HomeMy WebLinkAbout03-0542PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Constance B. Sempeles No.
~/also known as Constance Beleha~ Sempeles To:
, Deceased.
Social Security No. 186-24-7734
Register of Wills for the
County of Cumberland
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 ors
in the last will of the above decedent, dated October 11.
and
in the
codicil(s) dated
named
,19 [}1
(state relevant circmnstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
hot last family or principal residence at qOfl8 Mmrkor .qtrmat, Camp Hi 1 l
(list street, number and muncipality)
Decendent, then 78 years of age, died June 11, 2003 , :S~. ,
at Rorhmnv l/ill~c~o.. Moeh~nie.~h,,rg
Except as ~ollows, d~'cedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciledin- Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows: "
50,000.00
200,000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters. Testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron ....
3008 Market Street
Camp Hill. PA 17011
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA q
COUNTY OF Cumberland ~ 88
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 we~tnd truly administer the estate according to law.
Sworn to or aff?med and subscribed r/(~~~~
beforem, ethis. ~ dayof I/~ /' . ~-,~ _' a' ~
, ~\xa 2003 ~xxxx J~ / 3 ~// / ,, ~-~ '
% ' ~ '~o~-' ~3~ Register L ~
Estate of Constance B. Sempeles ., Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~.51,Jt~ ~
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated October 11, 1991
described therein be admitted to probate and fried of record as the last will of
COnstance B. Sempeles
and Letters Tes.tamentar ~
m~edto ' / '" *~ o .... ~
are hereby gra
1~ 200~ in consideration of the petition on
FEES
Probate, Letters, Etc .......... ~
Short Certificates( )'. ......... $~
~ y.~X~t:~.. $1~5. oc~
, $1o. oo
TOTAL . $~
Filed .7.'. ~- .~.3 .......................
~Register of Wills
Michael Cherewka PA35073
624
ATTORNEY(Sup. Ct.I.D. No.)
N. Front Street~ Wormleysburg, PA 17043
ADDRESS
717-232-4701
PHONE
.
WILL
I, CONSTANCE B. SEMPELES, of the Borough of Camp Hill,
County of Cumberland and Commonwealth of Pennsylvania, do
make, publish and declare this to be my Last Will and
Testament and revoke any and all Wills or Codicils
previously made by me.
ITEM I: I give, devise and bequeath to my son, JAMES
GEORGE SEMPELES, my home and household furnishings, and any
insurance thereon, located at 3008 Market Street, Camp Hill,
Cumberland County, Pennsylvania, provided he shall survive
me by sixty (60) days.
ITEM II: I have been making annual gifts of interests
in my real estate situate at 3002 Market Street, Camp Hill,
Cumberland County, Pennsylvania, in equal amounts to my
sons, James George Sempeles and David Alexander Sempeles.
Should I die prior to having conveyed my entire interest in
said property, I give and devise the remaining balance of my
interest therein to my said sons, or the survivor of them.
ITEM III: Ail the rest, residue and remainder of my
estate of whatever nature and wherever situate at the time
of my death I give, devise and bequeath in equal shares to
my sons, JAMES GEORGE SEMPELES and DAVID ALEXANDER SEMPELES,
absolutely, provided they respectively survive me by sixty
(60) days.
ITEM IV: A. In the event my son, JA~S GEORGE
SEMPELES, dies without issue on or before the sixtieth day
following my death, I direct that that the share to which he
would otherwise be entitled be given to my son, DAVID
ALEXANDER SEMPELES;
B. In the event my son, DAVID ALEXANDER
SEMPELES, dies without issue on or before the sixtieth day
following my death, I direct that the share to which he
would otherwise be entitled be divided as follows:
(i) twenty-five (25%) percent to my
son, JAMES GEORGE SEMPELES, per
stirpes;
(ii) seventy-five (75%) percent to my
daughter-in-law, KATHLEEN R.
SEMPELES, provided she survives me
by sixty (60) days; otherwise one
hundred (100%) percent to my son,
JAMES GEORGE SEMPELES.
ITEM V: In the event both my sons predecease me or die
without issue on or before the sixtieth day following my
death, I give, devise and bequeath my estate as follows:
(i) fifty (50%) percent to my
daughter-in-law, KATHLEEN R. SEMPELES,
provided she survives me by sixty (60)
days. Should my daughter-in-law,
KATHLEEN R. SEMPELES, die on or before
the sixtieth day following my death, her
share shall be added pro rata to the
other gifts set forth in this paragraph;
(ii) twenty-five (25%) percent to the
American Red Cross International
Disaster Fund;
(iii) twenty-five
American Baptist
(25%) percent to
Foreign Missions,
Valley Forge, Pennsylvania;
ITEM VI: Ail death taxes (not income taxes) that may
be assessed in consequence of my death, of whatever nature
and by whatever jurisdiction imposed, shall be considered a
part of the expense of the administration of my estate, and
my Executor shall have the absolute power in his discretion
to pay the same at once whether or not the law under which
they are imposed permits the postponement of payment of all
or part of them to a later date.
ITEM VII: No interest of any beneficiary of my
estate, either in income or principal, shall be subject to
anticipation or to pledge, assignment, sale or transfer in
any manner, nor shall my beneficiary have any power in any
manner to charge or encumber his or her interest, either in
income or principal, nor shall the interest of any
beneficiary be liable or subject in any manner while in the
possession of the Executor for the liability of such
beneficiary, whether such liability arises from his or her
debts, contracts, torts or other engagements of any type.
ITEM VIII: If my sons or either of them and I should
die under such circumstances that it cannot be determined
which of us died first, it shall be determined for all
purposes hereunder that I survived my sons.
ITEM IX: If I die leaving no issue to survive me I
give, devise and bequeath my estate in equal shares to the
American Red Cross International Disaster Fund and to the
National Cancer Research Institute.
ITEM X: I direct and empower my Executors to sell any
and all real estate of which I die seized, at such time and
upon such terms as they may deem best, and to deliver good
and sufficient deeds therefor to the purchaser(s) thereof.
ITEM XI: I nominate, constitute and appoint my sons,
JAMES GEORGE SEMPELES and DAVID ALEXANDER SEMPELES,
Co-Executors of this my Last Will and Testament. Should
either fail to qualify or cease to act, the other shall
serve alone.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this llth day of October, 1991, at the end hereof,
composed in all of six pages, including the self-proving
attestation clause and signatures of witnesses.
Witnesses:
NCE B. SEMPEL~I~3
COMMONWEALTH OF PENNSYLVANIA:
: SS:
COUNTY OF DAUPHIN:
We, CONSTANCE B. SEMPELES, the Testatrix and
Lori A. B. Zerbe and Dorm L. Snyder , the witnesses
whose names are signed to the attached foregoing instrument
of three pages, being first duly sworn, do hereby declare to
the undersigned authority that the Testatrix signed, sealed,
published, acknowledged, and declared the instrument as her
Last Will and Testament; and that she signed willingly and
that she executed it as her free and voluntary act for the
purposes therein expressed; and that each of the witnesses
in the joint presence of each other and in the presence and
hearing of the Testatrix, signed the instrument as witness
to her Last Will and Testament; and that to the best of
their knowledge the Testatrix was at the time eighteen years
of age or older, was of sound and disposing mind, memory and
understanding, and was under no constraint or undue
influence.
CONSTANCE B. ~SE~{PELE~, TESTATRIX
It I tiN,,,.z'2% . .
DON~ ~. SNTDER' ~-- WITNESs~
Subscribed, sworn to and acknowledged before me, the
undersigned officer, by CONSTANCE B. SEMPELES, the
Testatrix, and subscribed and sworn to before me by
Lori A. B. Zerbe '~,,., and Do~nn-~. Snyder ,
witnesses, in the presen%e of each othe~";.~.t~is llth day of
October, 1991. ~
Nota~rv Public . .~.~...~
I ~"----... NOTARIAL S~J"~ ........ j
I Hardsburg, PA Dauphi:! .......
L, ~ Commission Expires Nov :~;.
LAST WILL AND TESTAMENT
OF
CONSTANCE B. SEMPELES
BOSWELL, SNYDER, TINTNER & PICCOLA
COUNSELORS AT LAW
315 NORTH FRONT STREET
P.O. BOX 741
HARRISBURG, PA 17108-074i
Name of Decedent:
Date of Death:
No.
CERTIFIC/ITION OF NOTICE UNDER RU~,E 5.6(a)
CONSTANCE B. SEMPELES
June II, 2003
2003-00542
'03 JUL 23~,~:~1~' '~'.:,7
[,tfmL,],
To the Register:
I certify that the Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court
Rules was served or mailed to the following beneficiaries of the above-captioned estate on July 14,
2003.
NAMES
James G. Sempeles
David A. Sempeles
ADDRESS
3008 Market Street
Camp Hill, PA 17011
1202 Powderhorn Road
Mechanicsburg, PA 17050
Date: July 18, 2003
The Law Offices of Michael Cherewka
Michael Cherewka, Esquire
624 North Front Street
Wormleysburg, PA 17043
(717) 232-4701
Capacity:
Personal Representative
X Counsel for personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 002992
CHEREWKA MICHAEL ESQUIRE
624 NORTH FRONT STREET
HARRISBURG, PA 17043
........ fold
'ESTATE INFORMATION: SSN: 186-24-7734
FILE NUMBER: 2103-0542
DECEDENT NAME: SEMPELES CONSTANCE B
DATE OF PAYMENT: 09/09/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 06/1 1/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $34,541.82
TOTAL AMOUNT PAID'
834,541.82
REMARKS: DAVID A SEMPELES C/O
MICHAEL CHEREWKA ESQUIRE
SEAL
CHECK# 1010
INITIALS: JA
RECEIVED BY.'
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV-1500 EX (64)0)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17t28-0601
I--
Z
IJJ
U.I
LLI
rREV-1500
INHERITANCE TAX RETURN
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Sempeles Constance B
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) ....
06-11-2003 I 09-21-i924
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LA~T, FIRST, AND MIDr~LE INITIAL) '"
N/A
[] 11 Original Reit're.
[-'~ 4. Umited Estata
[-~"l 6. Decedent Died Testate
[--] 9. Uligatlon Proceeds Received
-'-]2. Supplemental Retum
"'] 4a. Future Interest Compromise ((~,, of am~h ,~r 12-12-82)
-']7. Decedent Maintained a Living Trust (Aa,m a,y of T,~)
---I10. Spousal Poverty Credit {dat, d a, ah ~ 12-31-91 .,~ 1-1-~)
NME
Michael Cherewka
FIRM NAME CA~oa:aue}
The Law Offices of Michael
TE~PHONE NUMBER
(717) 232-4701
Cherewka
OFFICIAL USE ONLY
FILE NUMBER
2. 1__' 0 3___ O..p... 0 5 4 2
COUNTY COOE YEAR NUIIBER
SOCIAL SECURITY NUMBER
186- 24 - 7734
THis R.TUR. "-UST B, ',LE0,"'DUP.,C TE W,TH THE
REGISTER OF WILLS
SOCIAL SECURrn, NU/~BER .......
r--i 3. Remainder Return (mt, of deah Ncx' t, 1243-s2)
'-]5. Federal Estate Tax Return Required
i 8. Total Number of Safe Deposit Boxes
-]11. Election to tax under Sec. 9113(A) (Att,m so, o)
COMPLETE MAILING ADDRESS
624 North Front Street
Wormleysburg, PA 17043
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B) (2) 5 9 5,6 3 6, ~ 2
3. Closely Held Co~ation, Partnemhip or Sole-Propdetorahip (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposita & Miscallaneous Personal Properly (5) 55,919,77
(Schedule E)
6. Jointly Owned R'opedy (Schedule F)
'L_J Separate ailing Requested (6)
7. Inter-Vivos Transfers & Miscellaneous Non-Pmtmta Properly (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Adminielralive Costa (Schedule H) (9) ! 6,4 8 4.1 4
10. Debts of Decedent, Mortgage Liebllilies, & I.lens (Schedule I) (10) 1,25 0.8 7
11. Total Deductlone (total Lines 9 & 10)
12. Net.Value of Estate (Line 8 minus Line 11)
(1) 196,760.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for wh~dn an election to tax has not been
made (Schedule J}
14. Net Value Subjecl to Tax (Line 12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(8) 828,316.59
(11) 17,735.01
02) 810,581.58
(13).. 0.00
(14) 810.581_.58
Amount of Une 14 taxaDle al the spousal tax
15.
rata. or transfem under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral role
19. Tax Due
810,581.58
x .o (15)
x.045 (16)_
x .12 (17)
x .15 (18)
36,476.17
2o. []] - i (19) 36,.476.17
Decedent's Complete Address:
ISTREET ADDRESS
3008 'Market Street
CITY ~ Camp Hill ·
Tax PaYments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credi!s/Peyme.nts
. A. Spousal P0vedy Credit
B~ Prior Payments 34,541.82
C. Discount 1,817.99
IziP '17011
Total Credits ( A + B + C )
InteresUPenalty if aPplicable
D, Interest
E. Penalty . . -
Total. Interesl/Penalty ( D + E)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, '
Check box on Page 1 Line 20 to request a refund
If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due. .,
B. Enter the total of Une 5 + SA. This is the BALANCE DUE,
36,476.17
(2) 36,359.81
116~36
'(3)
(4)
(5)"
(5A)
(5B)
116.36
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b.' retain the right to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a revereionary interest; or .......................................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receMng adequate consideration? ....................................................................................................... ; ...... [] []
3. Did decedent own an "in trust for' or payable upon death bank accounl or security at his orher death?'. ............. [] []
4. Did decedent own an IndMdual Retirement Account. annuity, or other non-pmbata property whic~
contains a beneficiary designation? ......................................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT'AS PART OF THE RETURN.
Under F~==~'_~-: d peC~ufl/, I dm"~_m ~ I have ~,,~, ~d ~is return, including ~,~.~ng ~-_~._~e~_ and ~,, ..,6, and to itie best of my kno~',~.~ and belief, it is true. cnn'ecl and compiele.
~,~ of pmpare~ ~ Ihan the personal representative is based on all Idormaiton of whlah pr-,,par~,- has any
~i~RESS 3008 Market Street', camp Hill, PA
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ..... : ' · .............
DATE
ADDRESS 624 North Front Street, Wormleysburg, PA 17043 ...........
For dates of death on or after July 1, 1994 and before January 1, 1995, Ihe tax rale imposed on the net value of transfers to or for the use of the surviving spouse is 3% -
[7'2 RS. §9116 (a) (1.1) (0].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. {}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 lax return are still applicable even if
lhe surviving spouse is the ~ly beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death Io or for the use of a natural parent, an adoptive parent,
or a stepparenl of the child is 0% [72 RS. §9116(a)(1.2)].
The tax rote imposed on the net value of transfers to or for lhe use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 RS. {}9116(1,2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of Ihe decadent's siblings is 12% [72 P.S. {}9116(a)(1.3)1. 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-1502 EX+ (6-98)~.~.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
Constance B. Sempeles FILENUMBER
21-03-00542
A~rea~pmpe~yowneds~e~yora$atenant~nc~mmonmustberep~dedatfa~rmarketva~e~Fairmarketva~ueisde§nedas~ep~cea~whichpmpe~yw~u~dbe
exchanged belween a willing buyer and a willing seller, neither being compelled lo buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
Residence - 3008 Market Street
Camp Hill, PA 17011
$196,760.00
TOTAL (Also enter on line 1, Recapitulation) $ 196,760.00
(if more space is needed, inserl additional sheets of the same size)
TAX YEAR
2003-04 REAL ESTATE TAX NOTICE
CAMP HILL SCHOOL DISTRICT
MAKE CHECKS PAYABLE TO:
MICHAEL W HARLING
206 S 17TH ST
CAMP HILL PA 17011
DATE ASSESSMENT
**SCHOOL ** JULY 1 2003
196,760 2438
WEDNESDAY 9:00AM TO 2:00PM
4:00PM TO 6:00PM
PHONE 717-730-0230
~CHOOL R/E .................................................................... ~
0%P 11.9 2M %P N %P M %P M %P M DURING ~IS PERIOD PAY THIS AMOUNT
2,298.4 DISCOUNT JULY - AUG 2,298.4'
2,345.3~ FACE SEPT - OCT 2,345.31
2,579.9~ ~ENALTY NOV - DEC 2,579.91
ACCT NO 01-21-0273-282 3008 MARKET STREET
SEMPELES, CONSTANCE B
LAND PT LOT 11 PB 2 PG 110
3008 MARKET STREET Residential Building
CAMP HILL PA 17011
IF TAXES ARE IN ESCROW, FORWARD
THIS BILL TO YOUR MORTGAGE COMPANY
TAX YEAR
2003-04 REAL ESTATE TAX NOTICE
· MAKE CHECKS PAYABLE TO:
MICHAEL W HARLING
~::~ 206 S 17TH ST
CAMP HILL PA 17011
IF UNPAID BY 12/12/03 TAXES WILL BE
TURNED OVER TO CUMBERLAND CO.
TAX CLAIM BUREAU.
$1.00 FEE FOR ADD'L RECEIPTS REQUESTED
DATE ASSESSMENT
**SCHOOL ** JULY 1 2003
196,760
WEDNESDAY 9:00AM TO 2:00PM
4:00PM TO 6:00PM
PHONE 717-730-0230
S;LL~o. C2
2438
~S C H 00 L R / E .......................................................................... ~,',,~i~
10%P 11.9 2M %. N %P M %P M %P M DURING THIS PERIOD PAY THIS AMO~INT
2,298.47~ DISCOUNT JULY - AUG 2,298.47
-
2,345.38
2,579. PENALTY NOV - DEC 2,579.92
.~:: ::::., ::: ~!::;.~i ACCT NO 01-21-0273-282 3008 MARKET STREET
· : ' "*:' *":;' "' ~'~' :? LAND PT LOT 11 PB 2 PG 110
~i~:':~~ : ::?:..~ :: !'~?.:?! '. ~ ..................................... . ...... ~-"-'~'-~ "-' .......... :~'~-- TURNED OVER TO CUMBERLAND CO.
; *.::~::[:?:~:{'~ ~}./'~{*'::::~ THIS BILL TO YOUR MORTGAGE COMPANY $1.00 FEE FOR ADD'L RECEIPTS REQUESTED
REV-1503 EX+ (6-98)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Constance B.
Sempeles
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
21-03-00542
ITEM
NUMBER
1,
All p~o~Ay jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
Hershey Trust Company, Account #2384
VALUE AT DATE
OF DEATH
$575,636.82
TOTAL (Also enter on line 2, Recapitulation $ 575,636.82
(If more space is needed, insert additional sheets of the same size)
P, 02
HERSHEY T~UST C05IPANY
Constance B. Sempeles T/U/A
Account #2384
Date of Death Value as of June 11, 2003
694 shares Common Trust Fund - Value Eqmty
358 shares Common Trust Fund - Fixed Income
Temporary Investment Fund
Accrued Interesl
$176,483.76
392,840.49
6,310.63
1.94
Toml Value $ 575,636.82
1(}(} MA,N~ION RO~J~'~ EAST * P, O. Box 445 · l~&[,l.l'£y, PENN~¥1.VANIA 17033.044.$ · (717) 554-3225 - FAX (?17) 520-1:
REV-1508 EX+ (6-98) . I
COMMO. VE^ T. OF' EN.SV.V^N,. I CASH, BANK DEPOSITS, & MISC. I
ESTATE OFINHERITANCE TAX RETURN ~ PERSnNAL PROPERTY
Constance B Sempeles FILE NUMBER
' 2[-03-00542
ITEM
NUMBER
Include the proceeds of litigation and the date the proceeds were received by Ihe estate.
All property Jointly.owned with right of suwlvorshlp must be disclosed on Schedule F.
DESCRIPTION
Pennsylvania State Bank: Checking Account #10121341
Accrued Interest
Pennsylvania State Bank: Savings Account #260-136-15
Accrued Interest
3. Miscellaneous furniture and household goods
~LUE ~ ONE
OF DE~H
$ 17,740.48
3.76
36,663.79
11.74
1,500.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
55,919.77
~'V485 EX+ (9-00) .~ ~ ~
COMMONWEALTH CF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERiTAnCE T~ DIVISION
DEPT. 2~0601
H~RRJSBURG, PA 17128~60t
INVENTORY
please Print or Type
IL 3T BE COMPLETED 6Y REPRESENTATIVE OF FiNANc',AL I;qS qTUTION WHERE SAFE DEPOSIT BOX iS LOCATED AND RETURNED TO ABOVE ADDRESS
~ COUNTY CODE FiLE NUMEE,X '~'
· , . . ~ SOCIAL S~CURFC~ OR ~EA-f~RTIFICATE NUMSER
~,~ DECEDENT'S NAME L~ FIRS; MlnnLE~ ~ i , '~"
.~ NAME AND ABDRESS OF PERSON ~,EQUES~NG THE O/~NiNG OF THE SAFE DEPOSIT ~OX
~., (NAME)' ~ ~ ~: , / ' ,
t' (~ ~ g . . Il' ~ (c~ s~
~ NAME ADDRESS AND RE~TIONSHIP (IF ~ t) TO DECEDEN ,, OF PERSON(S) PREScN~ AT t HE BOX OPENING ·
(STREET NAME)
b. (NAME)
' ~.~RELATiONSH~-P) '' '; I'
· ' (CITY) .... (STATE). (ZiP CODE)
.(RELATIONSHIP)
(STREET NAME)
(CITY)
, (.STATE) (ZIP CODE)
c. (NAME) : (RELATIONSHIP) -
(STREET NAME) (CITY) (STATE) (ZIP CODE)
~,J NAME AND ADDRESS OF FINANCIAL INSTITIJT;ON WHEPE THE SAFE DEFCSIT BOX IS LOCATED .
~NAME OF~P..~RSON MAKING LAST ENTRY .
OX, ~Jgt , BER CF
~NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX
a. (NAME) -.
T]TL:F. UNDE~ WHICH
LAST ENTRY
/o:
BOX IS_REQUE{~ED
(STREETADDRESS)
(CITY)
(STATE) (ZiP CODE)
(NAME)
(STREET AODRESS)
(CITY)
(STATE) (ZIP CODE)
NAME AND TITLE OF EMPLOYEE TAKING TH~NVENTO~'~y t
~"~J WAS A WILL'IN THE BOX? [] YES [] NO If yes, a. Date of will:
b. Name and address of pemonal mpr~tat[ve, if named in the wilt
(NAME) ..... ',, ", .. ,.
(STREET NAME) .... ~' '~ ' '. ~ '
~..;: ¥~: , .:., ~:.~ , : (CITY) .(STATE) . , (ZIP CODE)
c. Name and address ofatt~mey, ifany ! ' ..... 1
(NAME) . ~ ' ;i, ~ :"
-:' .:: ¢',,':;'~;::i~:, ,,:,;: ' "? · :: ', · ',..-,'; .
(STREET NAME) :'. ':: % ;,
.... ~ ....... (CITY)
; ~ :,~: ,,. ~, ~;'$5 ~ (STATE) (ZIP CODE)
",,
iNSTRUCTIONS
? of I'"
(1) Cash: Report total only.
(2) Stocks: List in detail every common o: prefe~'rec ce,~iScate, w-~rrant or cther rights found in box. Stocks are to be
designated by name of company, ce~:,f:,cat~ number, eate of'cert:ficate, name in which s[ocl( is registered, and
number of shares and class Of stock.
(:3) Obligations of U.S, Government: ,Number of ~erns, date of issue, face value, names in which registered and
type of ownership, i.e., jointly he!d, pays' ;e or death, etc.
(z} Bonds: Designate by name, amodnt, serial numbe-, or other designation. (Bearer Bonds)
(5) Bank ~nd Savings and Loan PassbooKs: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and baL~ce.
(~). Jewels, Coins, Stamps, Manus:ripts, etc: List and describe as fully as possible.
(7) Deeds, Mo~gages, Current Insurance F~licies or ~ther evidences of indebtedness: List and describe as fully
as possible.
(8) All other contents.
o. - ~ . ITEM DESCRIPTION ' '
CER,IFY UND PENALTY OF PERJURY THAT TI.~E A~=_ O¥= Rc~ " ~
C ., ~ .2 .:~-~,ORD IS PERSON REC=I,. ,NG COPY OF
' , ' ~ z ~ ~HI, iT NAME AND O8~OK AOPROPRIA~ BOX ~OW:
~xecutor(tHx) [] Administrator(trix)
[] Estate'Representat~Ve [] Joint owner of safe deposit box ,
NOTE: Attach additional 8'h# x '11" sheet(s) if necessary or use duplicates of this page of form.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
REV-1511 EX+ (12-9g)~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Constance B. Sempeles 21-03-00542
Debts of decedent must be reported on Schedule [,
ITEM
NUMBER DESCRIPTION AMOUNT
2.
3.
4.
FUNERALEXPENSES:
Myers-Harman Funeral Home, Inc.
James R. Gingrich Memorials
St. John's Cemetary
Funeral Reception
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Secudty Number{s)/EIN Number of Personal Representative(s)
Slreel Address
City
State
Year(s) Commission Paid:
Attomey Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State Zip
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Legal Notices
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$ 8,104.00
170.00
800.00
318.29
0.00
6,000.00
0.00
325.00
0.00
600.00
166.85
$ 16,484.14
MYERS-HARNER FUNERAL HOME, INC.
1903 MARKET STREET
P,O. BOX 291
CAMP HILL, PENNSYLVANIA 17011
LOCALLY OWNED AND
OPERATED
ROBERT H. HARNER
SUPERVISOR
TELEPHONE
717-737-9961
June 30, 2003
Mr. James G. Sempeles
3008 Market Street
Camp Hill PA 17011
Services for Constance B. SEmpeles
June 16, 2003
Charges for Services Selected
Professional services
Use of Facilities
Autanotive Equi~men t
Charges for M~rchandise Selected
Casket
Vault
Cash Advanced
N~vspaper Notice/Local
Clergy ( 2 )
Certified Copies
Flo~rs
Hair ~res ser
Pianist
Total due within thirty days, please:
$ 3,375.00
$ 3,150.00
980.00
$ 85.00
200.00
24.00
200.00
40.00
50.00
$ 3,375.00
$ 4,130.00
$ 599.00
$ 8,104.00
3ames R. Gingrich Memorials
5243 SimPson Ferry Road
Mechanicsburo, PA :t7055
(7Z7) 766-5622
Invoice
David Sempeles
1202 E. Powderhorn Road
10/1/2003
Mechanicsburg, PA 17050
125263 7/21/2003 Constance Sempeles
1 Cemetery Inscription
Ron Colvin
Order Total: $170.00
Payments: $0.00
Balance Due: $170.00
.4 finance charge of l ~ % per month (18% annuallv~ will h~ added after 30 days
' ' Page 1 of 1
DAVID A. $EMPELES 4-94 1 29
KATHLEEN R. SEMPELES
1202 F- POINDERHORN RD. /- / ~0-~3/03t3
MECHANICSBIJRG, PA 17055,-2000 DATE ~ 5~!
~ Harrisburg, PA 17101
,~UOOOO~OOOO,,,
Posting Date 2003 Jun 25
Research Seq # 2017480853
Account # 63610800001
Check/Store # 129
DB/CR DB
Dollar Amount $800.00
Bank # 001
Deposit Acct # 0
http ://p~-ncrw~b ~ .~rstmd~~~m/inquiry/s~rv~et/inquiry?C~NTEXT=print~~gging&A CT~~N... 8/21/2003
COMMONWEALTH OF PENNSYLVANIA I EBTS OFDECEDENT, I
INHERITANCETAX RETURN MORTGA E LIABILITIES & LIENS
ESTATE OF
Constance B. Sempeles FILENUMBER
21-03-00542
Include unrelmbursed medical expeneee.
ITEM
NUMBER
1,
2.
3.
4.
5.
6.
7.
8.
9.
10.
DESCRIPTION
Verizon, Account #717-737-6542957254
Pennsylvania-American Water Company, Account #24-1217259-1
Comcast, Account #09547183103-01-3
PPL Electric Utilities, Account #72890-73004
UGI Utility, Account #217561615006
Culligan
Schultz's Landscapting
Bethany Village
2003 Real Estate Taxes (Bill Date: 03/01/2003)
2003 Personal Tax (Bill Date: 03/01/2003)
~LUE ~ D~E
OF D~TH
32.31
22.39
11.94
68.45
14.27
11.77
148.40
11.00
924.84
5.50
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,250.87
Telephone Number: 717 737 6542
Account 717 737 6542 957 25 Y
How to Reach Us: See page 2
Make progress every day
, ver z.o._n
CONSTACE B SEMPELES
Account Summary
Previous Charges $32.31
Payments Received Jul 3 -32.31
Past Due Charges $,00
New Charges
Verizon (page 3) $29.24
Verizon Long Distance (page 6) 8.75
Total New Charges due Jul 29 $37.99
Total Due (Past Due + New) ~'/'. 99
Mail payments to:
Verizon, PO Box 28000, Lehigh Vly PA 18002-8000
Change of billing address?
Go to verizon.com/billingaddress or see page 2.
Welcome to the new Verizon B/Ill
This is the first in a series of changes that we are
making to improve the bill for you. You can find
more information by checking our webs/re
verizon.corn/newbill.
Manage Your Verizon Account Online/
View & pay bills, request repairs, place orders.
It's quick and easy:
Go to verizon.com
Click "Sign in" under "Manage My Account".
First time user? Get started with ...
User ID: 71773765425
Password: 159G86
... and customize your ID as you register.
Then follow the step-by-step instructions.
To enroll in the Verizon Direct Payment
Option please read and sign the agreement on
the reverse side of the payment form below.
Detach & return payment slip with your check, payable to Verizon,
.~:...- --,, .~-- ~--.~ TT -~-- -- ~ --..-- -- -- -- ~.-- ~. ~- -- ~- , -- -- .~-- , -- ....................
Cpstomer Account Information
For Service To: Constance Sempeles
3008 Market St
Account Number: 24-1217259-1
Premise Number: 24-0377095
Billing Period & Meter Information
Billing Date: Jun 17, 2003
Billing Period: May 13 to Jun 12 (30 days)
Next reading on/about: Jul 14, 2003
Rate Type: Residential
Meter readings in current billing period:
Meter Number N000014372 is a 5/8-inch meter.
Present-actual 63 8~00
Last-actual 636200
Gallons used
Billing Summary
...... Prior Balance .................
Balance from last bill
Payments prior to Jun 17, 2003. Thanks!
Total prior balance, Jun 17, 2003
....... Current Water Charges .....
Service Charge
Wafer Volume ($.005277 x 2,200)
STAS PAWC Water 0.07%
DSI - PA WC Charge 1.17%
Total water charges, Jun 17, 2003
........ AMOUNT DUE
Water Usage Comparison
Monthly usage in hundred gallons.
2 J J A $ O N D J F M A M J 2
0 u
~0 n ~ u e c ° e a e au ~
g p t v c n bra ~ y n
t~23.99
-23.99
.00
10.50
11.61
.02
.26
22.39
[ ~22.39
Messa_cles to,you from Pennsylvania American
* Any porton of this water bi}Twhich is not paid as of 7/1~r/03 will be subj~.t to a 1.50~o penalty.
* It's a well-known fact that d#nking water is crucial to your health, so drink up and enjoy the benefits of
tap water!
* At Pennsylvania Ametfcan, our customers are our top pdodty. Please let us know how we can serve you better.
* RESIDENTS: AVOID COSTLY SERVICE LINE REPAIRS...
To learn how you can protect yourself against unexpecfed and costly service line repairs, call (866) 430-0819,
and ask about the Wafer Line Protection Program. Your peace of mind is worth it.
* Sign up forAmerfcan Wafer's automaticpaymentplan. Through electronic transfer, you can take advantage
o..f t,h.i.s, co_nv, e. nient..way to pay.. your bill automatically on the day it's due. No more checks, stamps, or late bills!
~;al~ me z4-nour uusromer =ervice [;enter to request an application. You will need your Account Number when
you call. Just press 1 for the option to hear about Account and Billing Informal!on, then choose the oplion to
request an applica§on for automatic payment. Fill out the form and mail it back to us. It's that easyt
* Effective Apdl 1, 2003, the Dis~bution Sy.s. fem Improvement Charge (DSIC) has increased from'l. 12% to 1.17%.
This charge funds replacement of wafer distribution facilities.
Customer Service & Emergencies 1-800-565-7292 (24 Hours)
For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours)
Visit us on the INTERNET: www.pawc.com
AIM
30712
( omcc]st,
ACCOUNT DATE
NUMBER DUE
TOTAL
AMOUNT DUE
09547 183103-01-3 07~07~03 $11.94
How to reach us... How to reach us:
3800 Trindle Rd, Suite B
Camp Hill, PA 17011
(717)540-8900
Telephone Custo ruer Service
24 hours a day, seven days a week
Services
Taxes & Fees
Total Due
months.
_Types of
M&er Readings:
Actual /
Estimated ~
Customer l---I
Page 1
Summary Page
Balance as of Jun 12, 2003 $ 0.00
Charges:
Total-PPL ELECTRIC U~IIL1TIES Charges $ 68.45
Total Charges $ 68.45
................................. ~.,~.~..:;~..~..~....~:~:.,~.::..~ .................. ~ .,~:,: ~ ...:::./..~:~?.
Account Balance $ 68.45
or
66
55
44
Average - Jun
33 Temperature ,
22 KWH Per Day
Yearly Use:
11
Jul 2001 - Jun 2002
0 Jtll 2002 - Juu 2003
J JASONDJ FMAMJ
2002 Months 2003
KWH - Average Per Day Meter Reading Information
M eter//63114554
un 12 Actual
av 15 Actual
8 Days ~
6803
6036
2002 2003
64F 59F
39 27
Total Average
Use Mon_thly
10517 876
11324 944
Other important information on back
Schul ' dscaping
300 North 17th St. · Camp Hill, PA 17011 · (717) 761-5299
Bill To
James Sempeles
3008 Market St.
Camp Hill, PA 17011
Invoice
Date Invoice #
6/15/2003 1991
Terms Due Date Property
Net 15 6/30/2003
Serviced Description Qty Rate Amount
THANK YOU Previous Balance Paid Through 5111 0.00 0.00
LAWN CUTTING ON' 5/12, 5/22, 5/28, 6/2, 6/10 5 28.00 140.00T
THANK YOU FOR YOUR BUSINESS/ Subtotal $14o.oo
Sales Tax (6.0%) $8.4o
Total $148.40
1.5% Service Charge on Accounts Past 30 days
from Invoice Date Payments/Credits $o.oo
$5.00 Minimum Service Charge Balance Due $148.40
Z
C~
LU
Z
m
IF TAXES ARE IN ESCROW, FORWARD THIS BILL TO YOUR
MORTGAGE CO. $1.00 FEE FOR ADDITIONAL RECEIPT. TAXPAYER COPY Bill No:
PAYABLE
~Control N.o: 001 -002035 2003 Stat,
TO: Assessec[ Land ~ .~nent of R~ I Estate Taxes Bill Date:
MICHAEL iN. HARLING ~0 ~'"~'~6T~6~ "±neral -- Total
206 S. 17-rH ST. COUNTY OF CUMBERLAND 196,760
CAMP HILL, PA 17011 Rates .00204600 I .00204600 __ Discount Face
DESC: Rates .000~ 394.52 402.57
MAP NO: 01-21-0273-282 ~-~ ~- ~v~.~¢;.~ 2 % --
3008 MARKET STREET :[9.86 20.27
ACRES .310 Rates .0023.2400 I .0023.2400 2
~UNIC. R/E 42.48 375.44
LAND PT LOT 11 PB 2 PG 110 409.56 417.92
Residential Building TAX AMOUNT DUE
RESIDENTIAL ~ .~br,,3 ~%~ $823.94 $840.76
If Paid On or After ~ 5/01~
~~ If Paid On or Before 4/30/2003 6/30/2003
TAX SEMPELES, CONSTANCE B IF NOT PA~THIS ILL WILL BE RETURNED TO TAX
PAYEE 3008 MARKET STREET ~ .~.~.~ CLAIM BUREAU FOR COLLECTION AND FILING OF A LIEN AGAINST
CAMP HILL PA 17011 ~% o ~ . YOUR PROPERTY.
OE~CE OFFICE HOURS
HOUBS: WEDNESDAYS 9AM-2PM & 4PM-6PM
PHONE (717) 730-0230
Return Bill with Payment, For a Receipt, Enclose Self Addressed Stamped Envelope.
. ..-- ..'.'~
2444
3/0_.1/200~33.
10%
442.83
10 %
22.30
3.o %
459.71
$924.84
: ,::::~!: AND
:(~ TAX
BILL DATE 3/01/2003 BILL NO 4485
MICHAEL W. HARLING
206 S. 17TH ST.
CAMP HILL, PA 17011
JOB TITLE
HOMEMAKER
CTL 1 1883
SSN 186-24-7734
2003 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND
BOROUGH OF CAMP HILL
UNPAID TAXES SUBMITTED TO DELINQUENT COLL 12/12/03
VALUE
0
5.OOOOO 4.90 5.00 5.
SEMPELES, CONSTANCE B.
3008 MARKET ST.
CAMP HILL PA 17011
OFFICE HOURS
WEDNESDAY 9AM-2PM & 4PM-6PM
PHONE (717) 730-0230
2.0% 10.0%
4.90 5.00 5.50
DISCOUNT FACE PENALTY
3/01/2003 5/01/2003 AFTER
TO TO
4/30/2003 6/30/2003 6/30/2003
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Constance B. Sempeles
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-03'00542
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and Iransfers under
Sec. 9116 (a) (1.2)]
NUMBER
I
I!
James G. Sempeles
3008 Market Street
Camp Hill, PA 17011
David A. Sempeles
1202 Powderhorn Road
Mechanicsburg, PA 17050
Son
Son
$503,670.79
$306,910.79
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX iS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
None
None
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEP~RTMENT OF REVENUE
BUREAU OF iNDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002992
CHEREWKA MICHAEL ESQUIRE
624 NORTH FRONT STREET
HARRISBURG, PA 17043
........ fold
ESTATE INFORMATION: SSN: 186-24-7734
FILE NUMBER: 2103- 0542
DECEDENT NAME: SEMPELES CONSTANCE B
DATE OF PAYMENT: 09/09/2003
POSTMARK DATE: 00/00/0000
cOUNTY: CUMBERLAND
DATE OF DEATH: 06/1 1/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $34,541.82
REMARKS:
TOTAL AMOUNT PAID'
DAVID A SEMPELES C/O
MICHAEL CHEREWKA ESQUIRE
$34,541.82
SEAL
CHECK# 1010
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
TAXPAYER
Inventory of the real and personal estate of
Constance B. sempeles
deceased
Residence - 3008 Market Street, Camp Hill, PA 17011
Pennsylvania State Bank, Checking Account #10121341
accrued interest
Pennsylvania state Bank, Savings Account #260-136-15
accrued interest
Miscellaneous furniture and household goods
196,760
17,740.
3.
36,663.
11.
1,500.
79
74
00
$252,679 77
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
James George Sempeles and David Alexander Semples
being duly according fo law, deposes and says fhaf they ~r~ ~-h~ ~Y~r.~n~'~
of the Estate of Constance B. Sempeles
late of -- Camp__Hii1 .............. Cumberland County, Pa., deceased and that the
Semp~les ..
within is an inventory made by James Geor~m Rmmp~l~$_& Bmvid Almwmndmr , ?ne sala Executors
of the enfire estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde
the Commonwealth of Pennsylvania, and fhaf the figures opposlfe each item of the Inventory represent it's fair value
as of the date of decedenf's death.
and subscribed before me, ~~~
'~-~ E ecutor - Admlnisfrator
3008 Market Street, Camp Hill, PA 17011
Address
Date of Death
llth June 2003
Day Month Year
INSTRUCTIONS
I. An inventory must be filed wifhln three months after appointment of personal representative.
2. A supplement inventory must be filed wlfhin thirty days of discovery of additional assets.
3. Additional sheets may be attached as fo personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
I
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION '
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Constance B. Sempeles
Date of Death: June 11, 2003
Estate No.: 21-03-00542
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration of the above-captioned estate:
State whether administration of the estate is complete:
Yes × No
If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
If thc answer to No. 1 is yes, state the following:
A. Did thc personal representative file a final account with thc court?
Yes No .. x
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
C. Did the personal representative state an account informally to the parties in
interest? Yes x No
D. Copies of receipts, releases, joinders,and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
Date:
Signature
Michael Cherewka, Esquire
Name (Please type or print)
624 North Front Street
Address Wormleysburg, PA 17043
(MAH:rmt/AM3)
717-232-4701
Telephone No.
R.W. - 5t~
Capacity:
X
Personal Representative
Counsel for Personal Representative
First Class Mail
I!el/II sselo ~,sJ!=l
Lewis
Courthouse
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96}
CD 003311
CHEREWKA MICHAEL
624 NORTH FRONT STREET
HARRISBURG, PA 17043
........ fold
ESTATE INFORMATION: SSN: 186-24-7734
FILE NUMBER: 2103- 0542
DECEDENT NAME: SEMPELES CONSTANCE B
DATE OF PAYMENT: 12/05/2003
POSTMARK DATE: 1 2/04/2003
COUNTY: CUM BERLAN D
DATE OF DEATH: 06/11/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 9116.36
REMARKS:
TOTAL AMOUNT PAID:
RECEIVED JAMES G SEMI~rI~ES IN CO
MICHAEL CHEREWKA, ESQ.
9116.36
SEAL
INITIALS:
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF 'rNDZVZDUAL TAXES
· INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG,, PA 171Z8-0601
CONNONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RE¥-1S~7 EX AFP (01-05)
HICHAEL CHERENKA
H CHERENKA LAN OFFICES
6Zq N FRONT ST
NORHLEYSBURG PA 170q$
DATE c~ ..... ,.,~ 0Z-02-200~
ESTATE
DATE OF
F'rLE NUHBER 21 0~-05R2
COUNTY
aCN
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
RE61STER OF HZLLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 1701~
CONSTANCE
COMMONWEALTH OF PENNSYLVANIA
[;EPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128~0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003660
CHEREWKA MICHAEL
624 NORTH FRONT STREET
HARRISBURG, PA 17043
........ fold
ESTATE INFORMATION: SSN: 186-24-7734
FILE NUMBER: 2103-0542
DECEDENT NAME: SEMPELES CONSTANCE B
DATE OF PAYMENT: 03/10/2004
POSTMARK DATE: 03/09/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 06/11/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $899.97
REMARKS'
SEAL
CHECK//60-244/313
TOTAL AMOUNT PAID:
$899.97
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
James G. Sempeles
3008 Market Street
Camp Hill, PA 17011-4539
IIIIII I I IIII II II III
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DZVTSZON
DEPT. 280601
HARRISBURG.. PA 17128-0601
CONNONHEALTH OF PENNSYLVANZA
DEPARTNENT OF REVENUE
ZNHERZTANCE TAX
STATEMENT OF ACCOUNT
REV-160? EX AFP
HICHAEL CHEREHKA '04 APR 20
H CHEREHKA LAW OFFICES
624 N FRONT ST ~:;~.
WORHLEYSBURG P~t~O~$ ,
DATE 04- 05-Z004
ESTATE OF SEHPELES CONSTANCE B
])ATE OF DEATH 06-11-2005
FZLE NUHBER 11 05-0542
COUNTY CUMBERLAND
ACN 10 Z
I Amoun'lc Remi'H:ed
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF HILLS
CUNBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~:o your account, submi~ ~:he upper portion of ~:his form wi~h your ~:ax payment.
CUT ALONG THIS LTNE ~ RETATN LONER PORT'rON FOR YOUR RECORDS
REV-1607 EX AFP (01-03) .-# INHERITANCE TAX STATEHENT OF ACCOUNT
ESTATE OF SEHPELES CONSTANCE B F'rLE NO. ;'1 05-0542 ACN 101 DATE 04-05-1004
THIS STATEHENT TS PROV/DED TO ADV'rSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHO#N BELON
TS A SUNHARY OF THE PRINCIPAL TAX DUE., APPL/CAT/ON OF ALL PAYHENTS, THE CURRENT BALANCE., AND., ZF APPLTCABLE.,
A PROJECTED INTEREST FTGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 02-02-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
$7,$76.14
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AHOUNT PAID
1,817.99
09-09-Z00)
12-04-2005
05-09-2004
CDOO2992
CD005311
CD003660
.00
.00
34,541.82
116.36
899.97
TOTAL TAX CREDIT
ZF PA/D AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN $1,
NO PAYNENT IS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.
37,376.14
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
PAYMENT:
Detach the top portion of this Notice and submit with your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COMNON#EALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at
the Office of the Register of Wills, any of the Z3 Revenue District Offices or from the Department's Z4-hour
answering service for forms ordering: l-BOO-36Z-ZOSO; services for taxpayers with special hearing and / or
speaking needs: 1-800-447-50Z0 (TT only).
REPLY TO:
guastions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of lndividua! Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171ZB-06Ol, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid within three ($) calendar months after the dacedent's death, a five percent (SX) discount
of the tax paid is alZowad.
PENALTY:
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period.
INTEREST:
Interest is charged beginning with first day of delinquency, er nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes ahich became delinquent before January l, 19BZ bear interest at the rate of
six (6X) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after
January l, 19BI 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
Year Rate Factor Year Rate Factor Year
198Z ZOZ .0005¢8 1988-1991 11Z .000301 ZOO1
1983 162 .000438 1992 9~ .O00Zq7 ZOOZ
19&4 llX .000~01 1993-1994 7X .000192 2003
1985 152 .000356 1995-1998 92 .000247 2004
1986 102 .00027q 1999 72 .00019Z
1987 9~ .O00Zq7 ZOO0 82 .000Z19
Interest Daily
Rate Factor
92 .000247
62 .O0016q
52 .000137
42 .000110
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER 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.
E~UREAU OF INDIVIDUAL TAXES
TNHER'rTANCE TAX DZVTS]*ON
DEPT. ~'80601
HARRI'SBURG, PA 171~'8-0601
NICHAEL CHEREWKA
N CHEREWKA LAW OFFICES
6Z4 N FRONT ST
WORHLEYSBURG PA 170'q$
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISENENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE 02-02-2004
ESTATE OF SEHPELES
DATE OF DEATH 06-11-2005
FILE NUHBER 21 05-0542
COUNTY CUHBERLAND
ACN 101
I Aeoun~ Ree/~ed
CONSTANCE
HAKE CHECK PAYABLE AND REHZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LXNE ~ RETAXN LOWER PORTXON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTZCE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
ESTATE OF SEMPELES
DISALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX
CONSTANCE B FILE NO. 21 05-0542 ACN 101
DATE 02-02-2004
TAX RETURN NAS: ( ) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
(X) CHANGED
SEE ATTACHED NOTICE
APPRATSED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A)
2. S*ocks and Bonds (Schedule B)
3. Closely Held S~ock/Par~nership In~eres~ (Schedule C)
~. Nora:gages/No,es Receivable (Schedule D)
$. Cash/Bank Deposi*s/Hisc. Personal Proper~y (Schedule E)
6. Joln~ly Owned Proper~y (Schedule F)
7. Transfers (Schedule G)
8. To,al Asse~s
APPROVED DEDUCTTONS AND EXEHPTTONS:
9. Funeral Expenses/Ada. Cos~s/Nisc. Expenses (Schedule H)
10. Debts/Hot,gage Liabill)cles/L/ens (Schedule T)
11. To*l:al Deduc'l:/ons
12. Nat Value of Tax Ra~urn
13.
NOTE:
ASSESSNENT OF TAX:
1.6. Aeoun~ of L/ne lq a~ Spousal ra~e
16. Amoun~ of L/ne lq ~axable a~ Lineal/Class A ra~e
17. Amoun~ of Line 1~ a~ S/bl/ng ra~e
18. A,oun~ of L/ne lq ~axable at Collateral/Class B ra~a
19. Principal Tax Due
rAX CREDITS:
PAYHENT / ReC~'TPT
DATE NUNBER
09-09-2005 CD002992
12-04-2005 CD003511
PAYHENT HUST BE HADE BY
(1) 196z760.00
(2) 595z636.82
(3). .00
(4) .00
(5) 55~919.77
(6) .00
(7) .00
(8)
(9) 16,484.14
(10) 1 ,Z50.87
(11) .
NOTE: To insure proper
credi~ ~o your account,
submi~ ~he upper portion
of ~hls form wi~h your
~ex payeen~.
848,$16.99
17.735.01
830,580.98
ANOUNT PAID
34,541.82
116.36
(15)_ .00 X O0 = .00
(16) 830,580.98 X 045 = $7,376.14
(17) . O0 x 12 = .00
(18) .00 X 15 = .00
(19)= 37,$76.14
1,817.99
.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
$6,476.17
899.97
.00
899.97
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU HAY DE DUE.~'~:~
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.) /~ ) ~
ZF PAID AFTER DATE ZNDZCATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
DISCOUNT
INTEREST/PEN PAZD (-}
(12)
Char/~able/Oovernmen~al BequesXs; Non-elected 9115 Trusts (Schedule J) (13) . O0
Ne( Va/ua of Es~a~e Subjec~ ~o Tax (lq) 8)0,580.98
zf an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 w111
reflect figures that include the total of ALL returns assessed to date.
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December Il, 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coaaonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lamful Class B (collateral) rate on any such futura interest.
To ~ulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the tap portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #ILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z4-hour
answering service for fores ordering: 1-800-36Z-ZO50; services for taxpayers aith special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
Any party in interest not satisfied eith the appraisement, a11oeance, or disalloeance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object eithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, 8oard of Appeals, Dept. Z810Z1, Harrisburg, PA 17IlS-lOll, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Pest Assessment Raviee 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.
If any tax due is paid aithin three (5) calendar months after the dacedant's death, a five percent (52) discount of
the tax paid is allowed.
The ISZ 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-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aith first day of delinquency, or nine (9) months and one (l) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 mill bear interest at a rate which will vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOS ara:
Interest Daily Interest Deily Interest Daily
Year Rate Factor Yea._~ Rate Factor Yeast Rate Factor
198Z 207. .000548 1987 97. .000Z47 1999 77. .000192
1983 162 .000458 1988-1991 llZ .000301 ZOO0 82 .000219
1984 112 . O00SO1 1992 92 .000247 2001 92 . O00Z47
1985 15Z .000556 1993-1994 72 .000192 2002 62 .000164
1986 IOZ .000274 1995-1998 92 .000247 2005 52 .000157
--Interest is calculated as folloes:
INTEREST = BALANCE OF TAX UNPAID X NUtIBER OF DAYS DELINI~UENT X DAllY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 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.
REV-1470 EX (6-88)
INHERITANCE TAX
COMMONWEALTH OF PENNSYLVANIA EXPLANATION
DEPARTMENT OF REVENUE
suRE^u OF ~ND~WOU^L TAXES OF CHANGES
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDEN3"S NAME
Constance B Sempeles FILE NUMBER
REVIEWED BY 2103-0542
Sandra J Eslinger ACE
101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW
Page 1
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 5/03/2005
CHEREWKA MICHAEL
624 NORTH FRONT STREET
HARRISBURG, PA 17043
RE: Estate of SEMPELES CONSTANCE B
File Number: 2003-00542
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, NO.
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 is due by:
6/11/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
I/J r /
~~l/rAJ~
GLENDA FARNER STRAS~GH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
uR
STATUS REPORT UNDER RULE 6.12
Name of Decedent: CONSTANCE B. SEMPELES
Date of Death: June 11, 2003
Will No.: 2003-00542
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether the administration (lfthe estate is complete:
~Yes
No
2. If the answer is "No", state when the personal representative reasonably believes that
the administration will be complete:
If the Answer is "Yes" to No.1, state the following:
a. Did the personal representative file a final account with the Court?
Yes -L.. No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest?
~Yes
No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
! I
(
Date: ... May 16, 2005
THE LA W OFFICES OF MICHAEL CHEREWKA
By: J1tdu1~i ~
Michael Cherewka, Esquire
Capacity:
_ Personal Representative
--.2L. Counsel for Personal
Representati ve
~