enteron line 5, Recapnulatlon)
(If more space is needed, insert additional sheets of the same size)
$317,747.69
Cop)right 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CONTINUATION PAGE
SCHEDULE E-1
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER
21021161
ITEM
NUMBER
15.
DESCRIPTION
w.
Cop)Tight 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER
21021161
If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G.
JOINTLY-OWNED PROPERTY:
DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar identifying number.
Attach deed for joinUy-heId real estate
TOTAL (Also enter on line 6, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$301,131.87
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
CONTINUATION PAGE
SCHEDULE F-1
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER
21-02-1161
DESCRIPTION
Copyright: 2000 David James: Thorpe, Esq.
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER
21021161
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV~1500 COVER SHEET i. yes.
rrEM DESCRIPTION OF PROPERTY DATE OF DEATH '% OF DECO'S EXCLUSION
NUMBER INCLUDE THE NNJlE OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF "TRANSFER. VALUE OF ASSET INTEREST OF APPLICABLE)
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
cop)right 2000 David Janes Thorpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
VIRGINIA M. KURTZ
FILE NUMBER
21.()2-1161
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
1.
2.
B.
TOTAL (Also enter on line 9. Recapttulatlon)
(If more space is needed, insert additional sheets of the same size)
cDp)right 2000 David James TbOlpe, Esq.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
VIRGINIA M. KURTZ
21-Q2-1161
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
TOTAL (Also enteron line 10, Recapnulation)
(If more space is needed, insert additional sheets of the same size)
$3,503.17
Copyright 2000 David James Thorpe, Esq.
COMMONWEALTH OF PENNSYlVANIA
INHERrrANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
NUMBER
ESTATE OF VIRGINIA M. KURTZ
NAMe AND ADDRESS OF PERSON(S) RECEMNG PROPERTY
21-02-1161
AMOUNT OR SHARE
OF ESTATE
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
See 0 and made a part h
I.
ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. NA
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
(If more space is needed, Insert additional sheets of the same size)
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. St. Jolm'Sluthelllll C
44 West MllIn
Shifeman
Copyright 2000 David James Thorpo, Esq.
SCHEDULE J-l
Wilma Bosserman, friend (specific bequest)
1001 E. Walton Avenue, Apt. 305
A1toona, PA 16602
Meig Kurtz, nephew (specific bequest)
3200 Appel Road
Bethel Park, P A 15102
William C. Range, friend (specific bequest)
324 Glendale Drive
Shiremanstown, PA 17011
Elwood Friedline, cousin (l/9th residue)
943 Pleasant Hill Road
Somerset, PA 15501
Wayne E. Friedline, cousin (l/9th residue)
1027 Pleasant Hill Road
Somerset, PA 15501
Ronald Friedline, cousin (l/9th residue)
281 Wildcat Road
Friedens, PA 15541
Elsa Sutherland, friend (specific bequest)
61 Moraga Via
Orinda, CA 94563
Millie Lai, a/k1a Mildred Lai, friend (specific)
1816 Kualono Street
Honolulu, H196817
Susanne Funk, friend (specific bequest)
3773 Derry Street
Harrisburg, P A 17111
Ruth Sicheri, friend (specific bequest & POD)
730 Quecreek Road
Quecreek, PA 15555
Gerald Friedline, cousin (l/9th residue)
583 Sipesville Road
Sipesville, PA 15561
M. Joan Kimmel, cousin (l/9th residue)
2347 Huckleberry Highway
Berlin, PA 15530
Dolores Shaffer, cousin (l/9th residue)
2622 Raymond Avenue
Latrobe, P A 15650
Lois Jean Davis, cousin (l/9th residue)
668 Bruceton Road
Markleysburg, PA 15459
Charles Friedline cousin (l/9th residue)
195 Friedline Drive
Somerset, PA 15501
Carol Friedline, cousin ( l/9th residue)
413 Second Avenue
Meyersdale, PA 15552
Michael Kurtz, brother-in-law (specific)
3200 Appel Road
Bethel Park, P A 15102
Kay Range, friend (specific bequest)
324 Glendale Drive
Shiremanstown, PA 17011
John Stephens, friend (POD)
308 Pinewood Drive
Shiremanstown,PA 17011
Arbutus Focht, friend (specific)
423 Amaya Avenue
The Villages, FL 32195
Terri Seip, alk/a Theresa Seip, friend (specific)
33 South West Avenue
Shiremanstown, PA 17011
Nancy Berkey, friend (specific bequest)
173 Top of Hickory Hill Lane
Somerset, PA 15501
Connie Lee Kolesko, friend (specific bequest)
55 Vernon Road
Bolton, CT 06043
Charles Roberts, friend (POD)
772 South Warren Avenue
Columbus, OH 43204
Michael L. Seifried, Minister (POD)
44 West Main Street
Shiremanstown, P A 17011
Rena Steel, friend (POD)
4060 Lisbum Road
Mechanicsburg, PA 17055
Virginia Rebert,friend (specific bequest&POD)
105C Faith Drive
New Oxford, PA 17350
St.John's Lutheran Church (specific bequest)
44 West Main Street
Shiremanstown, PA 17011
Prince of Peace Church in Hawaii (specific)
1717 Mott-Smith Drive, Suite 1811
Honolulu, HI 96822
Vernon Berkey, half-brother (POD)
173 Top of Hickory Hill Lane
Somerset, PA 15501
Nicholas Christoff, Minister (POD)
1717 Mott-Smith Drive, Suite 1811
Honolulu, HI 96822
Deloris Friedline, friend (POD)
R.D.l
Friedens, PA 15541
LAS'I' HILL MID 'l'E:S'l'J\JmIJ'j' OF VIHGINIA H. lCUTI'rz
J, VIIWINU\ H. KunTZ, oj' the Township of Lower 1\llen,
County of Cumberland and state of Pennsylvania, being of sound
and dIsposing mind, memory and understanding, do mako, publish
and declare this my Last Hill and 'l'estalllent, hereby revokinG and
maltinr; void any and all prior Hills by me at any time heretoi'ore
me.de.
1.
I direct the payment of all my just debts and :funeral
expenses as soon a:fter my decease as the same can be conveniently
done, and in this respect, I direct that all estate, inheritance
and succession taxes that may be assessed in consequence o:f my deatl
of Hhatever nature and by whatever jurisdiction imposed, shall be
paid out of' the principal or my general estate to the same effect
as if said taxes Here expenses of administration, and that all
property includable in my taxable estate, Hhether or not passing
under tills 'dill, shall be free and clear thereof.
2.
I give and bequeath the sum of 'rhirty 9-'housand ($30,000.00)
Dollars to my good friend, WILl1!\. BOSSERHAN.
-1-
3.
I give and bequeath the sum of Thirty 1'housand ($30,000.00)
Dollars to my nephew, MEIG KURTZ.
4.
I give and bequeath the sum of Twenty Thousand ($20,000.00)
Dollars to my good friend, WILLIAM C. RANGE.
5.
I give and bequeath all the rest, residue and remainder of
my estate, of whatsoever nature and wheresoever the same may be
situate, to Iny cousins, immediately hereinafter named, who shall
survive me, to wit,
ELWOOD FRIEDLINE
KENNETH FRIEDLINE
WAYNE FRIEDLINE
RONALD FRIEDLINE
GERALD FRIEDLINE
11. JOAN KI/1HEL
DOTJOHES SIIAEFEH
LOIS JEAN DAVIS
CHAHLES F1UEDLINE
HAY WOOLLEY
CAHOL FRIEDLINE
-2-
6.
I authorize, empower Hnd direct my Executor, hereinafter
named, to sell any and all real estate which I may own at the
tinrn of my decease, as well as my personal property, at either
public or private sale or sales.
LAS'fLY, I nominate, constitute and appoint my good friend,
\VILLIAH O. HANGE, Executor of this my Last VIill and Testament,
and direct that he be excused from posting bond or other security
for the faithful performance of his duties in any jurisdiction.
this
IN \lI'fNESS HllliHEOF, I have hereunto set my hand and seal
<:;j.
/7 day of October, A. D., 1994.
(~~9?Z,~
Vi ginia l'l. Kurtz
(SEA)
-3-
Signed, sealed, published and declared by the above
named, VIRGINIA H. KURTZ, as and i'or her Last lHIl and Testament,
in the presence of us, who have subsoribed our names hereto as
witnesses, at the request at' said testatrix, in her presence and
in the presence of each other.
/2 ~...
>Y.. -
~...e ~
( ~:J8. . >>-U
-4-
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUHBERLJlND
)
I, VIRGINIA II. ICUIl'rZ , the testat rix
whose name Is s:Lgneu to the attached or foregoing instrument, having
been duly qualIfied accordIng to law, do hereby acknowledge that I
sIgned and executed the instrument as my Last WIli and Testament;
that I sIgned It willIngly; and that I signed it as my free and volun-
tary act and deed, for the purposes therein contained.
Sworn and affirmed to and acknowledged
VIRGJlIIA H. KUWrZ , the testatrix
day of October , A. D. , 1994.
before me ,by )'/1.
,this ! !
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11,/
SS.
NOlatfaJ Seal
MOO MaI!l'" Kay Eakin, Nolary Public
M fanCom""burg BolO, Combei1and CoUl1!y
y mIsSion Expires Nov. 6, 1997
L::'~:":;".':'(" "" '"
My C~lm;: :1:~::'1.,~ i i~:~7")b'-., .; (''1'/ '. :
--;-PanrISl'lvwii1~"'~.l
COHHONWEALTIl OF PENNSYLVANIA
)
COUNTY OF CUHBERLAND
)
We, the undersigned, J. ROBEHT STAUFFER
and EHIYul L. LEVENHAGEN , the witnesses whose names are
signed to the attached or foregoing 'instrument, being duly qualified
according to law, depose and say that we were present and saw the
testatriX VIRGINIA 1,'1. KURT:, . sign and exe-
cute the instrument as :~l1D;/her Last Wili and Testament; that the
said testatrix ,VIHGINIA.l:i--JaJR'l'7. , executed it as
lJ..1rsv'her free and voluntary act for the purposes therein expressed;
that each of us, in the hearing and sight of the testat rix , signed
the Will as witnesses; and that to the best of our knowledge, the
testatriX was, at the time, eighteen (18) or more years of age,
of sound mind, and under no constraint, duress or undue influence.
,/
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s~s~ibed to before
1-;1 day of
, 1994.
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"aniyn Kay Eakin, NoIaJy Public .
"'''csburg 80/0. Cunlbei1and C
Commission Expi Nov. Qunly
res ,6, 1997
llInbsr, ~IlINol8i1Eii
Sworn and
me this
October
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This Indenture,
MADE THE 16th day ofIune, in the year of our Lord two thousand three (2003).
BETWEEN
WILLIAM C. RANGE, Executor of the Last Will and Testament of VIRGINIA M. fJJRTZ,
unremfU'Tiedwidow, deceased, late of Lower Allen Township, Cumberland County, Pe~vania,
party of the first part, ~ l.j _.
r :JJ :-;', . ,
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MARLIN E. NAUMAN and GENEVA R. NAUMAN, husband and wife, of the same place, as
tenants by the entireties with right of survivorship, parties of the second part,
GRANTEES
WHEREAS, the said Executor was duly appointed as such Executor by Letters Testamentary
issued December 16, 1001, by the Register of Wills of Cumberland County, Pennsylvania; and,
WHEREAS, the Executor has determined to sell the real estate hereinafter described not
specifically devised to the parties of the Second Part herein for the sum of $136,000.00, which is,
in the opinion of the Executor, the best price obtainable for same.
WHEREAS the said Virginia M. Kurtz, unremarried widow, by her Last Will and Testament,
duly proved and recorded in the Register's Office of Cumberland County, Pennsylvania, duly
probated and filed to No. 1161 Estate 1001 appointed William C. Range, Executor, of the Estate
of said decedent as follows:
5. . . . I authorize, empower and direct my Executor, hereinafter named, to sell any
and all real estate which I may own at the time of my decease, as well as my
personal property, at either public or private sale or sales.
L4STLY, I nominate, constitute and appoint my good friend, WILLIAM C
RANGE, Executor of this my Last Will and Testament, and direct that he be
excused from posting bond or other security for the faithful performance of his
duties in any jurisdiction.
NOW, THIS INDENTURE WITNESSETH, that the said party of the first part, by virtue
of the power and authority aforesaid in said Will contained, and in consideration of the sum of ONE
HUNDRED THIRTY-SIX THOUSAND ($136,000.00) DOLLARS to him in hand paid by the
parties of the second part, at and before the ensealing aod delivery conveyed, and does hereby grant,
bargain, sell and convey to the said Marlin E. Nauman and Geneva R Nauman, husband and wife,
their heirs and assigns, forever,
fOOK 257 p.\u4639
ALL that certain piece or parcel ofland situate in the TOWNSHIP OF LOWER ALLEN, County
of Cumberland, and State of Pennsylvania, bounded and described as follows, to wit:
BEGINNING at a point at the. intersection of the eastern line of West Avenue with the southern line
of Glendale Drive; thence along the southern line of Glendale Drive, North 66 degrees 36 minutes
East, one hundred ten (110) feet to a point; thence South 23 degrees 24 minutes East, one hundred
fifteen (lIS) feet to a point; thence South 66 degrees 36 minutes West, one hundred nineteen and
seventy-six hundredths (119.76) feet to a point on the eastern line ofW est Avenue; thence along the
eastern line of West Avenue, North 18 degrees 33 minutes West, one hundred fifteen and forty-one
hundredths (115.41) feet to a point, the place of beginning.
BEING LOT NO.1, BLOCK "0" on Plan No. 1 of Shireman Manor Extension, said plan being
recorded in the Cumberland County Recorder's office in Plan Book 16, page 6.
HA VlNG THEREON ERECTED a one story brick ranch type dwelling house known and numbered
as 326 Glendale Drive.
BEING the same premises granted and conveyed unto JohnE. Kurtz and Virginia M Kurtz, his wife,
by Deed of Robert Leroy Wrightstone and Arlene H. Wrightstone, his wife, dated October 17, 1966
and recorded in Cumberland County Deed Book I Volume 22, page 564. Thereafter, John E. Kurtz
became deceased on April 7, 1994, thereby vesting full, complete and sole title in Virginia M Kurtz,
his wife, by virtue of survivorship to atenancy by the entireties.
Subsequently, Virginia M. Kurtz, an unremarried widow, became deceased on November 30, 2002
while a resident of Lower Allen Township, Cumberland County, Pennsylvania, and by her Last Will
and Testament dated October 19, 1994 and Codicil dated June 15,2001, and duly probated to No.
1161 Estate 2002 in the Office of the Register of Wills of Somerset County, Pennsylvania, duly
appointed William C. Range as Executor, who hereby executes this Deed in accordance with the
powers contained in said Will and Codicil on behalf the Estate of Virginia M Kurtz, as more fully
hereinabove set forth.
UNDER AND SUBJECT, nevertheless, to easements appearing on record on said plan and to the
restrictions as set forth in the Cumberland County Recorder's Office in Miscellaneous Record Book
167, page 435.
The premises are being conveyed in an "AS.IS" condition.
The Grantor hereby acknowledges that the Grantor has not disposed of hazardous waste on the
property ahove described, nor, to the actual knowledge of the Grantor, has hazardous waste ever
been disposed on the property above described. The terms "hazardous waste" and "disposed" as used
herein, shall have, in addition to their normal and customary meanings, the definitions contained in
the "Solid Waste Management Act", No. 970f1980.
The following notices are required by the Acts of Legislature of the Commonwealth of Pennsylvania,
specificallyheing thatthe Act ofJuly 17, 1957, P.L. 984, as amended (52 P.S. Section 1552) and the
Act of April 27, 1966, P.L. 31, as amended, (52 P.S. Section 1406.1 et seq.), and the inclusion of said
notices does not enlarge, restrict or modify any legal rights or estates otherwise created, transferred,
excepted or reserved by this instrument
This document may not sell, convey, transfer, include or insure the title to the coal and right of
support underneath the surface land described or referred to herein, and the owner or owners of
such coal may have the complete legal right to remove all of such coal, and, in that connection,
damage may result to the surface of the land, and any house, building or other structure on or
in such land. The inclusion of this notice does not enlarge, restrict or modify any legal rights or
estates otherwise created, transferred, excepted or reserved by this instrument.
p;aOK 257 F.,c;4640
NOTICE
The undersigned, as evidenced by the signatute(s) to this notice and the acceptance and
recording (if this deed, (is, are) fully CObTJ1izant of the fact that the undersigned may not be obtaining
the right of protection against subsidence, as to the property herein conveyed, resultingfrom coal
mining operations and that the purchased property herein conveyed, may be protectedfrom damage
due /0 mine subsidence by a private contract with the awners qf the economic interest in the coal,
This notice is inserted herein to comply with the Bituminous Mine Subsidence and Land
Consefvatlon Act of 1966.
Witness:
;1, . C)J
..7lc:?..'z.l.A.':::....j"..:."'!J..,.,44J.... ...........
Marlin E. Nauman
<')" .,' ) /1'
. ~~;~'.jU;~(X;;:'<J.\,...! &!:.-t.-i. :lJ.Lf.ij:i.-..............
Geneva R. Nauman
TOGETHER WITH all and singular the rights, liberties, privileges, hereditaments and appurtenances
whatsoever thereunto belonging or in anywise appertaining and the reversions and remainders, rents,
issues and profits thereof, and all the estate, right, title, interest, property, claim and demand
whatsoever of the said Virginia M. Kurtz, unremarried widow, deceased, at and immediately before
the time of her decease, in law or equity or otherwise howsoever, of, in, to or out of the same.
TO HA VE AND TO HOLD the said granted premises to the said Marlin E. Nauman and Geneva
R. Nauman, husband and wife, their heirs and assigns forever.
AND the said William C Range, Executor of the Last Will and Testament of Virginia M. Kurtz,
unremarried widow, does covenant, promise, grant and agree, to and with the said Marlin E.
Nauman and Geneva R. Nauman, husband and wife, their heirs and assigns, by these presents, that
he, the said Executor has not done, committed or knowingly or willingly suffered to be done, any
act, matter, or thing whatsoever, whereby the premises aforesaid, or any part thereof, is, are, shall
or may be charged or incwnbered, in title, charge or estate, or otherwise howsoever.
IN WITNESS WHEREOF, the said William C Range, Executor of the Last Will and
Testament of Virginia M. Kurtz, unremarried widow, deceased, has hereunto set his hand and seal
the day and year first above written.
Signed, Sealed and Delivered
in the Presence of:
)
)
)
)
)
)
-;'t.~;~f."1-V'; {:'~;:7/~L.GIec.tt. .t;:~
William C Range, Executor
(SEAL)
ESTATE OF VIRGINIA M. KURTZ
At/: ~~
~OOK 257 PrI[[4611
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SOMERSET
)
ss:
)
On this, the 17th day of June, 1003, before me, the undersigned officer, personally
appeared William C Range, Executor of the Last Will and Testament of Virginia M. Kurtz,
unremarried widow, deceased, known to me (or satisfactorily proven) to be the person whose
name is subscribed to the within instrument, and acknowledged that he executed the
same for the purposes therein contained
IN WITNESS WHEREOF, I hereunto set my hand and official seaL
NOTAFiiALSEAL
EaE~ M, OGU~,E~OTARY pusuc
SOMER'lET SCPO, sa~M:RSE7 COUNTY
MYCOJ,.iMISSil.,\i EX'-"RES NOV. 11,2004
CERTIFICATE OF RESIDENCE
I do hereby certify thai the precise residence and complete post office address of the
within named grantee is 326 Glendale Drive, Shiremanstown, PA 17011.
Jtl a ~/~" /'(la i? Iii Lii'
, MBI'lin E., auman
corec"r!
, to be re
1 certl~)' thIS d Count)' P A.
r.,mber1an '2A~
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Prepared by:
William L Kimmel, Esq.
166 East Union Street
P. O. Box 551
Somerset, Pennsylvania 15501
'r ot Deeds
. '.cord"
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JEWEI.Il'
121 NORTH CENTER AVE.
SOMERSET, PA 15501
814-445-4062 814-445-8841
FAX 814-443-9875
Certificate of Appraisal
Name of Owner: Estate of Virginia Kurtz
Date .T"'nn"'rJi 20. 2003
Description of Items:
Page 1
BOX #1 Assorted costume jewelry. . . . . . . . .. .. . .. . .. .. .. .. .. .. NO VALUE
Box #2 Assorted Costume Jewelry.. . .. . . .. .. .. .. . .. . .. . .. . . .. . NO VALUE
Box #3 Assorted Costume Jewelry. .. ....... . .. .. .... .. ..... . .. .. NO VALUE
Assorted HUMMEL figurines
#328 Carnival....................................$245.00
#195/2/0 Barnyard Hero........................... 195.00
#255/1 A stitch in time......................... 250.00 estimated
#BH53 Drummer boy.............................................. 200.00 estimated
#136/1 Friends.................................. 240.00 estimat~d
#199/0 Feeding Time............................. 235.00
#56?A Culprits................................. 345.00
#315 Mountaineer.............................. 250.00
#6/1 sensitive Hunter......................... 235.00
#8749 Chopping wood with blue bird/boy......... 250.00 estimated
#1 Ruth Sicheri Lady's bangle bracelet marked l4k yellow
gold, 12mm wide. $150.00
#2 Ruth Sicheri Lady's rusted jade pendant with a l4k
yellow gold mounting and 20 inch chain,t
3,5mm wide rope design. $150.00
#3
Ruth Sicheri Lady's diamond enga~ement ring, l4k yel.
mounting. with 4 prtncess cut dias. 3.50
~ each and 8 round cut dias. .05 pts. each.
The appraised value as expressed bmilillepresents the approximate A pp r ox . 1. 50 car a t s
retail replacement value. It is for insurance only and not a valuation total we i ght.
for sale. This paper is rendered at the customer's request for their use.
$1,500.00
The diamonds and gem stones are graded in as far as the mounting
permits. The weight of the diamonds and gem stones are approximate
unless otherwise indicated.
Stdt4- ~.
Sta4t4-
JflYELI'
121 NORTH CENTER AVE.
SOMERSET, PA 15501
814-445-4062 814-445-8841
FAX 814-443-9875
Certificate of Appraisal
Name of Owner: Estate of Virginia Kurtz
Date Januarv 20. 2003
Description ofItems: Page 2
#4
Ruth sicheri
l4k yellow gold mesh style bracelet
10mm wide.
l4k yellow gold mesh style bracelet
15mm wide.
Lavender jade pendant in l4k mounting
and l4k yellow gold 16 inch 2.50mm
herringbone chain.
Lavender jade ring, l4k yellow gold
mounting. The ring features one 19x14.50
mm cabashon oval cut and 16 2.00mm round
cut amethysts and 16 round single cut
diamonds,c,approx. .01 pt. each.
1 oz. liberty gold piece pendant in a 14k
yellow gold mounting. The mounting features
10 round full cut diamonds approx. .08 pts.
each and 1 round brilliant cut diamond
approx. .20 pts. on a 20 inch 3.50mm wide
14k yellow rope chain.
Lavendar jade bangle bracelet with a 14k
yellow gold catch and hinge.
Lady's emerald and diamond ring, 14k yellow
gold mounting. The ring features one 6.25x
7mm emerald cut emerald and 10 round full
cut diamonds approx. .05 pts. each. with
a total weight of .50 pts.
Lady's amethyst and diamond ring, l4k
yellow gold mounting. The ring features
one l8x13 Pear cut genuine amethyst and
Theappraisedvalueas""",""...Jd~lhf~s. .01 pts. each.
retail replacement value, it is for insurlm<e only and not . valuation
for sale, This paper is renderod at the custvmer's request for their use.
#5
Millie Lai
#6
Millie Lai
#7
Millie Lai
#8
Millie Lai
#9
Joann Kimmel
#10 Joann Kimmel
The diamonds and gem stones are graded in as far as the mounting
permits. The weight of the diamonds and gem stones are approximate
unless otherwise indi<:ated.
Sedt:4- ~.
$125.00
95.00
150.00
125.00
$1100.00
350.00
1,500.00
200.00
SuU:4-
JEWEI..'
121 NORTH CENTER AVE.
SOMERSET, PA 15501
814-445-4062 814-445-8841
FAX 814-443-9875
Certificate of Appraisal
Date .January 20. 2003
Name of Owner: Estate of Virginia Kurtz
Description of Items:
Page 3
#11 Nanay Berkey Lady's diamond tennis bracelet, l4k yellow
gold. The bracelet features 50 round bril-
liant cut diamonds approx. .08 pts. each,
totaling approx. 4.00 carats. $2500.00
#12 Nancy Berkey Lady's Tanzanite and diamond ring, l8k
white gold mounting. The ring features
one 12x8.5mm oval cut genuine tanzanite
and 2 trillion cut diamonds r.5mm each. $4500.00
#13 Nan~ Berkey Lady's emerald and diamond bracelet, l4k
yellow gold. The bracelet features 13
5x3mm oval cut genuine emeralds and 13
round full cut diamonds approx. .01 pt.
each. $$~OO.OO
#14 Terri Seips Lady's emerald and diamond ring, l8k
white gold mounting. The ring features
one 9x5mm pear cut genuine emerald and
32 approx. 3xl.5mmbaquette cut diamonds
and 12 princess cut diamonds l.5mm each. 2000.00
#15 Terri Seips Lady's l4k yellow and white gold bracelet
The bracelet features 195 round single cut
diamonds approx. .01 pt. each. Approx.
total weight of 2.00 carats. $800.00
#16 Joann Kimmel Lady's fres~water pearl and diamond ring,
l4k yellow gold mounting. The ring fea4
tures one 33x8.50mm odd shape freshwater
pearl and 3 round full cut diamonds approx.
.04 pts. and 2 round full cut diamonds
approx. .01 pt. each. 450.00
The appraised value as ~sed hemn n:presents the approximate
retail replatemenl value. It is for insurance only and not . valuation
for sale. This paper is rendered at the CUStDm<r's request for their use.
The diamonds and gem stones arc graded in as far as the mounting
permits. The weight of the diamonds and gem stones arc approximate
unless otherwise indicat<:d.
Stdt4- ~.
,
Name of Owner:
Description of Items:
#17 Carol Friedline
#18 Carol Friedline
#19 Kay Range
#20 Kay Range
#21 Kay Range
#22 Wilma Bosserman
#23 Wilma Bosserman
#24 Dolores Shaffer
#25 Lois J. Davis
Seait4-
JEWEl.R'
121 NORTH CENTER AVE.
SOMERSET, PA 15501
814-445-4062 814-445-8841
FAX 814-443-9875
Certificate of Appraisal
Date Januarv 20. 2003
Estate of Virginia Kurtz
Page 4
Lady's jade ring, l4k yellow gold mounting
The ring features one 15x7mm pear cut jade. $75.00
Lady's gre~and rust colored jade bangle
bracelet with a l4k yellow gold catch
and hinge. $100.00
Lady's jade ring, l4k yellow gold mout-
ing. The ring features one 20x10mm
marquise cut jade. $100.00
Lady's carnival color 2 stone ring, l4k
white gold mounting. $50.00
Lady,s green and rust colored jade
pendant with a l4k yellow gold mount-
ing on a heavy 18 inch gold chain. $50.00
Lady's diamond dinner ring, l4k yellow
gold mounting. The ring features 27
round brilliant cut diamonds totaling
approx. 1. 50 carats. $800.00
Lady's diamond dinner ring, l4k yel-
low gold mounting. The ring features
17 round brilliant cut approx. total
weight 1.50 carats. $1000.00
Lady's Seiko watch, 17 jewel movement,
white gold plated case. NO VALUE
Lady's strand of cultured pearls with
a l4k yellow catch. The necklace features
80 cultured pearls 6~-7mm, 24 inches
long. $400.00
The appraised value as expressed hemn rcpreseo1S the opproximate
retail replacement value. It is for insurance only and not a valuation
for sale. This paper is n:ndemi at the customer's request for their use.
The diamonds and gem stones are graded in as far as the mounting
permits. The weight of the diamonds and gem stones are approximate
unless otherwise indicated.
Stdt4- ~.
Name of Owner:
Description ofItems:
#26
#27 Arbutus Focht
#28 Virginia Rebert
#29 Suzanne Funk
#30
#31
#32
#33
Sea-Aid-
JfWfLR'
121 NORTH CENTER AVE.
SOMERSET, PA 15501
814-445-4062 814-445-8841
FAX 814-443-9875
Certificate of Appraisal
Date Januarv 20, 2003
Estate of Virginia Kurtz
Page 5
20 inch herringbone chain, 9.7mm wide.
l4k yellow gold hard bangle bracelet,
"kealoha"
Lady's Tanzanite and diamond ring, l8k
yellow gold mounting. The ring features
8 pear cut genuine tanzanites,4x3mm and
12 single cut diamonds.
Lady's synthetic aquamarine in a gold
plated mounting.
Lady's jade ring, l4k yellow gold
mounting.
SCRAP GOLD
18 size Elgin pocket watch, 15 jewels
with a watch chain and knife.
18 size Elgin pocket watch, 7 jewels,
in a yellow case.
The appraised value as expn:ssed herein .......0ClIIs the approximate
retail replacement value. It is for insurance ooIy and not . valuation
for sale. This paper is rendered at the customer's request for their use.
The diamonds and gem stones an: graded in as far as the mounting
pencits. The weight of the diamonds and gem stones are approximate
unless otherwise indicated.
Stdt4- ~.
$295.00
$195.00
$200.00
NO VALUE
$75.00
21.00
$100.00
$35.00
IN THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DMSION
In the
Estate of
VIRGINIA M. KURTZ, deceased
No. 1161
Estate
2002
DISCLAIMER OF SERIES HH
U. S. SAVINGS BONDS
FIT-ED ON BEHALF OF:
JOHN STEPHENS, DISCLAIMANT
cr.
COUNSEL OF RECORD:
William L. Kimmel, Esq.
Attorney for Estate
166 East Union Street
Somerset, PA 15501
(814) 445-9651
Pa. lD 05632
..,'
l...J
(r-
C'
A TRUE Copy FROM RECORD
In Testimony whero!, I hereunto
set my hand and the seal
of said Court a Carlisle, PA03
is .l."2-ctay of 2
IN TIlE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYL VANIA
ORPHANS' COURT DIVISION
In the
Estate of
)
)
)
) No. 1161
)
)
Estate
2002
VIRGINIA M. KURTZ, unremarried widow,
deceased, late of Lower Allen Township,
Cumberland County, Pennsylvania
DISCLAIMER
WHEREAS, VIRGINIA M. KURTZ (the ''Decedent''), an unremarried widow,
became deceased on November 30, 2002 while a resident of Lower Allen Township, Cumberland
County, Pennsylvania; and
WHEREAS, as of the date of her death, Decedent was the owner offour $10,000.00
Series HH United States Savings Bonds, Serial Nos. X1157814HH, X 1157815, X1157816 and
X1157817HH issued June, 2002, and fifteen $10,000.00 Series HH United States Savings Bonds,
Serial Nos. X1157820HH, X1157821HH, X1157822HH, X1157823HH, X1157824HH,
X1157825HH, X1157826HH, X1157827HH, X1157828HH, X1157829HH, X1157830HH,
X1157831HH, X1157832HH, X1157833HH, and X1157834HH issued June, 2002 (collectively,
the "Bonds"), the face value of all of said Bonds totaling $190,000.00; and
WHEREAS, each Bond designates the undersigned, JOHN STEPHENS, as "POD"
Beneficiary, with each Bond payable to him upon Decedent's death; and
WHEREAS, the undersigned has not accepted any interest in or benefits of the Bonds;
and
WHEREAS, the undersigned will not receive any consideration in money or money's
worth for making a disclaimer or renunciation of any interest in the proceeds of the Bonds.
NOW, THEREFORE, the undersigned, JOHN STEPHENS, intending to be legally
bound, hereby irrevocably disclaims, renounces and refuses to accept any and all interest of any kind
in the proceeds of said Bonds as Beneficiary.
2
1. The undersigned intends that this Disclaimer shan constitute a "qualified
disclaimer" as defined in Section 2518 of the Internal Revenue Code of 1986, as amended, or the
corresponding provisions of any subsequent federal tax law. This Disclaimer shall be irrevocable.
2. This Disclaimer is not made to prejudice the rights of any creditor of the
undersigned.
IN WITNESS WHEREOF, the undersigned hereby executes this Disclaimer this 20th
day of August, 2003.
Wim". ~
~~ . ' L
)
)
)
~.~
(SEAL)
3
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF SOMERSET
)
I, JOHN STEPHENS, the Disclaimant, whose name is signed to the foregoing
Disclaimer, being first duly sworn according to law, do depose and say that I signed and executed the
foregoing instrument as my Disclaimer, that I signed willingly, that I executed it as my free and
voluntary act for the purposes therein expressed, and that I am eighteen y'ears of age or older, of
sound mind and under no constraint or undue influence.
Subscribed, sworn to and acknowledged
before me by John Stephens, the
Disclaimant, this 20'" day of August, 2003.
8t1<>..../h{,1~-~ .
NOTARIAL SEAL I
ELLE.'IJ M. OGLI.~E, ,'JOTARY PU3LiC
SOMERSET aCRD, SOMERSET COUI\iTY
MY CCr.JMISS'O,"" EXPRES NOV. 11, 2:Y:'.::. ,I
4
nuU' 1..J c..UU.J ~L:.U lc..1 c..U fll DUl\c.nU ur rUDLll1 Ur.O I
r MA l'iU. .JULf'iOUOOOq
r. Ul:
. .
REQUEST AND RENUNCIATION BY SURVIVING
REGISTRANT NAMED ON UNITED STATES SAVINGS BONDSINOTES
WITHIN 8 MONTHS OF CO-REGISTRANT'S DEATH
VIRGINIA M. KURTZ'
. who died onll/30/Q2and I are both registrants on the United States Savings Bond listed
below:
Issue Date Denomination Serial Number Inscn"tion
ti/U~ ~lU,UUU.UU X1l57814HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 X1l57815HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 X1l57816HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 X1l57817HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 X1l57820HH Virginia M. Kurtz POD John Stephens
I am aware that by virtue of the regulations of the Department of the Treasury governing United
States Savings BO'l<js and Notes. I, as surviving registrant, am the sole and absolute owner of
the above described bond. Nevertheless, I renounce all my right. title and interest in and to the
said bond. This renunciation was made or is being made within nine months of the other
registrant's death. and satisfies the requirements of a qualified disclaimer under Section 2518 of
the Internal Revenue Code.
VIRGINIA M. KURTZ
As I am also an heir to the estate of / . I hereby renounce:
[J (a) All my right, title and interest in the bonds only;
cgr (b) All my right, title, and interest to the bonds and to that part of the estate of
re rt~se e by t bond or their proceeds.
308 Pine wood Dri'oTe
Shiremanstown. PA 17011
(Na (Address)
181-22-9094
(Social Security Number)
I CERTIFY that
John Stephens
, whose identity is well known or proven to
me, personally appeared before me this ,~O~ day of
AUg'ust
(Month)
. 2003 at
(Year)
'E~.:j-- Pennsylvania , and signed the above
(City) . 0 (State)
instrument, acknowledging the same to be his/_~~~..nd .81:1. ' ,~~m
(:l~i~)
, ii
(OFFICIAL STAMP OR SEAL)
Ii'
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AUG-13-2003 WED 12:26 PH BUREAU OF PUBLIC DEBT
.
FAX NO. 3044808584
P. 02
REQUEST AND RENUNCIATION BY SURVIVING
REGISTRANT NAMED ON UNITED STATES SAVINGS BONDS/NOTES
WITHIN' MONTHS OF CO-REGISTRANT'S DEATH
VIRGINIA M. KURTZ
. who died onll/30/Q2and I are both registrants on the United States Savings Bond listed
below:
Issue Date aeflomifla/ian Serfal Number Iflscription
ti I U2 $10, OOU .llo X1l57821HH Virginia M. Kurtz POD John Step hem
6/02 $10,000.00 X1l57822HH Virginia M. Kurtz POD John StephenE
6/02 $10,000.00 X1l57823HH Virginia M. Kurtz POD John Stephem
6/02 $10,000.00 X1l57824HH Virginia M. Kurtz POD John Step hem
6/02 $10,000.00 X1l57825HH Virginia M. Kurtz POD John StephenE
. I am aware that by virtue of the regulations of the Department of the Treasury governing United
States Savings Bonds and Notes. I. as surviving registrant, am the sole and absOlute owner of
the above described bond. Nevertheless, I renounce all my right, title and interest in and to the
said bond. This renunciation was made or is being made within nine months of the other
registrant's death, and satisfies the requirements of a qualified disclaimer under Section 2518 of
the Intemal Revenue Code.
VIRGINIA M. KURTZ
As I am also an heir to the estate of 1 , I hereby renounce:
o (a) All my right, title and interest in the bonds only;
n (b) All my right, title, and interest to the bonds and to that part of the estate of
pres by e bond or their proceeds.
, 308 Pinewood Drive
Shiremanstown. PA 17011
John Steph ns (Address)
181-22-9094
(Social Security Number)
, CERTIFY that
John Stephens
, whose identity is well known or proven to
me, personally appeared before me this ,;? (}tlJ day of AUlZ'ust.
(Month)
. 2003 at
(Year)
w~ t Pennsylvania , and signed the above
(City) (State)
instrument. acknowledging the same to be h...Wh~~ ~~., ,'. ',J.~!1)
., ~(l~
~Aature and TiUe of OertWYinti::OmCer)
(OFFICIAL STAMP OR SEAL)H ' , , '.
IIH :i~lfli
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~
. . l\UG-13-2003 WED 12:26 PM BUREAU OF PUBLIC DEBT
FAX NO. 3044808584
P. 02
REQUEST AND RENUNCIATION BY SURVIVING
REGISTRANT NAMED ON UNITED STATES SAVINGS BONDS/NOTES
WITHIN' MONTHS OF CO-REGISTRANT'S DEATH
VIRGINIA M. KURTZ
. who died onll/30/Qalnd I are both registrants on the United States Savings Bond listed
below:
Issue Date Denomi~afion Serial Numb.,. InseriDtion
ti/uz ~lu,o ll.Oo Xllo'/MZtiHIt Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 X1l57827HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 X1157828HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 n157829HH Virginia M. Kurtz POD John Stephens
6/02 $10,000.00 . X1157830HH Virginia M. Kurtz POD John Stephens
I am aware that by virtue of the regulations of the Department of the Treasury governing United .
States Savings Bonds and Notes. I, as surviving registrant, am the sole and absolute owner of
the above described bond. Nevertheless. I renounce all my right. title and interest in and to the
said bond. This renunciation was made or is being made within nine months of the other
registrant's death, and satisfies the lIlquiremenls of a qualified disclaimer under Ser:tion 2518 of
the Internal Revenue Code.
VIRGINIA M. KURTZ
As I am also an heir to the estate of / . 1 hereby renounce:
o (a) All my right, title and interest in the bonds only;
IDrCb} All my right. title, and interest to the bonds and to that part of the estate of
r rese led by t bond or their proceeds.
. 308 Pinewood Drive
Shiremanstown. PA 17011
dohn Steph s (Address)
181-22-9094
(Social Security Number)
I CERTIFY that John Stephens
me, personally appeared before me this ,;;{()-II>..
. whose identity is well known or proven to
day of August.
(Month)
. 2003 at
(Year)
'1/ ~ v Pennsylvania
(City) q (State)
.llll?2~~~T.. - ',,'" '., -'11.;'
instrument, aeknowledging the same to be hi~~ autJdeeGL.. .'. ,- m:s..
~(f~r)
. and signed the above
(OFFICIAL STAMP OR SEAL)
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AUG-13-2003 WED 12:26 PM I:lUI{I:.AU O~ PUI:lLlU !Jr.I:l!
~AX NU. jU44HUHOH4
r. ut:
REQUEST AND RENUNCIAnON BY SURVIVING
REGISTRANT NAMED ON UNITED STATES SAVINGS BONDS/NOTES
WITHIN. MONTHS OF CO-REGISTRANT'S DEATH
VIRGINIA M. KURTZ'
. who died onll/30/~nd I are both registrants OIl the United States Savings Bond listed
below:
Issue Date
fj/U~
6/02
6/02
6/02
~rJnatio"
, 011. Olt
$10,000.00
$10.000.00
$1_0.000.120
Serlal Number
X1.1.:Jilj;J.Ll1t1.
IlIScrilJtion
Virginia M. Kurtz POD John Stephens
Virginia M. Kurtz POD John Stephens
Virginia M. Kurtz POD John Stephens
Virginia M. Kurtz POD John Stephens
X1l57832HH
X1l57833HH
X1l57834HH
I am awarlil tt.at by virtue of the regulations of the Department of the Treasury governing United
Stales Savings Bonds and Notes. I. as surviving registrant. am the sole and absolute owner of
the above described bond. Nellel'theless, I /8I1Ounce an my right, title and interest in and to the
said bond. This renunc:iation was medeer is being made within nine months of the other
registrant's death. and satisfies the requirements of a C1ualitisd disclaimer under Section 2518 of
the Intemal Revenue Code.
VIRGINIA M. KURTZ
As I am also an heir to the estate of / . I hereby renounce:
o (a) All my right. title and interest i1i the bonds only;
I} (b) All my right, . Ie, and inlerest to the bonds and to that part of the estate of
res by t bond or their proceeds.
308 Pinewood Drive
Shiremanstown.' FA 17011
(Address)
181-22-9094
(Social Security Number)
I CERTIFY that
John Stephens
. whose identity is well known or proven to
me. personally appeared before me this ,?50m day of
AUl!ust '
(Month)
. 2003 at
(Year)
-4~'lY Pennsylvania
(City) U (State)
instrument. acknowledging the same to be _t\f~ano deed" ,c , ' 'Iii;t;
"U".' '~~A-A-
~1Vaturea~~~cer)
. and Signed the above
(OFFICIAL STAMP OR SEAL)
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~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT ALLONANCE OR DISALLONANCE
OF DEDUCTION, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
JOHN STEPHENS
308 PINE WOOD DR
SHIREMANSTOWN PA 17011-6527
REV-1548 EX ~FP (O1-OS)
DATE 12-15-2003
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
COUNTY CUMBERLAND
SSN/DC 187-14-4574
ACN 03119430
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-15-2003
ESTATE OF KURTZ VIRGINIA M DATE OF DEATH 11-30-2002 COUNTY CUMBERLAND
FILE N0. 21 02-1161 S.S/D.C. N0. 187-14-4574 ACN 03119430
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT N0. 6240994923
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (X) TIME CERTIFICATE
DATE ESTABLISHED 10-07-2002
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
70,331.89
X 1.000
70,331.89
- .00
70,331.89
X .15
10,549.78
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE T0:
"REGISTER OF WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
08-05-2003 CD002870 .00 10,549.78
TOTAL TAX CREDIT 10,549.78
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
^ IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ''CREDIT'' ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): 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-1313). Applications are available at the Office of
the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service
for forms ordering: 1-800-362-2050; services far taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
OBJECTIONS: 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 may 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
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing ta: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%)
discount of the tax paid is allowed.
PENALTY: The 15% 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 end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the sane time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 (6%) percent per annum calculated at a daily rata of .000164.
All taxes which became delinquent on or after January 1, 1982 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 1982 through 2003 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1987 9% .000247 1999 7% .000192
1983 16% .OOD438 1988-1991 11% .OOD301 2000 8% .000219
1984 11% .ODD301 1992 9% .000247 2001 9% .OOD247
1985 13% .OOD356 1993-1994 7% .000192 2002 6% .000164
1986 10% .000274 1995-1998 9% .000247 2003 5% .000137
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER 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 be calculated.
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 286601 INHERITANCE TAX
HARRISBURG, PA 17128-6661
STATEMENT OF ACCOUNT
REY-1607 E% AFP t01-037
DATE 04-26-2004
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
COUNTY CUMBERLAND
WILLIAM L KIMMEL ESQ ACN 101
166 E UNION ST
SOMERSET PA 15501 Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (01-03) ~(*~( INHERITANCE TAX STATEMENT OF ACCOUNT ~~~
ESTATE OF KURTZ VIRGINIA M FILE N0. 21 02-1161 ACN 101 DATE 04-26-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-20-2004
PRINCIPAL TAX DUE:
PAYMENTS CTAX CREDITS):
138,456.05
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
02-27-2003 CD002230 6,922.80 160,000.00
,
04-20-2004 REFUND .00 28,466.75-
~ ..~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN 51,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT^ (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
138,456.05
.00
.00
.00
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested an the Tax Return, may be requested by completing an
^Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO: questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. 28D601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CS%) discount
of the tax paid is allowed.
PENALTY: The 15% 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 end of the tax amnesty period.
INTEREST: 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, 1952 bear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 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 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1988-1991 11% .000301 2001 9% .000247
1983 16% .000438 1992 9% .000247 2002 6% .000164
1984 11% .000301 1993-1994 7% .000192 2003 5% .000137
1985 13% .000356 1995-1998 9% .000247 2004 4% .000110
1986 10% .000274 1999 7% .000192
lgg7 9% .000247 2000 8% .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) 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.
"~-
(~
G ~C~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280~A1
HA'n~ISBURG, PA 17128-0601
.'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT ALLONANCE OR DISALLOHANCE
OF DEDUCTION, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
JOHN STEPHENS
308 PINE WOOD DR
SHIREMANSTOWN PA 17011-6527
REV-1548 EX AFP (81-85)
DATE 05-03-2004
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
COUNTY CUMBERLAND
SSN/DC 187-14-4574
ACN 03119431
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS
----------------------------------------------------------------------------------------------------------------
REV-1548 EX AFP (01-03)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-03-2004
ESTATE OF KURTZ VIRGINIA M DATE OF DEATH 11-30-2002 COUNTY CUMBERLAND
FILE N0. 21 02-1161 S.S/D.C. N0. 187-14-4574 ACN 03119431
TAX RETURN WAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: CITIZENS BANK OF PA ACCOUNT N0. 6140830648
TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST ( ~ TIME CERTIFICATE
DATE ESTABLISHED 09-07-2001
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS:
33,115.85 NOTE:
X 0.500
16,557.93
- .00
16,557.93
X .15
2,483.69
TO INSURE PROPER CREDIT TO
YDUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE T0:
"REGISTER OF"WILLS, AGENT."
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
08-05-2003 CD002870 .00 745.11
08-15-2003 CD002908 .00 2,371.92
TOTAL TAX CREDIT 3,117.03
BALANCE OF TAX DUE 633.34CR
INTEREST AND PEN. .00
TOTAL DUE 633.34CR
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
PURPOSE OF
NOTICE: Tc fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check or money order payable to: REGISTER OF WILLS, AGENT.
REFUND (CR): 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-1313). Applications are available at the Office of
the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service
for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and or speaking needs:
1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisament, allowance, or disallowance of deductions or assessment
of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Oept. 281021, Harrisburg, PA 17128-1021, OR
--electing to have the matter determined at the audit of the account of the personal representative, OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered an this assessment should be addressed in writing tc: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident
Decedent^ CREV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%l
discount of the tax paid is allowed.
PENALTY: The 15% 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 end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as ycu would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) 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 (6%) percent per annum calculated at a daily rate of .000164.
All taxes which became delinquent on or after January 1, 1982 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 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1988-1991 11% .000301 2001 9% .000247
1983 16% .000438 1992 9% .000247 2002 6% .000219
1984 11% .000301 1993-1994 7% .000192 2003 5% .000137
1985 13% .000356 1995-1998 9% .000247 2004 4% .000110
198b 10% .000274 1999 7% .OD0192
lgg7 9% .000247 2000 8% .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER 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
j ~~"?A. Notice, additional interest must be calculated.
`a
REV-1470 EX (&BB)
.~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
DECEDENTS NAME
VIRGINIA M KURTZ
REVIEWED BY
JUDY WATTS
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
2102-1161
03119431
ITEM
SCHEDULE NO, EXPLANATION OF CHANGES
The payment of $745.11 cannot be used as a deduction on the above ACN.
Row Page 1
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 INHERITANCE TAX
HARRISBURG, PA 17128-0601
STATEMENT OF ACCOUNT
REV-1607 EX 6FP (01-OS)
JOHN STEPHENS
308 PINE WOOD DR
~,
SHIREMANSTOWN PA 1701-6527
ti.
DATE 05-03-2004
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
-..;;COUNTY CUMBERLAND
~-CN 03119431
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (01-03) ~(~(* INHERITANCE TAX STATEMENT OF ACCOUNT **~
ESTATE OF KURTZ VIRGINIA M FILE N0. 21 02-1161 ACN 03119431 DATE 05-03-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-03-2004
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
2,483.69
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID (-) AMOUNT PAID
08-05-2003 CD002870 .00 745.11
08-15-2003 CD002908 .00 2,371.92
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
3,117.03
633.34CR
.00
633.34CR
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application far Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at
the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's 24-hcur
answering service for farms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Oept. 280601, Harrisburg, PA 17128-0601, phone
C717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount
of the tax paid is allowed.
PENALTY: The 15% 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 end of the tax amnesty period.
INTEREST: 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 hear interest at the rate of
six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will hear 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 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1988-1991 11% .OOD301 2001 9% .000247
1983 16% .000438 1992 9% .000247 2002 6% .000164
1984 11% .OOD301 1993-1994 7% .000192 2003 5% .000137
1985 13% .000356 1995-1998 9% .000247 2004 4% .000110
1986 10% .000274 1999 7% .000192
1987 9% .000247 2000 8% .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) 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
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION NOTICE OF DETERMINATION AND
DEPT. 280601
HARRISBURG, PA 171zs-obol ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN REV-483 EX RFP (01-03)
DATE 05-10-2004
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
''~ •-;% COUIi'TX CUMBERLAND
~_~ , ~~
WILLIAM L KIMMEL ESQ ACN 201
166 E UNION ST
Amount Remitted
SOMERSET PA 15501
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR FILES ~
----------------------------------------------------------------------------------------------------------------
REV-483 EX AFP (01-03) ~* NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN *~
ESTATE OF KURTZ VIRGINIA M FILE N0.21 02-1161 ACN 201 DATE 05-10-2004
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
TAX CREDITS:
39,052.00
144,566.72
.00
144,566.72
.00
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
*IF PAID AFTER THIS DATE, SEE REVERSE SIDE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
(IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 (b) of the Inheritance and Estate Tax Act, Act 23 of 2000.
(72 P.S. Section 9140).
PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the
reverse side.
-- Make check ar money order payable tc: REGISTER OF HILLS, AGENT.
REFUND (CR): A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania
Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Wills,
any of the 23 Revenue District Offices ar from the Department's 24-hour answering service for forms ordering:
1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the assessment of tax as shown on this notice may abject 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
--electing to have the matter determined at audit of the personal representative, OR
--appeal tc the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: 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 17128-0601,
Phone (717) 787-6505. See page 5 of the booklet ^Instructions for Inheritance Tax Return far a Resident
Oecedent^ CREV-1501) for an explanation of administratively correctable errors.
PENALTY: The 15% tax amnesty non-participation penalty is computed an 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-participaticn
penalty is appealable in the same 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: For dates of death on or after 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax
return becomes delinquent at the expiration of nine (09) months from the date of death.
For dates of death prior tc 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return
becomes delinquent at the expiration of eighteen (18) months from the date of death.
Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%] percent per annum
calculated at a daily rate of .000164. All taxes whi ch became delinquent an or after January 1, 1982 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 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rata Factor V=ar Rate Factor
1982 2D% .000548 1988-1991 11% .000301 20D1 9% .OD0247
1983 16% .000438 1992 9% .000247 2002 6% .000164
1984 11% .000301 1993-1994 7% .000192 2003 5% .000137
1985 13% .000356 1995-1998 9% .000247 2004 4% .000110
1986 10% .D00274 1999 7% .000192
1986 10% .000274 20D0 8% .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation tc fifteen C 15) days
beyond the date of the assessment. If payment is made after the interest computation date shown an the
Notice, additional interest must be calculated.
~,
CCE'.~-~
.~
t",. c~ ~
....-..
JAMES DURYEA CAMERON
ATTORNEY-AT-LAW
1325 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102
LICENSED IN BOTH PENNSYLVANIA
AND MARYLAND
TELEPHONE: (717) 236-3755
FACSIMILE: (717) '?_36-3655
May 19, 2004
Office of the Register of Wills
CUMBERLAND COUNTY COURTHOUSE
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of William H. Geisel, deceased
No. 21-02-1161
To Whom It May Concern:
You will find enclosed the original and one copy of a Status
Report Under Rule 6.12 for the above-referenced Estate.
Kindly file the original document and return the time-stamped
copy to us in the envelope provided.
Please contact my office if you have any questions. Thank
you.
Sincerely,
J m D. Cameron
JDC/sg
Enclosure
cc: Elizabeth R. Geisel, Co-Executor
Robert Keck, M&T Trust Co., Co-Executor
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
WILLIAM L KIMMEL ESQ
166 E UNION ST
SOMERSET PA 15501.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
REV-0SC EX AFP (01-02)
DATE 05-17-2004
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
~(~1NTY CUMBERLAND
ACN 202
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR FILES ~
----------------------------------------------------------------------------------------------------------------
REV-736 EX AFP (01-02) *~ NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER **
ESTATE OF KURTZ VIRGINIA M FILE N0.21 02-1161 ACN 202 DATE 05-17-2004
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
2. Pennsylvania Inheritance Tax Assessed 144,566.72
(Excluding Discount and/or Interest)
3. Inheritance Tax Assessed by Other States .00
or Territories of the United States
(Excluding Discount and/or Interest)
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
7. Additional Pennsylvania Estate Tax Due
TAX CREDITS:
39,052.00
144,566.72
.00
.00
.00
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
*IF PAID AFTER THIS DATE, SEE REVERSE SIDE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
(IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 91407.
PAYMENT: Detach the top portion of this Notice and submit with ycur payment to the Register of Wills printed on the
reverse side.
-- Maka check ar money order payable tc: REGISTER OF WILLS, AGENT.
REFUND (CR): A refund of a tax credit may be requested by completing an "Application for Refund of Pennsylvania
Inheritance and Estate Tax" (REV-13137. Applications are available at the Office of the Register of Wills,
any of the 23 Revenue District Offices or from the Department's 24-hour answering service far forms ordering:
1-800-362-2050; services for taxpayers with special hearing and/or speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the assessment of tax as shown on this notice may abject within
sixty (607 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
--electing to have the matter determined at audit of the personal representative, OR
--appeal to the Orphans' Court
ADMIN-
ISTRATIVE
CORRECTIONS: 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 17128-0601,
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent^ (REV-1501) for an explanation of administratively correctable errors.
PENALTY: The 15% 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 same 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: Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing
letter becomes delinquent at the expiration of one (1) month from the date the final notice of the increase
in Federal Estate Tax is received.
Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum
calculated at a daily rate of .000164. All taxes which became delinquent on ar after January 1, 1982 will hear
interest at a rate which will vary from calendar year tc calendar year with that rate announced by the PA
Department of Revenue. The applicable interest rates for 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
VV=ar Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1988-1991 11% .000301 2001 9% .000247
1983 16% .000438 1992 9% .000247 2002 6% .000164
1984 11% .000301 1993-1994 7% .000192 2003 5% .000137
1985 13% .000356 1995-1998 9% .000247 2004 4% .000110
1986 10% .000274 1999 7% .000192
1987 9% .OD0247 2000 8% .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
~µ beyond the date of the assessment. If payment is made after the interest camputaticn date shown on the
Notice, additional interest must be calculated.
~ 7 - ~~
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601 INHERITANCE TAX
HARRISBURG, PA 17128-0601
STATEMENT OF ACCOUNT
REV-1607 E% AFP (01-03)
JOHN STEPHENS
308 PINE WOOD DR
SHIREMANSTOWN PA 17011-6527
DATE 06-07-2004
ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
FILE NUMBER 21 02-1161
COUNTY CUMBERLAND
ACN 03119431
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment.
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1607 EX AFP (01-031 *~(~( INHERITANCE TAX STATEMENT OF ACCOUNT **~
ESTATE OF KURTZ VIRGINIA M FILE N0. 21 02-1161 ACN 03119431 DATE 06-07-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-26-2004
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
2,483.69
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST/PEN PAID (-) AMOUNT PAID
08-05-2003 CD002870 .00 745.11
08-15-2003 CD002908 .00 2,371.92
05-20-2004 REFUND .00 633.34-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
3E IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN S1,
~' NO PAYMENT IS REQUIRED.
~ IF TOTAL DUE IS REFLECTED AS A ''CREDIT'' (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
2,483.69
.00
.00
.00
~~
PAYMENT: Detach the top portion of this Notice and submit with your payment made payable tc the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check ar money order payable to: COMMONWEALTH OF PENNSYLVANIA.
REFUND (CR): 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-1313). Applications are available at
the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour
answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
REPLY T0: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone
(717) 787-6505.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount
of the tax paid is allowed.
PENALTY: The 15% 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 end of the tax amnesty period.
INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) 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 (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 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 1982 through 2004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20% .000548 1988-1991 11% .000301 2001 9% .000247
1983 16% .000438 1992 9% .000247 2002 6% .000164
1984 11% .OOD301 1993-1994 7% .000192 2003 5% .000137
1985 13% .OD0356 1995-1998 9% .000247 2004 4% .000110
1986 10% .000274 1999 7% .000192
1987 9% .000247 2000 8% .000219
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER 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 an the
Notice, additional interest must be calculated.
t• 1 ' ' ~ ~ . r 1 , I r , , ' r i r
THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the )
Estate of )
VIRGINIA M. KURTZ, unremarried )
widow, deceased, late of Lower Allen ) No. 1161 Estate 2002
Township, Cumberland County, Pennsylvania )
Social Security No. 187-14-4574 )
FIRST AND FINAL ACCOUNT ~ °'-
._ .
,.
.~.
AND PROPOSED DISTRIBUTION °
~_.
-,
CHARGES
Real Estate
All that certain lot of land, together with one story brick ranch-type
dwelling house erected thereon, situate in Lower Allen Township,
Cumberland County, Pennsylvania, granted and conveyed unto John
E. Kurtz and Virginia M. Kurtz, husband and wife, by Deed of Robert
Leroy Wrightstone, et. ux., dated October 17, 1966 and recorded in
Cumberland County Deed Book "I" Volume 22, page 564.
Thereafter, John E. Kurtz became deceased on April 7, 1994, thereby
vesting full, complete and sole title in Virginia M. Kurtz, his wife, by
virtue of survivorship to tenancy by the entireties.
Value at time of death in accordance with conveyance unto Marlin E.
Nauman, et. ux., dated June 16, 2003. $136,000.00
Stocks and Bonds
Series HH United States Savings Bond Nos. M4334389HH, M4334390HH,
M4334391HH, M4334392HH, M4334393HH, M4334394HH, M4334395HH,
and M4334396HH in name of Virginia M. Kurtz, dated May, 1992 in the face
amounts of $1,000.00. 8,000.00
~ ~
Series HH United States Savings Bond No. M4742292HH in name of Virginia
Kurtz, dated March, 1993 and in the face amount of $1,000,00. $ 1,000.00
Series HH United States Savings Bond No. X585001HH in name of Virginia
Kurtz, dated May, 1992 and in face amount of $10,000.00. 10,000.00
Series HH United States Savings Bond No. D3392607HH in name of Virginia
Kurtz, dated March, 1993 and in face amount of $500.00. 500.00
Sipesville Water Company, Inc. Certificate No. 68 in name of Virginia Kurtz,
dated March 12, 1946 for 5 Shares of Capital Stock. Value at time of death. 250.00
Penn Treaty American Corporation Stock Certificate No. PT0440 in name of
Virginia Kurtz;, dated November 24, 1987 for 28 Shares Common Stock.
Value at time of stating account of $1.70 per share. 47.60
Penn Treaty American Corporation Stock Certificate No. PT2089 in name of
Virginia Kurtz, dated May 15, 1995 for 14 Shares Common Stock.
Value at time of stating account of $1.70 per share. 23.80
Penn Treaty American Corporation Stock Certificate No. PTAR0274 in name
of Virginia Kurtz, dated April 27, 2001 for 47 Shares Common Stock.
Value at time of stating account of $1.70 per share. 79.90
Series HH United States Savings Bond No. D3648027HH in name of Virginia
M. Kurtz, dated June, 1994 and in face amount of $500.00. 500.00
Series HH United States Savings Bond Nos. M5135710HH, M5135711HH,
M5135712HH[, M5135713HH, M5135714HH, and M5135715HH in name
of Virginia M. Kurtz, dated June, 1994 and in the face amount of $1,000.00. 6,000.00
Series HH United States Savings Bond Nos. X691805HH, X691806HH,
X691807HH, X691808HH, X691809HH, X691810HH, X692811HH,
X691812HH, X691812HH, and X691814HH in name of Virginia M.
Kurtz, dated June, 1994 and in the face amount of $10,000.00. 100,000.00
Series EE United States Savings Bond No. L459134956EE in name of
Virginia M. Kurtz, dated June 21, 1990 and in the face amount of $50.00.
Value, including interest, to time of close. 53.94
2
Personal ProQertX
All the following items of personal property contained in and surrounding
residence of decedent, bequeathed in Codicil dated June 15, 2001, with
value at time c-f death in accordance with Appraisal performed by Stahl's
Jewelry, Somerset, Pennsylvania dated January 20, 2003:
14k Wide Gold Herringbone Necklace; 6-Diamond Ring; Man's Masonic
Ring-Diamond (disposed of by decedent prior to death and therefore not
in possession of decedent at time of death); Lavender Jade Pendant;
Lavender Jade Bracelet; Lavender Jade Ring; Gold Coin & Diamond
Pendent & Chain; Green Jade Pendant; Silver with 2 Zercon stones Ring;
Small Green Jade Ring; Green Jade Bracelet; Large Green Jade Ring; Blue
Topaz Ring; 24" Pearls 1 strand 14k Clasp; Silver Seiko Wrist Watch; Wide
Gold Bracelet:, 2 Smaller 14K Gold Bracelets; Rust Red Jade Pendant &
Gold Chain; Gold Bracelet (Kealoha); Emerald & Diamond Ring; Diamond
12 Diamonds Cluster Ring; Fresh Water Pearl & Diamond Ring; Amethyst
(Purple) & Diamond Ring; Emerald & Diamond Ring; Small Tanzanite &
Diamond Ring; 27 Small Band Ring; Diamond Tennis Bracelet; 4k Tanzanite
& 1/2k Diamond Ring; Emerald & Diamond Bracelet; Pava-Diamond Bracelet;
10 Hummel Figurines. $ 22,405.00
Painting by Gr~aystone Sayre (Covered Wagons). Value in accordance with
Appraisal performed by Somerset Galleries, Somerset, Pennsylvania, dated
January 15, 2003. 75.00
Clothing No Value
Lady's jade ring, scrap gold, two watches in accordance with
sale of same to Stahl's Jewelry and Hauger's Jewelry. 126.00
Waterbury Mantel Clock -Value of $1,000.00 included within public auction
sale receipts. N.A.
Checking Account No. 610071-671-6 -Citizens Bank, Providence, RI in
name of Virgina M. Kurtz.
Value, including interest, per balance in checking account at time of death. 32,335.52
Circle Money Market Account No. 610119-204-4 -Citizens Bank,
Providence, R[ in name of Virginia M Kurtz.
Value, including interest per balance in account at time of close. 30,030.59
Citizens Investment Services Corp., Providence, RI -Account No.
57557225 in name of Virginia M. Kurtz.
Value, including interest and dividends, at time of close.
Certificate of Deposit No. 6140-803965 -Citizens Bank, Providence,
RI in name of Virginia M. Kurtz.
Value, including interest, to the time of close.
Certificate of Deposit No. 61-40-831113 -Citizens Bank, Providence,
Iti in name of Virginia M. Kurtz.
Value, including interest, to the time of close.
Checking Account No. 0513132894 -Commerce Bank, Camp Hill,
PA in name of Virginia M. Kurtz.
Value, including interest per balance in checking account at time of
close.
Certificate of Deposit No. 23597 -Commerce Bank, Camp Hill,
PA in name of Virginia M. Kurtz.
Value, including interest, at time of close.
Checking Account No. 0003361367 -Territorial Savings, Honolulu,
HI in name of Virginia M. Kurtz.
Value, including interest per balance in account at time of close.
Certificate of Deposit No. 8000053934 - Waypoint Bank, Harrisburg,
PA in name of Virginia M. Kurtz.
Value, including interest at the time of death.
Certificate of Deposit No. 2474120509-46353 -First Union, in name
of Virginia M. Kurtz, dated January 26, 2001.
Value, including interest at the time of close.
1998 Lincoln 'Town Car Signature Sedan bearing VIN
1LNFM82W6WY716759 in name of Virginia M Kurtz.
Value at time of death in accordance with Appraisal and sale,
less broker's commission.
$ 5,849.07
16,309.31
50,000.00
739.93
13,752.28
3,250.92
10,022.26
49,352.64
11,700.00
4
One lot of used, miscellaneous items of personal property and contents
in and surrounding residence of decedent consisting of, but not limited
to, furniture, furnishings, appliances, household items, and lawn and
gazden items.
Value at time of death in accordance with public auction conducted
by Chazles Bricker, Auctioneer, on May 2, 2003.
Miscellaneous 925 silver ingots located in residence of decedent
at time of death.
Value at time of death in accordance with Appraisal performed by
Copenhaver Coin Exchange, dated Apri122, 2003.
Motorists Insurance Companies Check No. 174879 made payable to
Virginia M. Kurtz dated Apri18, 2003 -Refund on overpayment of
automobile insurance coverage due decedent at time of death.
Citibank (South Dakota), N.A. Check No. 8920000630 made payable
to Virginia Kurtz, dated March 11, 2003 -Refund on overpayment
of credit card balance due decedent at time of death.
American Express Travelers Cheque Nos. RE388295465 through
RE388295469 in name of Virginia Kurtz and in the face amount of
$100.00. Vahae at time of death.
American Express Travelers Cheque Nos. HZ215851600 through
HZ215851609 in name of Virginia Kurtz and in the face amount of
$50.00. Value at time of death.
One used, dyed squirrel sling-cape. Value at time of death in
accordance with Appraisal performed by Charles Exclusive Furriers,
Womleysburg, PA.
Citibank (South Dakota), N.A. Check No. 8790000552 made payable
to Virginia Kurtz, dated February 26, 2003 -Refund on overpayment
of credit card balance due decedent at time of death.
United States 'Treasury Check No. 63704770 made payable to Virginia
M. Kurtz, dated May 23, 2003 -Refund on overpayment of 2002
Federal Income Tax Return due decedent at time of death.
$ 12,383.75
1,076.00
52.49
35.44
500.00
500.00
20.00
282.55
1,138.00
Southern Company Investment Plan Account No. 0000565182 in name
of Virginia M. Kurtz.
Value, including interest and dividends at time of death. $ 57,372.51
The Southern Company Stock Certificate No. SC 1287697 in name of
Virginia M. Kurtz, dated August 1, 1994 for 100 Shares Common
Stock.
Value at time of close. 713.84
Verizon Checlc No. 605971 made payable to Virginia Kurtz -refund
due decedent at time of disconnect. 12.65
Motorists Insurance Companies Check No. 193946 made payable to
Virginia M. Kurtz dated July 2, 2003 -Refund on overpayment of
homeowners insurance coverage due decedent at time of death. 115.52
Thrivent for Lutherans Check No. K669594 made payable to
Virginia Kurtz Estate, dated Apri130, 2003 on life of Virginia
Mae Kurtz. 5,100.16
U. S. Treasury Check No. 02179782 made payable to Virginia
Kurtz Estate, dated September 30, 2003 -Lump sum Civil
Service benefit. 230.00
Bureau of Public Debt -Series HH interest due decedent at
time of death and directly deposited to Estate Checking Account. 5,032.50
Delaware Investments, Philadelphia, PA Account No. 60002585503
in name of Virginia M. Kurtz, TOD John Stephens -Income
due decedent at time of death. 365.58
UMWA Health -Reimbursement for health benefits due decedent
at time of death. 20.00
Citizens Bank, Providence, RI -Certificates of Deposit in name
of Virginia M. Kurtz and John Stephens -Income due decedent
at time of death. 181.97
Waypoint Bank Certificates of Deposit in name of Virginia M.
Kurtz and John Stephens -Income due decedent at time of death. 105.95
6
Charles Schwab Account No. 6170-6439 in name of Virginia Kurtz
or John W. Stephens -Income due decedent at time of death. $ 460.94
Citizens Bank,. Providence, RI -Certificates of Deposit in name
of Virginia Kurtz or John W. Stephens -Income due decedent at
time of death. 435.47
Pro-rata share of real estate taxes due decedent at time of closing. 361.38
Citizens Bank, Providence, RI -Certificates of Deposit in name
of Virginia M. Kurtz and John Stephens -Income due decedent
at time of death.
TOTAL CHA[~GES
982.73
$595,883.19
7
CREDITS
Costs During Administration
Register of Wills -Filing fees $ 663.50
Patriot News Co. -Advertising Letters Testamentary 217.51
Cumberland Law Journal -Advertising Letters Testamentary 75.00
Stahl's Jewelry -Jewelry Appraisal fee. 477.00
Citizens Bank -Fee for insufficient funds and account
research. 110.00
McCray Press -Laminated obituaries. 17.50
J. Robert Stauffer, Esq. -Professional services rendered. 500.00
Mark Hilbert -• Appraisal of real estate. 300.00
Wonders, LTI) -Rental of canopies for public auction. 275.60
William C. Range -Reimbursement for copy costs, supplies
and mailings during estate administration. 1,258.77
Cohen & Grigsby, P.C. -Estimated research fees. 352.00
Brickers Auction -Auctioneer, advertising, clerks, sale
help and commission. 3,600.00
Citizens Bank -Reimbursement for overpayment of
close-out on. checking account. 204.00
Eugene M. Hankinson, P.C. -Preparation of 2002 Income
Tax Returns. 595.00
U.S.Postal Sewice -Overnight mail for closing real estate. 13.65
Commerce Bank -Medallion fees for transfer of HH Bonds. 50.00
William L. Kimmel, Esq., Costs Advanced Account -
Reimbursem~ent for two overnight mailings. 27.30
Citizens Bank -Check printing fee. 54.84
William L. Kimmel, Esq., Costs Advanced Account -
Reimbursement for two additional overnight mailings. 27.30
U.S.Postal Service -Certified mailings. 9.10
Olan Mills -Release for reproduction of 8"x10" photo of decedent. 10.00
CVS -Reproduction of 8"x10" photo of decedent. 37.05
Postmaster - Certified mailings of Series HH United States
Savings Bonds to owners. 102.75
Pennsylvania Department of Revenue - 2003 Individual Income
Tax. 304.00
Recorder of Deeds -One-half transfer tax, sale of real estate. 1,360.00
Register of Wills -First and Final Account and Proposed
Distribution for Confirmation. 146.00
Register of Wills -Reserved for Discharge. 1,500.00
8
U.S. Postal Service -Reserved for estimated mailing
charges -First and Final Account and Proposed
Distribution and subsequent distribution to heirs.
Postmaster -Mailing photographs to cousins.
Funeral Expenses
Robert H. Halverson Funeral Home -Funeral services.
Robert H. Halverson Funeral Home -Certificates of Death.
Oakhurst Tea Room -Funeral meal, including tip.
Somerset Floral Company -Flowers for funeral.
Debts of Decedent:
Pinnacle Health Care -Book account not covered by insurance.
Citi Cards -Credit card charges owed by decedent.
PA American Water Co. -Water assessment to disconnect.
Verizon -Telephone to disconnect.
PPL -Electric to disconnect.
Lower Allen Township -Sewage and refuse to cancellation.
Comcast Cablevision -Cable to disconnect.
PA Department of Revenue - 2002 Income Tax.
Bonnie K. Miller, Treasurer - 2003 Real Estate Taxes.
MSHMC Physician Group -Last illness not covered by insurance
$ 500.00
18.05
$ 12,805.92 $ 12,805.92
$ 6,532.21
12.00
380.00
53.00
$ 6,977.21 $ 6,977.21
$ 5.00
828.99
111.48
43.02
972.92
146.70
47.63
81.63
433.13
77.80
$ 2,748.30 2,748.30
9
Accountant, Executor and Attorne,
Eugene M. Hankinson, P.C. -Accounting services.
William C. Range, Executor
William L. Kimmel, Esq.
Inheritance and Estate Taxes:
Commonwealth of Pennsylvania - 15% Inheritance
Tax, less discount.
U. S. Treasury -Federal Form 706 -Federal
Estate Tax.
Internal Revenue Service -Form 1041, Fiduciary Tax
Return.
TOTAL CREDITS
RECAPITULATION
TOTAL CHA[ZGES
TOTAL CREDITS
BALANCE FOR DISTRIBUTION
$ 16,000.00
77,3 50.00
77,350.00
$170,700.00 $170,700.00
$131,533.25
102,526.11
13,000.00
$247,059.36 247.059.36
$440,290.79
$595,883.19
440.290.79
$15 5, 592.40
10
PROPOSED DISTRIBUTION
BALANCE FOR DISTRIBUTION
In accordance with Codicil of the Last Will and
Testament of decedent, distribution INKIND is
made, as follaws:
Elsa Sutherland - 14K Wide Gold Herringbone
Necklace.
Wilma Bosserman - 6 diamond ring.
Michael Kurtz -Man's Masonic Ring (disposed
of prior to death of decedent).
Millie Lai -Lavender Jade Pendant.
Millie Lai -Lavender Jade Bracelet.
Millie Lai -Lavender Jade Ring.
Millie Lai - $50.00 Gold Coin & Diamond
Pendant & Chain.
Ka, R~ an~e -Green Jade Pendant.
K~~ -Silver with 1 Zercon stones Ring.
Carol Friedline -Small Green Jade Ring.
Carol Friedline -Green Jade Bracelet.
Kav Range -Large Green Jade Ring.
Susanne Funk -Blue Topaz Ring.
$ 295.00
1,000.00
None
150.00
350.00
125.00
1,100.00
50.00
50.00
75.00
100.00
100.00
No Value
$155,592.40
11
Lois J. Davis - 24" Pearls 1 strand, 14K clasp. $ 400.00
Dolores Shaffer -Silver Seiko Wrist Watch. No Value
Ruth Sicheri -Wide Gold Bracelet. 150.00
Ruth Sicheri - 2 Smaller 14K Gold Bracelets. 125.00
95.00
Ruth Sicheri -Rust Red Jade Pendant & Gold Chain. 150.00
Arbutus Focht -Gold Bracelet (Kealoha) 195.00
Joann ]Kimmel -Emerald & Diamond Ring 1,500.00
Ruth Sicheri - 12 Diamond Cluster Ring 1,500.00
Joann ]Kimmel -Fresh Water Pearl & Diamond Ring 450.00
Joann Kimmel - Amathist (Purple) & Diamond Ring. 200.00
Terri Seip -Emerald & Diamond Ring 2,000.00
Vi_~a Rebert -Small Tanzanite & Diamond Ring 200.00
Wilma Bosserman - 27 Small Diamond Band Ring 800.00
Nancv Berkev -Diamond Tennis Bracelet 2,500.00
Nancv Berkev - 4K Tanzanite & 1/2K Diamond Ring 4,500.00
Nancv Berkev -Emerald & Diamond Bracelet 1,000.00
Terri Seip - Pava-Diamond Bracelet 800.00
John Stephens -Name is on $150,000.00 HH Bonds
these are to be given to St. John's Lutheran Church
(joint tenants with wishes of decedent honored). N.A.
12
John Steyhens -Name is on $40,000.00 is to be given
to Prince of Peach Church in Hawaii, Lutheran Church
(joint tenants with wishes of decedent honored).
Terri Seib - 10 Hummel Figurines:
Carnival
Barnyard Hero
A stitch in time
Drummer Boy
Friends
Feeding Time
Culprit,
Mountaineer
Sensitive Hunter
Chopping wood with blue birdlboy
Connie' Lee Kolesko -Painting by Grayson Sayre
(Covered Wagons)
Nancv Berkev - lg` choice of clothing
Vir inia Rebert - 2nd choice
Total Specific Bequests in Kind
BALANCE FOR DISTRIBUTION
In accordance with Paragraphs 2, 3 and 4 of the
Last Will and 'Testament of decedent, distribution
is made, as follows:
2. Wilma Bosserman, good friend -specific
bequest.
3. Meig Kurtz, nephew -specific bequest.
4. William C. Range, good friend -specific
bequest.
Total Specific Bequests.
N. A.
245.00
195.00
250.00
200.00
240.00
235.00
345.00
250.00
235.00
250.00
75.00
No Value
No Value
$ 22,480.00 $22.480.00
$133,112.40
$ 30,000.00
30,000.00
$ 20.000.00
$ 80,000.00 $80.000.00
13
BALANCE REMAINING FOR DISTRIBUTION. $ 53,112.40
In accordance with Paragraph 5, of the Last Will
and Testament: of decedent, distribution is made,
as follows:
ELWOOD FRIEDLINE, cousin -One-ninth
(1 /9th) share. $ 5,901.3 8
WAYNE FRIEDLINE, cousin -One-ninth
(1/9th) share. 5,901.38
RONALD FRIEDLINE, cousin -One-ninth
(1/9th) share. 5,901.38
GERALD FRIEDLINE, cousin -One-ninth
(1/9th) share. 5,901.38
M. J0,4N KINIlVIEL, cousin -One-ninth
(1/9th) share. 5,901.38
DOLORES SHAFFER, cousin -One-ninth
(1 /9th) share. 5,901.3 8
LOIS JEAN DAMS, cousin -One-ninth
(1/9th) share. 5,901.38
CHARLES FRIEDLINE, cousin -One-ninth
(1/9th} share. 5,901.37
CAROL FRIEDLINE, cousin -One-ninth
(1 /9th) share. 5 901.3 7
Total Distribution. $53,112.40 $53.112.40
BALANCE FOR DISTRIBUTION. NONE
14
WHICH EXHAUSTS THE FUNDS 1N HANDS OF
EXECUTOR :FOR DISTRIBUTION.
Respectfully submitted,
By lT~~ E~ t1t~- ~ ~ r~a ~~ c. t~~.~`cr<;_,
William C. Range,~xecutor
August 27, 2004
15
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF' SOMERSET
ss:
Before me, the undersigned authority, personally appeared WILLIAM C. RANGE, who
acknowledged himself to be Executor of the ESTATE OF VIRGINIA M. KURTZ, unremarried
widow, deceased, who, after being duly sworn according to law, deposes and says that the foregoing
First and Final Account and Proposed Distribution correctly and accurately represents all receipts and
disbursements as such Executor, that all parties having an interest in said Estate have received a copy
of decedent's Last Will and Testament, and a copy of this First and Final Account and Distribution,
that all debts or claims against the decedent presented for payment have been paid and that the
Inheritance Tax assessed against the Estate has been paid in full.
l~lliam C. Range, Executor
Sworn to and subscribed before me
this 27th day of August, 2004.
i
NOTARIAL SEAL
E: LEN M. O ~l!NE. NOTARY PUBLIC
SOMERSET rIORO . SOMERSET COUNTY
MY COMMISSION ci(PiRES NOV. 11, 2004
16
09/13/04 MON 13:11 FA% 814 445 6362
ATTYS . AT LAFF f~J 0 0 2
THE COMMONPZEAS COi7RT OF CUMBERLfIIYD COUNTY, PENNSYLVANIA
D~RPIIANS' COURT DIVISION
Tn the
Estate of
VIRGINIA M. giTRTZ, unremarried
vvidow, deceased, late of Lower Allen
Township, G~mberland Counrty, Pennsylvania
Social Security No. 187-14-4574
No. 1161 Estate 2002
The Patriot News Publication:
February 7, 14, 21, 2003
Cumberland Law Journal Publication:
February 14, 21, 28, 2003
FIRST AND ,FrTN~4Y. ACCOUNT
AND PROPOSED DISTRIBU'TXON
William L. Kimmel, Esq.
Attorney at Law
166 East Union Street
Somerset, PA 15501
(814) 445-9651
I.A. No. 05632
09/13/04 MON 13:12 FAg 814 445 6362 ATTYS. AT LAF9
PROOF OF PUBLICATION OF NOTICE
Y1~T CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P_ L.1784
STATE OF PENNSYLVANIA
COUNTY O:F CUMBERLAND
ss.
Lisa Marie Coylae, Esquire, Editor of the Cumberland Law Joulxlal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly izl the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal vn the following dates,
viz:
FEBR~(JARY 14, 21, 2$, 2003
Affiatlt further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of gezleral circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, piece and character of publication are true.
i
Sorts. Vtsgiuia 1oR., deed.
late of Shiremanstown Sorougk~-
~cecutor: W111tana C_ Range. 324
Glendale Urlve, Shiremanstown,
PA 17011.
Attorney: wwlam L<. Kimmel. Esq..
166 East Union Street, Somerset,
PA 15501.
„^,~.~,.
isa Marie Coyne, E or
SWORN TO AND SUBSCRIBED before me this
2~day of FEBRUARY. 2003
~~f7 ~ ''~~~~
f~ 003
1
09/13/04 MON 13:12 FA% 814 445 6362 ATTYS. AT LAF9
THE PATR~UT NEWS
THE SUN~AX PATRYOT NEWS
Proof of Publicsation
Undsr Act No. 587, Approved May 16,1928
Cvmmvnweakh of Pennsylvania, County of Dauphin} ss
~ 004
JOSEPIi A. (DENNISON being duty sworn according to law, deposes and says: That he is the Asst.
Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of
Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg,
Courity of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-_dQws anci~he Sunday Patriot-News
newspapers of general) arculation, printed and published at 812 to 818 Market Street, in the City, County and State
aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September
18th, 1849, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published in
----their regular daily andlor Sunday/ Metro editions which appeared on the 7th, 14th and 21st day(s) of February
2003. That neither he nor said Company is interested in the subject matter of said printed notiC6 Or adVeRising, and
that all of the allegations of this statement as to the time, place and character of publication are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuarrt to a resolution unantmousty passed and
adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in
the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
PU13L.ICA710N
.............................. ... 1 ~:.~.....
~ ~~`
CQPY Sworn to and subsc ' e re t s 21st day a•e a 2003 A.D.
nlotarial Seal
Terry 1. Russell, ntdary Pubis;
~~~'~~""CO1n~' NO ARY PUBLIC
My Gbmmis6lon Expires Jtne 6
2006
~~ ,
AAernber, Pwmsvhmni~ 0.45~xiadon prNota~ My commission expires June 6, 2006
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For publishing the notice or publication attached
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Probating same Notary Feels} $ 1.75
Total $ 217.51
Publisher's Receipt for Advertising Cvst
The Patriot News Co., publisher of ~e Patriot-News and The Sunday Patriot-News, newspapers of genera[
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same hav9
been duly paid.
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IN THE GAMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of: )
VIRGINIA M. KURTZ, ) No. 1161
unremarried widow, deceased, late of )
Shiremanstown Borough, Cumberland )
County, Pennsylvania )
AFFIDAVIT OFNOTICE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF SOMERSET
ss:
Estate 2002
I, WILLIAML. KIMMEL, ESQ., being duly sworn according to law, deposes and
says that he is the Attorney for the ESTATE OF VIRGINIA M. KURTZ, unremarried widow,
deceased; that a First and Final Account and Proposed Distribution in said Estate has been filed, and
written notice has been given of the time of presentation of said Account and Proposed Statement
of Distribution in said Estate at least ten (10) days prior to the date fixed for confirmation thereof,
with a copy of the Proposed Distribution, to every person of whom he has notice or knowledge, who
claims an interest in the Estate as a beneficiary, heir, next of kin or unpaid creditor.
Sworn to and .subscribed before
me this 5~' day of October, 2004
William .Kimmel
~~~,' > ~
c.
,'~ -
E
NDTARIAL SEAL v
ELLEN M. CGLINE. NOTARY PUBLIC '
SOMERSET BORO., SOMERSET COUNTY
MY COMMISSfON F~(PIRES NOV. 71, 2004
1N THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of: )
VIRGINIA M. KURTZ, ) No. 1161 Estate 2002
unremarried widow, deceased, late of )
Shiremanstown Borough, Cumberland )
County, Pennsylvania )
AFFIDAVIT OF NOTICE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF SOMERSET
ss:
I, WILLIAM C. RANGE, being duly sworn according to law, deposes and says that
he is the Executor of the ESTATE OF VIRGINIA M. KURTZ, unremarried widow, deceased; that
he has filed a First and Final Account and Proposed Distribution in said Estate, and has given written
notice of the time of presentation of said Account and Proposed Statement of Distribution in said
Estate at least ten (10) days prior to the date fixed for confirmation thereof, with a copy of the
Proposed Distribution, to every person of whom he has notice or knowledge, who claims an interest
in the Estate as a beneficiary, heir, next of kin or unpaid creditor by Exhibit A attached hereto and
made a part hereof.
William C. Range ~-
Sworn to and subscribed before
me this 5~` day of October, 2004.
,1' /l,l ~~(~
~_...
~!
NOTAP,IAL SEAL
ELLEN M. OGLME, NOTARY PUBUC
SOMERSET BCR(i SOMERSET COUNTY
MY COMMISS!CP: 1~iP!RES NOV. 11, 2004
rt.l ~ , ~ Complete items 1, 2, 8nd 3. Also complete
~ item 4 if Restricted Delivery is desired.
~ ~ ~ _
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-- - -- - - -- - - --------------------------. 2. a
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PS Form
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~r_ _ _ _N~_---Walton-Avenue, -Apt: 305
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7~~3 050 ~0~4 3937 5152
38~~,`f4ugust `'2bb1' - ' ' ''Domestic Return Receipt
... . ~v
_a Signature _
. Received by (Printed Name) C. Date of va
D.'~s' delivery address different from item 1 ? ^ Yes
ff YES, enter delivery address below: ^ No
3. ice Type
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102595.02-M-1
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B. Receryryed by (Printed Name) C. Date of Deliv
-- _ _ - _ -
D. Is delivery address different from Item 1? ^ Yes
If YES, enter delivery address below: ^ No
3. Service Type
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Registered ^ Return Receipt for Merchan~
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^ ' ompie~li~grrts 1, 2, and 3. Also gomplete
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^ Print yote and address on the reverse
so that . ' return the card to you,;
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or on the font if space permits.
1. ARlcle Addt~ed to:
~SF~, Michael Irtz
3200 App~~, Road
~~ Bethel Pam, PA 15102
~~
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D. Is delivery address different fiont itbrirl7 ^ Yes
If YES, entet;:delivery address below: ^ No
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2. Article Numbs ° • °°
'~ (rrarisi<ei,fiem ~ 7 3. Q:5 p p Q Q Q 4 3 9 3 7 516 9 ...
`'nP5 Form 3811, August 2001 ~ Domestic Return Receipt
! .''
^ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
^ Print your name and address on the reverse
so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
nr nn #i~o 4mn# i4 cn~no normi#c "
1. Article Addressed to:
• ~
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D. Is delivery address different from item 1? ^ Yes
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3. Service Type
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^ Registered ^ Return Receipt for Merchandise
r~ - ------------•------------...-- - ~------------------------------ ~ Restricted Delivery? (Extra
S`t t Apt. No.; -
or Box No. 1816 Kualono Street_____ 2 ArtloleNumbei
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PS Form 3811,iA-ugtasY2001 ' Domestic Rectum R®aeipt
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m or on the front if space permits.
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D. Is d very add Brent em 1 T
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~ CertiOedFee 5~ Kay: Range \\ LISPS
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Street, Apt No.;
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4. Restricted Delivery? (ExtNt ) Yes
City, Stafe, Z/P+4
Shiremanstown,
PA 1
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PS Form 38 1, August 2001 Domestic Return Receipt 102595-02-M-t5a0
CERTIFIED M~
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:3.50
~
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m
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' ^ Complete tams 1, 2, end 3. Also complete
item 4 ff Restricted Delivery is desired.
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^ Agent
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so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits B. Received by (Pdn Name) C. Date of el
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1. Article Addressed to: D. Is delivery address differentflortt !Mm 19
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SIR 1~!
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Meyersdale, PA 15552 ... , ~- n u_ ---
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D. - -l :
4. Restricted Delivery? (Extra Fee) yes
or POBOxNo.~' 413 Second Avenue
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Meyersdale, PA 1555
2. Artl~ 7223 2522 2224 3937 5237 ~-'
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item 4 if Restricted Delivery is desired.
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or on the front if space permits.
r~
rTt 1. Article Addressed to:
m Postage s ME~ Susanne Funk
.~-
12
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Certified Fee
0 . 01 Posy Harrisburg, PA 17111
~ Retum Reciept Fee
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D. Is delivery address dih
If YES, enter delivery
~~~ ~'
^ Re 'ded Delivery Fee 3. Service Type _'
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m
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- ------ -------•----------------- --u'~ ? ~ a. Restricted Delius ~1 /' ,_
0 or PO Box NO. LO15 Jean Davi r r ry? ,
^ street, Apt- No., R . R .1 Box 200A I Fee Yes
- 2. Artlcl .. ,
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Markle sbur PA 15~ ~ ~ 1 +°' ~ ~ - --
„ ; , , , . , , Ps Form 3811, August 2001 Domestic Return Rece p 102595-02-M-1540
. ^ .Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
" ^ Print your name and address on the reverse
so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
,_ m or on the front if space permits.
1, Article Addressed to:
~ Lois Jean Davis •
Rbi R. R. 1, Box 200A
.---k Marklesburg, PA 15459
119/88/
CERTIFIED M~
(Domestic Mail Only; Nt
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~reai,apt~No.;---- __ --------------------- ------------
orPOBoxNo• 2622 Raymond Avenue ___________
-
cry,s~re,-ziP+a-'--Latrobe, PA ______
15650 _
M1
~ QUECREEK PA 15555
rU Postage $ 11.06
~
m Certified Fee
~
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D. Is delivery address different item 1? ^ Yes
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PA 15650
3. rvtce Type
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7003 05~p pp04 3937 52p6
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item 4 ff Restricted Delivery is desired.
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or on the front ff space permits,
1. Article Addressed to:
X64 Ruth Sicheri
02
Poi 730 Quecreek Road
"' Quecreek, PA 15555
09!21/2U
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2. Article Number
-----------'-- ~'~'"ro'"~ ;x`1000 Q520~0021 3492 4977 I
PS Form 3811, August 2001 Domestic Return Receipt to2595-o2~n-te
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m
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423 Amaya Avenue
~
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°'PO~x^~• 2347 Huckleberry__
cfi;'s~ie. ziR:a --------------------------------------
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Street, Apt No.;
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Clfy, State, ZlP+4
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7003 o5po ~ ~ ;
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fTl Postage $
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0 Return Reciept Fee
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to2sa5-o2-n~PtSao
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or PO Box No.
105 C Fa>.th Driv 15F 7pp3 p5p~ 268
----------------- - ---------- -------- ------------- x (fiansfe
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~ 1. Article Addressed to:
OOtt~ M . Joan Kim meY,~ a/ k:/ a Joann
~ Ft~o 2347 Huckleberry Highway
"~ Berlin, PA 15530
63
2. Article Number
(frensfer frogr
PS Form 811,
A.
~ _
B. Recdlved by (Pdnt Na`r-re) C. Date of melivery
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3. ice Type
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4. Restricted Delivery? (Extra Fee) Yes
703 p5pp ppp4 3937 5190
01 Domestic Return Receipt 102595-02~- t540
~ O 0 ~ 33 South West Avenue
~ ", Shiremanstown, PA 17011
' item 4 if Restricted Delivery is desired. - ^ Agent
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1, Article Addressed to: If YES, enter delivery address below: ^ No
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or on the front if space permits.
X2.30 ~ 1. Article Addressed to:
Nancy Berkey
11.75 ~ 158 Manjit Road
:3.50 ~C '~ P. O. Box 753
~ ~ Somerset, PA 15501
~ t8.b1 ~ 9/081
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hard to the back of the mailpiece,
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------------------------ ----
City, State, Z/P+4 "'- -" --
Somerset, PA 15501 ' 2. A•~~^'° ti„mti°• ~-~.._
7553 5555 5554 3937 5312
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~
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city, State. Z/P+4 -- - - - -- -- - - - -- -- - -------------------------------- y
Shiremanstown, PA 17011 _ __ - _-- -- ~ - -
7553 5555 5554 3937 5299
PS Form 3811, August 2001 Domestic Return Receipt to25s5-o2
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^ Insured Mail ^ C.O.D.
4. Restricted Delivery? (Extra Fee) ^ >~es
7553 5505 0254 3933 5149 ~
1, August 2001 Domestic Return Receipt tozese-oz-r
THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the )
Estate of
VIRGINIA M. KURTZ, unremarried )
widow, deceased, late of Lower Allen )
Township, Cumberland County, Pennsylvania )
No. 1161 Estate 2002
WAIVER OF NOTICE
The undersigned, NICHOLAS CHRISTOFF, of PRINCE OF PEACE CHURCH
IN HAWAII, hereby waives notice of the Hearing for confirmation of the First and Final Account
and Proposed Distribution in the foregoing Estate scheduled for Tuesday, October 12, 2004 at
9:30 A.M, in the Cumberland County Courthouse, Carlisle, Pennsylvania.
i
September .?'~ 2004 y ~ -4'v~~ 4 ~--._. ~ "° -ti ~° .
Nicholas Christoff
N ~ ' ~ ^ Complete items 1.2. and 3. Also complete A.
m • • • - Rem 4 R ResMcted Delivery is desired. ^
m ^ Print your name and address on the reverse Addressee
~
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^ Attach tltis card to the back of the mailp Receved by (Piloted ) C. Date of Delivery
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m Postage S
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~
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E 911.75
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S Connie Lee. Kolesko ~ d. °~
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(
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(Endo ant Required) 13.50 G Bolton, CT 06043 '~ y
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Lee
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~
------------
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S4reef, ilpi No.;
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-°____________
4. RestciCted 0!elivery? (Extra Fee) Yea
City, State. ZIF+4
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g. Received by (Printed Name)
C. Date of Deliv
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m 1. Article Addressed to: If YES, enter delivery address below:
•
Postage s Meig Kurtz ~.,
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° Cert'rfied Fee X2.30 r
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PA 15102
Bethel Park ;~, ;
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r°- - -~~eLLi~~--Kurtz----------------------------
~i~X~ppel Road
~e~ie~~~ark, PA 15102
.C.O.D. -1
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2. Article Number
(rtansferboRr•. 7333 0503 X004 3937 517 _ •
PS Form 381 y`, `August2001 Dbmestid Return Receipt 102595-o2-M-t5ao
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~
O 1. Article Addressed to:
«.30
006 William C . Range
~
/1'~ ~ 06 Pystr
e 324 Glendale Drive
o Shiremanstown, PA 17011
~.~
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X ~ (1,.
B. Received by (Printed Na ~ C. Date
. > _ .~ . ~.
D. Is delivery address different item 17 +L~
If YES, enter delivery add ow: ^
3. Ice Type
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RegisteredJ,~. ^ Retum Receipt for Merchandise
^ Wir .an? :: C :. R_ante---------------------------------
9Boi~endale Drive
Slate, z~P+a 2. Article Numr -
iremanstown, PA 17011 (rransfer,froi
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PS Form 811,
a
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~ Total Postage 8 Fees
m
a ~~lwood Fried
Restricted Delivery? (Extra
Yes
7003 0500 X004 3937 5114
Sao
,,,r,~ .. ..- --- ---
~ item 4 if Restricted Delivery is desired.
^. Print your name and address on the reverse
• ~ so that we can retum the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits.
1, Article Addressed to:
Q~ Elwood Friedline
943 Pleasant Hill Road
~~** ~p~ Somerset, PA 15501
rlti~ ~~Q v Ht
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erset, PA 15501
^ Agent
B. ~'Lw d a (G F at C 91 ` C. Date of Delivery
D. Is delivery address different from{-Rem 1? ^ es
If YES, enter delivery address below: ^ No
3. ice Type ..
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Registered ^ Return Rbc~tp"4`#~or Merchandise
4. Restricted Delivery? (Entry Fee)J ~1 Yes
2. Article Number
(fn3nsfeftioms 703 050 X004 3937 5121
Ps Form 3811, August 2001 Domestic Return ece p t 02595- M-15ao
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$
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^ Complete items 1, 2, and 3. Also complete
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^ rrrint your name and address on the reverse
so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
~MEFi; Wayne Friedline
1027 Pleasant Hill Road
Post Somerset, PA 15501
EP-~
~s~
A. signature (`/~~(,(~
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B. Received by (Printed Name) C. ggt~ of
D. Is delivery address different from Rem 1? L7 Yes
If YES, enter delivery address below: ^ No
3. rvice Type
Certified Mail ^ Express Mail
Registered ^ Retum Receipt for Merchandise
~ m .Restricted Delivery? (Extra Fee) Yes
o qro ne Friedline ___
----3'------------------------------------------------------------- 2. Article N 7 0 3 0 5 0 0 0 4 3 9 3 7 513 8
~ S`treet Apt No.;
~ or POeoXNo. 1027 Pleasant Hill Road (rrartsfer
cny, siaie,-ziR+a ----- pA 15 5 01 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-1540
Somerset,
u-- ~ ~ ~
.. •
~
fr'1 P,..
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m Postage $
"~
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' Cerfiried Fee X2.30
o
~ Return Reciept Fee li1
75
(Endorsement Required) .
~ Restricted Delivery Fee
X3
50
O (Endorsement Required) •+
u" 1
~ Total Postage 8 Fees
58.61
m
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° RQr~~l si
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^ Complete items 1, 2, and 3. Also complete
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1.
item 4 if Restricted Delivery is desired.
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' so that we can return the card to you.
ya ^ Attach this card to the back of the mailpiece,
or on the front M space permits.
1. Article Addressed to:
0064 Ronald Friedline
Ob Posy 281 Wildcat Road
/"~ Friedens, PA . 15541
A. Signature ,
.. ^A
^A
B. Received by (Printed Name) C. Drs o1
D. Is delivery address different from item 1'i ^ Yes
If YES, enter delivery address below: ^ No
3. rvice Type
'Certified Mail ^ Express Mail
^ Registered ^ Return Receipt for Merchandise
Restricted Delivery? (Extra Fee)
Yes
ar PO aox IJO. 2 s 1 __wi~~c~~.--RQ.asi-- ~`,':.,
City, State, ZlP+4 2. ~(
.~~ Friedens, PA 15541 (r,~,s„
o~ ~~~
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+! CERTIFIED MAILTr~ REC
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(Endorsement Required)
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(Endorsement Required) S3. ~ ~
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Total Postage & Fees
$
s$•61
m
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7003 ~5pp ppp4 3937 5145
item 4 if Restricted Delivery is desired.
^ Print your name and address on the reverse
t so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Gerald Friedline
583 Sipesville Road
~ Sipesville, PA 15561
t `,
^ Agent
(Pr/q~d Name) ~ C. Date of Delivery
D. Is delivery address difierertt from item f? ^ Yes
If YES, enter delivery address below: ~d No
3. Service Type
Certified Mall ^ Express Mail
Registered ^ Return Receipt for Merchandise
~ Gerald Friedline `" '~ -
----------------------
- --i, Api No.; --------- ------• 4. Restricted Delivery? (Extra Fee) Yes
orPOBox/VO.-----583 Sipesville--Road___--_- 2. ArtioleNuml
cty,s~ara,Z/P+4 7pp3 050 0004 3937 5183
Sipesville, PA 15561 (rransfarlrq~
"' " PS Form 3811, August 2001 Domestic Return Receipt to2sss-o2
~ ' • ^ Complete items 1, 2, and 3. Also complete
~
~ ~
~ item 4 if Restricted Delivery is desired.
.~ ~ Print your name and address on the reverse
'~
"~ ' ' • so that we can return the card to you.
~ ^ Attach this card to the back of the mailpiece,
m . or on the front if space permits.
,r ~~mmb'e~lth of Pennsylvania
r
, Postage s Office of Attorney General
O Certified Fee 62.30
Q Western Re onal Office
6th Floor, Manor Complex
~
~ Return Reciept Fee
(Endorsement Required) 61.75 I- P°s
t,,) l<H. 564 Forbes Avenue
Pittsbur h, PA 15219
~
^ Restricted Delivery Fee
~
~ ty ° ATTN : ~ohn L . Downing
~
u, (ndorsement Required)
• ~ Deputy Attorney General
~ tai Postage & Fees $ 66.49 OS 09I089~!
m
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6th Floor, Manor
Complex
- -
_ ___-
A. Sign
X ~~~ Addressee
B. Received by (Printed Name) C. D~ pf Delivery
D. Is delivery address different from ftem 1? ^ Yes
If YES, enter delivery address below: ^ No
3. rvice Type
Certified Mail ^ Express Mall
^ Registered ^ Return Receipt for Merch
^ Insured Mail ^ C.O.D.
4. Restricted Delivery? (Extra Fee) ^ Yes
teet,~lo.,~*orbes Avenue 2. Article
or Po i'~'sbur_gh,--~A----L5~19--------------. (rransf 7 0 0 3 ~ 5 0 ~ 3 0 0 4 3 9 3 3 516 3
i;nx sr .ter ~. ~._..__.~..,„ ~.
~r~T~'ld : John L . Downing, DE pS Form :3811; Augu?;t 2b61 l7omestic Refum Receipt 102595-o2-M-t 540.
THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' CDURT DIVISION
In the )
Estate of )
VIRGINIA 11~ KURTZ, unremarried )
widow, deceased, late of Lower Allen ) No. 1161 Estate 2002
Township, Cumberland County, Pennsylvania )
WAIVER OF NOTICE
The undersigned, CHARLES FRIEDLINE, hereby waives notice of the Hearing
for confirmation of the First and Final Account and Proposed Distribution in the foregoing Estate
scheduled for Tuesday, October 12, 2004 at 9:30 A.M. in the Cumberland County Courthouse,
Carlisle, Pennsylvania.
t ~...~ ~
September ,, 2004 ~j~/_ ~ c~ ,.~,~~
Charles Friedline
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone:(717) 240-6345
Date: 12/01/2004
KIMMEL WILLIAM L
166 EAST UNION ST
PO BOX 51
SOMERSET, PA 15501
RE: Estate of KURTZ VIRGINIA M
File Number: 2002-01161
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 11/30/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
/s
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
1N THE COMMON PLEAS COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
In the
Estate of
VIRGINIA M. KURTZ, unremarried widow,
deceased, late of Lower Allen Township,
Cumberland County, Pennsylvania
No. 1161
STATUS REPORT UNDER RULE 6.12
Estate 2002
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report to the
following with respect to completion ofthe administration ofthe above captioned Estate:
1. State whether administration of the Estate is complete: Yes.
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete: N.A.
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.
b. The separate Orphans' Court number (if any) for the personal
representative's account is: None.
c. Did the personal representative state an account informally to the
parties in interest? No, formally.
d. Copies of receipts, releases, joinders and approvals of formal or
informal accounts may be filed with the Clerk of the Orphans' Court and may
be attached to this report.
By
Willi m L. Kimmel, Esq.,
Counsel for Personal Representative
166 East Union Street
Somerset, PA 15501
(814)445-9651
Date: April 18, 2005
Murrel R. Walters, III
Attarney I.D. No. 24849
David R. Galloway
Attorney I.D. No. 87326
WALTERS & GALLOWAY, PLLC
54 E. Main Street
Mechanicsburg, PA 17055
Telephone: (717) 697-4650
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: : Estate No: 21-02-1161
ESTATE OF VIRGINIA M. KURTZ :
PRAECIPE FOR ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Please enter our appearance on behalf of the Estate of Virginia M. Kurtz. Papers may be
served at the address set forth above.
{,`
Respectf 11 su i,tted,
WALT � L AY, PLLC
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Murrel R. Walters, III, #24849
Counsel for the Estate of Virginia M. Kurtz
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1505610140
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 2 1 1 6 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 8 7 1 4 4 5 7 4 1 1 3 0 2 0 0 2 0 5 2 4 1 9 2 1
Decedent's Last Name Suffix Decedent's First Name MI
KURTZ V I RGI N I A M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1.Original Return O 2.Supplemental Return F� 3. Remainder Return(Date of Death
Prior to 12-13-82)
F] 4.Limited Estate ❑ 4a. Future Interest Compromise(date of F� 5.Federal Estate Tax Return Required
death after 12-12-82)
OX 6.Decedent Died Testate M 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
9.Litigation Proceeds Received E] 10.Spousal Poverty Credit(Date of Death 11.Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DAV I D R GAL L OWAY 7 1 7 6 9 7 4 7 0 0
-713
G.^'7
r
r �REGISTEII-&WILL, QR
11 ONLY
�} ( Cy7
First Line of Address
- r.._ rJ
5 4 E MAI N S T = ` =J `='
Second Line of Address
... }
City or Post Office State ZIP Code DATE FILLED ryl
Cri V7 Yt
MEC HA NI CS BU RG PA 1 7 0 5 5'- CD
Correspondent's e-mail address: DAVIDOWALTERSGALLOWAY.COM
Under penalties of perjury,1 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 and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON REEESPO�`yyNCCuu��rriiLE FOR FILI RETURN p�jTE p
C RANGE 324 GLENDALE DR SHIREMANSTOWN PA 17011 ,
SI URE OF OTHER THAN REPRESENTATIVE DAT
Z (3 __r J
ADDRESS
DAVID R GA OWAY 54 E MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 �\
1505610240
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name: VIRGINIA M. KU RTZ 1 8 7 1 4 4 5 7 4
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . .. . . . . . . .. .. . . . .. . ... . . . . . . . . . . . . . . . . 1.
2. Stocks and Bonds(Schedule B) 2. 4 0 1 1 6 5 , 0 0
B) . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . .. . . .. .. . . . . . . . . . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . .. . 5. 2 0 2 • 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 5 0 4 8 8 2 , 6 0
(Schedule G) [:] Separate Billing Requested . .. . . .. 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 9 0 6 2 4 9 , 6 0
9. Funeral Expenses and Administrative Costs(Schedule H) . . . .. . . . . . . . . . . . . . 9. 3 6 7 8 8 • 7 6
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . .. . .. . .. 10. 3 0 • 3 0
11. Total Deductions(total Lines 9 and 10) . . .. .. . . . . .. .. . .. . . . . . . . . . . . . . . 11. 3 6 8 1 9 . 0 6
12. Net Value of Estate(Line 8 minus Line 11) . . . . .. . . . . . . . . . . . . . . . . . . . . . . 12. 8 6 9 4 3 0 . 5 4
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . .. . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . .. . . . . . . . . . . . . . . . . 14. 8 6 9 4 3 0 . 5 4
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)x.06 2 5 3 2 1 2 . 7 8 15. 1 5 1 9 2 . 7 7
16. Amount of Line 14 taxable
at lineal rate X.0_ 0 . 0 0 16. 0 . 0 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 6 1 6 2 1 7 . 7 6 18. 9 2 4 3 2 . 6 6
19. TAX DUE ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . 19. 1 0 7 6 2 5 . 4 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 02 1161
DECEDENTS NAME
VIRGINIA M. KURTZ
STREET ADDRESS
326 GLENDALE DRIVE
CITY STATE ZIP
SHIREMANSTOWN PA 17011
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) (1) 107,625.43
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 107,625.43
Make check payable to: REGISTER OF WILLS, AGENT _
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X
c. retain a reversionary interest ..................................................................................................... El0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... El ❑X
3. Did decedent own an"in trust for"or payable
-upon-death bank account or security at his or her death? ......... ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. ❑
IXI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
,For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[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 21 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 percent[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 percent,except as noted in p2 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 percent[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.
REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VIRGINIA M. KURTZ 21 02 1161
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Virginia Kurtz 401,165.00
Date of Death 11/30/2002
"Found Assets"-Savings Bonds
TOTAL(Also enter on Line 2,Recapitulation) $ 401 165.00
If more space is needed,insert additional sheets of the same size
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
VIRGINIA M. KURTZ 21 02 1161
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. HAAR'S AUCTION 202.00
CURRENCY COLLECTION- "Found Assets"
GROSS SALE VALUE
TOTAL(Also enter on Line 5,Recapitulation) $ 202.00
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VIRGINIA M. KURTZ 21 02 1161
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (WAPPUCABLE) VALUE
1. Estate of Charles Kurtz 239,396.80 100.00 239,396.80
Date of Death 08/15/1992
"Found Assets"-Savings Bonds-Joint with Brother:John Kurtz
2. Estate of John Kurtz 265,485.80 100.00 265,485.80
Date of Death 04/07/1994
"Found Assets"-Savings Bonds-bequest to Wife:Virigina Kurtz
TOTAL (Also enter on Line 7,Recapitulation) $ 504 882.60
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VIRGINIA M. KURTZ 21 02 1161
Decedents debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) William C. Range 17,697.18
Street Address 62 Longwood Dr
city Mechanicsburg state PA ZIP 17050
Years)Commission Paid: 2015
2. Attorney Fees: Walters &Galloway, PLLC 17,697.18
3, Family Exemption:(If decedents address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS-CUMBERLAND COUNTY 105.00
5 Accountant Fees:
6. Tax Return Preparer Fees: Keller Financial Group 1,200.00
Federal and State Fiduciary Returns
7. Register of Wills-Copies 31.00
8. Death Certificate-Copies 18.00
9. Accurint-Skiptracing to locate Heirs 25.40
10. Register of Wills-Supplemental Filing 15.00
TOTAL(Also enter on Line 9,Recapitulation) $ 36 788.76
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
VIRGINIA M. KURTZ 21 02 1161
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. HAAR'S AUCTION 30.30
COMMISSION FOR SALE OF CURRENCY
TOTAL(Also enter on Line 10,Recapitulation) $ 30.30
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
VIRGINIA M. KURTZ 21 02 1161
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. ESTATE OF RONALD FREIDLINE Collateral 0.11
2. ESTATE OF GERALD FRIEDLINE Collateral 0.11
c/o MICHAEL KUHN, ESQUIRE
555 E. MAIN ST., SOMERSET, PA 15501
3. M. JOAN KIMMEL, A/K/A MONA J. KIMMEL Collateral 0.11
2347 HUCKLEBERRY HIGHWAY
BERLIN, PA 15530
4. DOLORES SHAFFER-POA TO DANIEL SHAFFER Collateral 0.11
2622 RAYMOND AVE
LATROBE, PA 15650
5. LOIS J. DAVIS Collateral 0.11
668 BRUCETON RD
MARKLEYSBURG, PA 15459
6. ESTATE OF CHARLES FRIEDLINE Collateral 0.11
7. CAROL FRIEDLINE Collateral 0.11
305 MEYERS AVE
MEYERSDALE, PA 15552
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
VIRGINIA M. KURTZ 21 02 1161
Decedent's Name Page 1 File Number
Schedule J -Beneficiaries -1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outri ht spousal distributions and transfers under
Sec.91?6(a)(1.2).]
8. ESTATE OF WAYNE FRIEDLINE Collateral 0.11
9. ESTATE OF ELWOOD FRIEDLINE Collateral 0.11
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 020273
RANGE WILLIAM C
308 PINEWOOD DRIVE
SHIREMANSTOWN, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
__________ --------
101 $107,625.43
ESTATE INFORMATION: SSN: 187-14-4574
FILE NUMBER: 2102-1161
DECEDENT NAME: KURTZ VIRGINIA M
DATE OF PAYMENT: 02/24/2015
POSTMARK DATE: 02/24/2015
COUNTY: CUMBERLAND
DATE OF DEATH: 11/30/2002
TOTAL AMOUNT PAID: $107,625.43
REMARKS: RCPT TO ATTY
CHECK# 1004
INITIALS: DB1
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
52
WALTERS & GALLOWAY, PLLC
54 East Main Street,Mechanicsburg,PA 17055
Phone:717-697-4700 Fax:717-697-9395
Murrel R.Walters III David R.Galloway
Murrel@waltersgalloway.com David@waltersgalloway.com
,,I
C--)
:Z
r"!
February 13, 2015
Ca
as c")
Register of Wills
Cumberland County
Courthouse -TI
I Courthouse Square, Ste 102
Carlisle, PA 17013
Cn G7 "Tl
CD
RE: Estate of Virginia Kurtz
Supplemental Return
Dear Sir/Madam,
Enclosed,please find a copy of the Supplemental Inheritance Tax Return—Resident
Decedent form.
It had been brought to our attention that there were additional "discovered assets"
that were not previously included on the original Inheritance Tax Return. Per our
conversation with Joan at the Department of Revenue — Inheritance Tax Division on
October 1, 2014,the interest on the savings bonds will be waived. Please accept the check
for $107,625.43 as payment.
Today, we spoke with Diane in your office to calculate the additional fees for
probate as $105.00 plus filing fee of$15,00. Attached is a check for $120.00.
Should you have any questions or concerns, please feel free to contact me at 717-
697-4700.
Very truly yours,
David R. Ga way
DRG/klr
Enclosure
cc: William C Range, Executor(via first class mail) (w/A enclosures)
Pennsylvania Department of Revenue—Inheritance Tax Division
NOTICE OF INHERITANCE TAX pennsyLvarna
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX
INHERITANCE TAX DIVISION REV-1547 EX AFP (11-14)
PO BOX 280601 RI: ,gRGEC OFFICE OF
HARRISBURG PA 171 0
REGIST17,1 'F WILLS
t; DATE 04-13-2015
?Q15 PPR 13 Ri 111 59 ESTATE OF KURTZ VIRGINIA M
DATE OF DEATH 11-30-2002
C LEr"K Or FILE NUMBER 21 02-1161
COUNTY CUMBERLAND
KIMMEL MHQI'r';_M11MAMIT L ACN 101
166 E CUAWt I " APPEAL DATE: 06-12-2015
SOMERSET PA 15501 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE ! RETAIN LOWER PORTION FOR YOUR RECORDS
REV 1547 EX AFP (11-14) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: KURTZ VIRGINIA MFILE NO. :21 02-1161 ACN: 101 DATE: 04-13-2015
TAX RETURN WAS: ( X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON- SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) C2) 401,165.00 credit to your account,
S. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 submit the upper portionof this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 202.00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 504,882.60
8. Total Assets (8) 906,249.60
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 36,788.76
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 30.30
11. Total Deductions (11) 36,819.06
12. Net Value of Tax Return C12) 869,430.54
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts CSchedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 1,792,470.84
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 will
reflect figures that include the total of all returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at spousal rate C15) .00 X 00 = .00
16. Amount of Line 14 taxable at lineal rate (16) PqA•71 2-7R X 045 = 11,394.58
17. Amount of Line 14 at sibling rate (17) nn X 12 = .00
18. Amount of Line 14 taxable at collateral rate (18) 1,539,258.06 X 15 = 230,888.71
19. Principal Tax Due (19)= 242,283.29
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-27-2003 CDO02230 8,421 .05 160,000.00
04-20-2004 REFUND .00 28,466.75-
02-24-2015 CD020273 5,296.44- 107,625.43
BALANCE OF UNPAID INTEREST/PENALTY AS OF 02-25-2015 TOTALTAX PAYMENT 242,283.29
BALANCE OF TAX DUE .00
INTEREST AND PEN. 49,325.30
TOTAL DUE 49,325.30
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE \
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.