HomeMy WebLinkAbout02-0257PETITION FOR PROBATE and GRANT OF LETTERS
Estate of John F. Moeslein No.
also known as To:
Register of Wills for the
Deceased. County of C'umberl~
Social Security No. I TI-42-043~ 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 rix
in the last will of the above decedent, dated A _ug'tmt 20
and codicil(s) dated none
in the
named
,19 91
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumber].and County, Pennsylvania, With
hi.a___ last family or principal residence at 22 N. Front: St:., Apt:. 2,
Wormle_vsburg, PA 17043 t-~"/,~_ r'- IOft0A/3~O,e..i.Y
flisC Street, number, Twp. or Boro.)
Decedent. then 46 ),ears of age, died March 1 ., t~ 2002 ,
at 22 N. Front St;., Apt. 2, Wormleysburq, PA 17043
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: no exceptions
Decedent 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 request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
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 a~ truly administer the estate according to law.
Sworn to or affirmed and subscribed ~* ~' '
before me this 1 ?th day of
._ _ MAR.C,H r ~ . Xl~i~_ 2_'00~._
r M/~R Y C L E W I S Register {I
No. 21 - o? - 0?57
Estate of JOHN F. MOF. SLEIN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW MARCH 13 :~ 2002, 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 Auqust 20, 1991e
described therein be admitted to probate and filed of record as the last will of John F. Moeslein
and Letters T~_st'am~nt'ar'y
are hereby grante~d to Susan E. Mo~sloin
FEES
Probate, Letters, Etc .......... $ 9. 5.00
Short Certificates(5) .......... $ 18.00
Renunciation ................ $
X-Pages $ 18.00
,]CP ~. O0
TOTAL __ $
~) '3 · UU
Filed MARCH 13, ?002
t ,/I Register of ~rills
MARY C LEWIS
Dennis J. Shatto, Esquire
PA Attorney ID [25675
ATTORNEY (Sup. Ct. I.D. No.)
119 Locust St., P.O. Box 11847
Harrisburg, PA 17108-1847
ADDRESS
717 ) 238-1731
PHONE
-0
Mailed letters to Executrix on 3-13-~09.
h is is to certify that the information here given is correctly copied from an original certificate of death du, ly filed with me as
l.ocal Kegistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 8 0 ~ G 7 9 3 ~~~ ~fzzz~.~j oz~__
No. '~ Date
Local Registrar
TYPE~PRINT
PERMANENT
BLACKINK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
Moeslein 2. Male ,. l~ - ~- .. March 1, 2002
46 v,.. t (~ ,.. [] n.,~ .... s~.,,~ E]
John F
Cumberland Wormleysburg 22 North Front Street .o~
J.. 8:50 p. ~ J,,. March 1, 2002 ~,,ffi
;','.~i',;;',:~,~;~ . Pendin~ Investigation _
~,~.~,~.,~,~.,~,.~..,~.,~.~.).~.,...~,,.~ .......................... ~ ~,~. ~,~. March 5, 2002
I
'MEOICALEXAMINE~ER' Michael L. Norris, Coroner
~n~m~"v~'~n~y~n~de~h~c"~red~he~N~da~d~a~e~d"~h~H~d ~ 6375 Basehore Road, Suite
LAST WILL AND TESTAMENT
OF
JOHN F. MOESLEIN
I, JOHN F. MOESLEIN, of the Borough of Camp Hill, County of
Cumberland, Commonwealth of Pennsylvania, make this Last Will
and Testament, hereby revoking all of my former wills and
codicils.
ITEM I - I devise and bequeath all of my estate, real and
personal, together with all insurance thereon, to my wife, SUSAN
E. MOESLEIN, if she survives me by sixty (60) days.
ITEM II - If my said wife does not survive me by sixty (60)
days, I devise and bequeath my estate as follows:
A. I bequeath all of my tangible personal property
(excluding cash, bank accounts and securities), in equal
shares to my brother, FRED E. MOESLEIN, JR., my brother,
RICHARD MOESLEIN, my sister, ELLEN PANROCK, and my sister,
MARGARET HARDER. If any of my brothers or sisters fail to
survive me, the share of such deceased brother or sister
shall be distributed to such of said brother's or sister's
issue who survive me.
B. I devise and bequeath all of the rest and remainder
of my estate, real and personal, together with all
insurance thereon, to my stepchild, TARAN R. BRANDT. If my
stepchild, Taran R. Brandt, predeceases me, then I devise
and bequeath all the rest and remainder of my estate, real
and personal, together with all insurance thereon, in equal
shares to my brother, FRED E. MOESLEIN, JR., my brother,
RICHARD MOESLEIN, my sister, ELLEN PANROCK, and my sister,
MARGARET HARDER. If any of my brothers or sisters fail to
survive me, the share of such deceased brother or sister
shall be distributed to such of said brother's or sister's
issue who survive me.
ITEM III - If any beneficiary of my estate is under the age
of twenty-six (26) years at the time at which distribution of
any property devised and bequeathed by this Will would otherwise
be made to such beneficiary, my personal representative shall
distribute the share of such beneficiary to the Trustee herein
named, to be held in separate trust for such beneficiary. The
Trustee shall hold, manage, invest and reinvest any property
received by the Trustee, whether under this Will or otherwise,
and shall collect the income thereof, and shall apply so much of
the net income and, if the net income is insufficient, so much
of the principal of the property held for such beneficiary as
the Trustee shall deem necessary or advisable for such benefici-
ary's health, maintenance, support and complete education, both
undergraduate and graduate. When such beneficiary attains the
age of twenty-six (26) years, the Trustee shall distribute to
such beneficiary all remaining property held by the Trustee for
such beneficiary. If such beneficiary dies before attaining
twenty-six (26) years of age, the Trustee shall distribute all
property held by the Trustee for such beneficiary in equal
- 2 -
shares to my brother, FRED E. MOESLEIN, JR., my brother, RICHARD
MOESLEIN, my sister, ELLEN PANROCK, and my sister, MARGARET
HARDER. If any of my brothers or sisters fail to survive me,
the share of such deceased brother or sister shall be distri-
buted to such of said brother's or sister's issue who survive
me.
ITEM I¥ - All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obliga-
tion of the beneficiaries and any of them, and shall not be
subject to any execution, attachment, levy or sequestration or
other claim of creditors of said beneficiaries or any of them.
ITEM ¥ - No fiduciary under this Will shall be required to
give bond or other security for the faithful performance of the
fiduciary's duties. Any such fiduciary shall have the following
powers, in addition to those given by law:
A. To invest in, accept and retain any real or
personal property, including stock of a corporate fiduciary
or its holding
investments;
B. To sell,
company, without restriction to legal
exchange, partition or lease for any
period of time any real or personal property and to give
options therefor for cash or credit, with or without
security;
C. To borrow money from any person, including any
fiduciary acting hereunder, and to mortgage or pledge any
real or personal property;
- 3 -
D. To hold shares of stock or other securities in
nominee registration form, including that of a clearing
corporation or depository, or in book entry form or unreg-
istered or in such other form as will pass by delivery;
E. To engage in litigation and compromise, arbitrate
or abandon claims;
F. To make distribution in cash, or in kind at current
values, or partly in each, allocating specific assets to
particular distributees on a non-pro rata basis, and for
such purposes to make reasonable determinations of current
values; and
G. To make elections, decisions, concessions and
settlements in connection with all income, estate, inheri-
tance, gift or other tax returns and the payment of such
taxes, without obligation to adjust the distributive share
of income and principal of any person affected thereby.
ITEM ¥I - I appoint my wife, SUSAN E. MOESLEIN, Executrix
of this Will. If my said wife is unwilling or unable to act or
continue as Executrix, for any reason whatsoever and whether
before or after my
successor Executor.
ITEM ¥II - I
death, I appoint DENNIS J. SHATTO as
appoint DAUPHIN DEPOSIT BANK AND TRUST
COMPANY, Harrisburg, Pennsylvania, Trustee under this Will.
ITEM ¥III - All estate taxes, inheritance taxes, transfer
taxes and other taxes of a similar nature payable by reason of
- 4 -
my death to any property subject to such tax, and any penalties
thereon, shall be paid by the personal representative out of my
residuary estate, and all interest with respect to any such
taxes shall be paid by the personal representative out of the
income or principal or partly out of the income and partly out
of the principal of such portion of my estate, in the absolute
discretion of the personal representative, without reimbursement
from or apportionment among the beneficiaries, recipients or
owners of such property for any such taxes, penalties or
interest; provided, however, that the personal representative
shall not pay any such taxes, penalties or interest attributable
to any property included in my estate solely because a power of
appointment thereover which I possess, and such property shall
bear its proportionate share of such taxes, penalties and
interest.
ITEM IX - It is my desire that my body be cremated, and
that my ashes be spread over my family's burial plots. I direct
that my personal representative make all necessary and appropri-
ate arrangements for my cremation and disposal of my ashes
pursuant to my desire as expressed herein.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last Will and Testament this ~D day of ~U6~~-- ,
1991.
F. MOESLEIN
(SEAL)
- 5 -
The preceding instrument, consisting of five typewritten
pages, each identified by the signature of the Testator, was on
the date hereof signed, published and declared by the said
Testator, JOHN F. MOESLEIN, to be his Last Will and Testament,
and, at his request, in his presence and in the presence of each
other, we, believing him to be of sound mind, memory and
understanding, have hereunto subscribed our names as witnesses.
of
- 6 -
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF DAUPHIN :
SS:
and
We, JOHN F. MOESLEIN, Testator, ~E/~//~ ~. S~7~
J~ ~. ~0~'C~ , witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testator signed and executed the instrument as his Last
Will and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the Will as
witnesses and that to the best of their knowledge, the Testator
was at that time eighteen (18) years of age or older, of sound
mind and under no constraint or undue influence.
J~ F./~OESLEIN - Testator
Subscribed, sworn to an~.~nowledged before me by JOHN F.
MOESLEIN, the Testator, and subscribed and sworn to before me by
witnesses, this 20 ~ day of /~6~ ~ , 1991.
NOTARIAL SEAL
SHARON K SHAFFER, NOTARY PUBLIC
HARRISBURG, DAUPHIN COUNTY
MY CC%.I~,{I$SIO~',' F_.XF IRES AUG. 17, 1992
Name of Decedent:
Date of Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. ~ 00 '~."- i00 ~ 5 7 Admin. No.
To the Register:
I certify that notice of (bcr. zff:~_-2 L"_!e.'-~'.) estate administration required by Rule 5.6(a) of. t~e Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on /V/? 7 91 2-00 2 :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a)except ,/~/0 ~l./~.~.[ coal 5
Date:
Address
Telephone (7/7
Z3f-/'75/
Capacity: __
Personal Representative
Counsel for personal representative
Name of Decedent:
Date of Death:
Will No.:
STATUS REPORT UNDER RULE 6.12
Admin. No.:
'Pursuant to Rule 6.12 of the Supreme Court Orph~n~' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
State whether ~mlnistration of the estate is complete:
Yes FI No [~
2. If the answer is No, state when the personal representative reasonably believes
that the admlni~trafio~ will be complete:
3. If the answer to No. 1 is Yes, state the following:
Did the personal representative file a final account with the Court?
Yes_ No ~
b. The separate Orph~m.~' Court No. (if any) for the i~ersonal representative's
account is: __
c. Did the personal representative state an account informally to the parties
in interest? Yes [~ No' [-']
Date:
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the. Orpba,~.~' Court
and may be attached to this
Signature /
lq, amc
Address'
Z 0: f~ 0[ ~/~1 ~ Telephone No.
Capacity: ~-~Personal Representative
~ ~ Counsel for persona/representative
JRD/JundO, 1992/17858
Date: February 03, 2005
ORPHANS' COURT DIVISION
Dennis Shatto, Esquire
119 Locust Street
P.O. Box 11847
Harrisburg, PA 17108
COURT OF COMMON PLEAS OF
RE: Estate of John F. Moeslein
File Number: 21-02-0257
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. I, 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: 03/01/2005
Your prompt attention to this matter will be appreciated.
Thank you.
Sincerely,
~~~~
GLENDA FARNE;;;~dA~GH
REGISTER OF WILLS
cc: File
Judge
vA
.
Register of Wills of Cumberland County
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
JoHN f 110E5LE/lJ
}II/o~
ADD']...... 7-51
Date of Death:
Estate No.:
Pursuant to Rule 6,12 ofthe Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
I. State whether administration of the estate is complete:
. Yes 0 No 181
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete: 1ft,.. S/JCtq( ~/"~ c/",m hits bl!e~ ~~
.(7.-- "'11,,(k,.. ht~/"itf' ,;: ~xFt fIt<- f/'1CtsS /D b! CD"'fkGIIJ;ff,..... Z 1{1f/'S'
3. If the answer to No. I is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
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 0 No 0
Date:
J7/0,?
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. ~
S' L
19nature
Pf'}/NIS J. 5tfAlIO
Name J1'1l-iJCv'$t Sr:
/1-I1IU./5!3I/1:?(r PA 17/rJ/
Address
,
('I")
(
717....'J-3g -/73/
Telephone No.
Capacity:
o Personal Representative
5a Counsel for personal representative
;
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/02/2006
SHATTO DENNIS J ESQ
119 LOCUST STREET
PO BOX 11847
HARRISBURG, PA 17108-1847
RE: Estate of MOESLEIN JOHN F
File Number: 2002-00257
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:
3/01/2006
Your prompt attention to this matter will be appreciated.
Thank You.
SincerelYI
ff...
~~t~0~
" //
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
~
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Jr""~\~~..!1.::slttt;;ll..~ lUl.!i.. W~ lLlULai OJ!. ~1Ui.!LldllLj)c;lr.llQi.ll..ll.U vVUJil1.lL.y
STATUS REPORT Ul'\Jl)ER RULE 6.12
Name of Decedent:
Jo}fA! F
;rjareA
'2 () (Xl ~ frD ').. 5" 7
;f1 ~FS U/lv
Date of Death:
I. ~ tJ tJ cJ...
.
Estate No.:
.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration efthe estate is complete:
Yes 0 No ~ .
2. If the answer is No, state when the personal reJ?resentative reasonably believes that
the administration will be complete: L! "'r? I .30. ]A:dJ't,
~I/
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 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state ~J. account informally to the parties in
interest? Yes 0 No 0
Date: Jj t ~ (,
. .
c. Copies of receipts, releases, joinders and approval of formal or iL-uonnal
accounts may be filed with the Clerk O.f th. le ,/lhans' Court and may be
attached to this report L."U14~
Signature
~"
..
t,',.;
])EA/JJ/:5 J. 5HATTlJ
Name / _
/ /q /...--OCVsr sT.
I-fAJU<. 1->13 tit<(; rA /1/()/
Gj
Address
C)
1
-; /7- ~3S-17 3/
T'elephQ11e No.
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va..}JCl.vHj.
.LJ ?e:LsQ~a.l P___epresenI3.."'Ci",;re
I':Joor,.,"-~"'l .(:~- "e-~~-.~l ""'--e~"'-t~~vo
~ ,-,--Y!.-L:...:.;),,-,,_ .!..Ul F 1.. ;::'Ulla._ 1 '-'}ll .,......2..1 a.l..!.. ,.........
~-~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
i
SHATTO DENNIS JAMES ESQUIRE
CLECKNER & FEAREN
119 LOCUST STREET
HARRISBURG, PA 17108-1847
RE: Estate of MOESLEIN JOHN F
File Number: 2002-00257
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 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:
3/01/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
/ ..
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
('~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 2/20/2007
MOESLEIN SUSAN E
1918-B LOGAN STREET
CAMP HILL, PA 17011
RE: Estate of MOESLEIN JOHN F
File Number: 2002-00257
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
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:
3/01/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
OEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
l1oE3~l-e'N JOHN F
DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM-DD.YEAR)
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o 4. Limited Estate
~ 6. Decedent Died Testate (Allach copy of Will)
~ 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
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FIRM NAME (IlAppllcable) C U CK..NfiR E t<6 N
TELEPHONE NUMBER 1/1- ).3 g - (731
COMPLETE MAILING ADDRESS
/lq L.oCl/$t Sr:
p. (/. /}JOX /lf~7
H/r~~/SetlI!G, ~A- /71 0/'-/ 3~7
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. C~h, Bank Deposits & Miscellaneous Personal Property
(Scredule E)
6. Jointly Owned Property (Schedule F)
o -Separate Billing Requested
7. Intar-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & 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 8 minus Line 11)
(9)
(10)
tfJ bft,.4-tf,
I t:; g . ..1t)
(6)
(7)
()
. .
13. Charitable and Governmental BequestS/See 9113 Trusts for which an election to tax has not.been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal lax
rate, or transfers under Sec. 9116 (a)(1.2)
q-:J.I.4e';> x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19)
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
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
dlY)
20.0
;'~.ii,~~);t'S'\1~~l;;/~~.~,~~~'~'>' BE;SO~ETO.ANSWE~ AL~:tl\J.E;Srt.O _~.;: ".~'
OFFICIAL USE ONLY
FILE NUMBER
2L-12.~
COUNTY"CQOE YEAR
00257
- NuMBER - -
SOCIAL SECURITY NUMBER
1'17 - 4'). -~# 38
THIS RETURN MUST BE FIl.ED IN DUPLICATE WITH THE
REGISTER OF WILLS
S CIAL SECURITY NUMBER
o 3. Remainder Return (date of dealt1 prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Allacl1Sch0)
USE ONLY
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(11)
(121
(13)
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Decedent's Complete Address:
STREET ADDRESS P. :2 II ' r~ 011.,.- oS '77
CITY
() /1..M LC'(~ e II~ G
Tax. Payments,and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
Total Credits ( A + 8 + C ) (2)
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
4.
o TotallnterestJPenalty ( 0 + 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
(3)
(4)
(5)
(5A)
5.
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. d.ue.
. , - + .
B. Enter the total of Line 5 + 5A.lhi~ is t6e' BALANCe DUE.' (58)
~. 'e: .' . '.
M~ke)Check Pa'yable to: REGISTER OF WILLs, 'AGENT
'l. . . .
'.'
ZIP /7 oL/- 3
";.r--. ~ oJ ".:7~ ':oIJ ;"'t'\~r.s..~:.,~, ./~(:: .;:. n..;~:,<:~":..~ .:;.;.tl?..;-:{r;::~~'~",~~';!,,~J"!i." ~::: ~'.I~:~~~ ':'-:'",\.;':~J:~:'-~"~}f":.,~.2i~""~.~7':;~'l\!""(;;~ '":"t-:~~.~w..~!.:. ::."~.1'~~ ~:,,;~....~~~,~ .....:~~-~;r. ~,~~,,,~"..~: Y';:"1"~.~ ~~
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.................................................o........................................ 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......:........,........:.........:...,.................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12. 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
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? ........................................................................................................................ ~
No
~
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~
8l'
~
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IF THE ANSWER TOANY OF THE ABOVE QUESTJO~S IS Y~S, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalUes of peDury. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all in(onnation o(Whjch preparer has any knowledge.
RL~RE5N .
ADD
(,"35 Mq.(/~;[ 1>,. I E" tt~"'4) , PA
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE .
173/t:(
ADDRESS
DATE
:;'E:~:.;;~'{;;.~..:~~!:::::J~zr~;!;"::1~~;Z.:.Ti~iifg~J.:?t~~~.~..iDa%~~c.~~~~~'!'t,?;~;l'l~~.~~<'F,.a
For dates of death on or after July 1, 1994 and before January 1, 1995, 'the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 la) (1.1) (i)].
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot 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
the surviving spouse is the only beneficiary.
For dates of death on or after July 1. 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. ~9116(1.2) [72 PoS. ~9116(a)(1)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102. as an
individual who has at least one parent in common with the decedent. whether by blood or adoption.
~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
M()~S IA51N
I)() fftJ F
FILE NUMBER
'). J -tJ ')..- ()O ~.l? 7
Include the proceeds of litigation and the date the proceeds were received by lhe eslale. All property jointly-owned with the right of survivorship must be disclosed on Schedule
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
CF DE-\TH
ALLARSr f)Af'lk - Cl-/eCK'/1I6 ACC()//Ni
7tJ~./()
2..
CoL/...G'Crll),.j Or k,J,.I&S
/ 8" (). tr()
~.
50CIA-L 5t=Cvt.ITY PI$/t8/l,lrY 13 Ei"N'[i"FI TS
9~2.fo. GO
TOTAL (Also enter on line 5, Recapitulatico) I S 10 J It t, . t. 0
(If more space is n~ed. insert additicnal sheets ci the same size)
'.' ~""~'."~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MOe~W/N
JOliN
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
F
FILE NUMBER
~/- ()").... Of)~? 1
This schedule must be ccmpleted and fried if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE OA TE OF TRANSFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH ACDFY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPliCABLE)
NUMBER
1. 5r,A Ie t:MfJt.OY6ES' ~~TI1.61H fiJ#r 7 ~, ()3~.l'f /~() A t..L -o-
S Y~"-eM - 1)€ATH I!>6NfirlT TO
~ (JolI'Se AS !lAMeD e~"'1iFiC(Atl'1'
TOTAL (Also enter on line 7, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
',' REV-"1~ll EX+ (12-99) .
. ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
/vI() 6'5 Le /I.)
JDHN
F
FILE NUMBER
?/ -~'J..-() d).'51
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
IVG"Il..t. FIJ;V'€.RAL If;UE, INC.
GIN GJ1./ &1-/ ;f4/EltDI<IAi..S
"1.07itf. qS
J
7t 5. 4~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2.
I
Attorney Fees C /.ECK#Gfl... f F&,A./l..eN
/ ~"I) . d()
I
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees
5 7!' () ()
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
LI1"IG"A1"fOtJ E;<fE~1~-S - SoCIA/... seCVlll1Y ])/SA8JI..J7"(
CtA 1M
/ gt/. ~f)
TOTAL (Also enter on line 9, Recapitulation) $ CJ J fJ r' .4!J
(If more space is needed, insert additional sheets of the same size)
REV.IIll ~X' (1.911 f))
. ~, ~.~
' . . v-~.>..~.
" · ~n~.
? \ ~ ,-D
~~-~~
COMMONWEALTH OF PENNSYLIJAWA
ItlHERITANCE TAX RETURN
RESIDENT DECEDE'lT
ESTATE OF
/l1 OI?S L5/N
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
JOIIIJ F
FILE NUMBER
2/-/)'J..-tJt);2.57
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
A.MOUNT
1.
Cl-6c~AI~(l.. fF6AeeN
/ JSFl. 70
TOTAL (A.lso enter on line 10, Recapitulation) sIt;> g. 70
(If more space is neeced. insert additional snee!s cf the same size)
. ,
. .' REV'1~13 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MO~Sf,eIN
JoliN P
FILE NUMBER
~ /-() ')..- O();J..~ 7
NUMBER
I
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LlstTrustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
5v-:>/rAJ E. ,MOE'SL6/N -SP()tI~e
AMOUNT OR SHARE
OF ESTATE
1.
/()tJ 'fiJ
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
.
. .
LAST WILL AND TESTAMENT
OF
JOHN F. MOESLEIN
I, JOHN F. MOESLEIN, of the Borough of Camp Hill, County of
Cumberland, Commonwealth of Pennsylvania, make this Last Will
and Testament, hereby revoking all of my former wills and
codicils.
ITEM I - I devise and bequeath ull of my estate, real and
personal, together with all insurance thereon, to my wife, SUSAN
E. MOESLEIN, if she survives me by sixty (60) days.
ITEM II - If my said wife does not survive me by sixty (60)
days, I devise and bequeath my estate as follows:
A. I bequeath all of my tangible personal
(excl ud i ng cash, ba nk accoun ts and secur i ties) ,
shares to my brother, FRED E. 110ESLEIN, JR., my brother,
property
in equal
RICHARD MOESLEIN, my sister, ELLEN PANROCK, and my sister,
MARGARET HARDER. If any of my IJrothers or sisters fail to
survi ve me, the share of such deceased brother or sister
shall be distributed to such of said brother's or sister's
issue who survive me.
B. I devise and bequeath all of the rest and remainder
of my estate, real and personal, together wi th all
insurance thereon, to my stepchild, TARAN R. BRANDT. If my
stepchi Id, Taran R. Brand t, predeceases me, then I dev i se
and bequeath all the rest and remainder of my estate, real
and personal, together with all insurance thereon, in equal
j~
o
:E:
shares to my brother I FRE:D E. f'10ESLEIN, JR., my brother,
RICHARD MOESLEIN, my sister, ELLEN PANROCK, and my sister,
MARGARET HARDER.
If any of my brothers or sisters fail to
surv i ve me, the share of such deceased brother or sister
shall be distributed to such of said brother's or sister's
issue who survive me.
ITEM III - If any beneficiary of my estate is under the age
of twenty-six (26) years at the time at which distribution of
any property devised and bequeathed by this Will would otherwise
be made to such bene f i c ia ry I my personal represen ta t i ve shall
di s t r i bute the share of such benef i c i ary to the 'rrustee herei n
named, to be held in separate trust for such beneficiary. The
Trus tee shall hold I manage, i nves t and re i nves t any property
rece i ved by the Trus tee, \vhe ther under th is W ill or otherwise,
and shall collect the income thereof, and shall apply so much of
the net income and, if the net income is insufficient, so much
of the principal of the proper-ty held for such beneficiary as
the Trustee shall deem necessary or- advisable for such benefici-
ary I S heal th, maintenance, support and complete educat ion, both
undergradua te and graduate.
When such beneficiary attains the
age of twenty-six (26) years, the Trustee shall distribute to
such beneficiary all r-emaining property held by the Trustee for
such beneficiary.
I f such bene f ic iary dies before attain ing
twenty-six (26) years of age, the Trustee shall distribute all
property held by the Trustee for such beneficiary in equal
- 2 -
shares to my brother, FRED E. MOESLEIN, JR. I my brother, RICHARD
MOESLEIN, my sister, ELLEN PANROCK, and my sister, MARGARET
HARDER. If any of my bt:"others or sisters fail to survive me,
the share of such deceased brother or sister shall be distri-
buted to such of said brother's or sister f s issue who survi ve
me.
ITEM IV - All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obliga-
t i on of the benef i c i ar ies and any of them, and shall not be
subject to any execution, attachment, levy or sequestration or
other claim of creditors of said beneficiaries or any of them.
ITEM V - No fiduciary under this Will shall be required to
give bond or other security for the faithful performance of the
fiduciary's duties. Any such fiduciary shall have the following
powers, in addition to those given by law:
A. To invest in, accept and retain any real or
personal property, including stock of a corporate fiduciary
or its holding company, without restriction to legal
investments~
B.
To
sell,
exchange,
or
partition or lease
personal property and
or credit, with or
for any
to give
without
of time any real
therefor for
period
options
security;
C. To
cash
money
from
any person, including any
to mortgage or pledge any
borrow
fiduciary acting hereunder I
real or personal property;
and
- 3 -
i~
~~
D. To hold shares of stock or other securi ties in
nominee registration form, including that of a clearing
corporation or depository, or in book entry form or un reg-
istered or in such other form as will pass by delivery;
E. To engage in litigation and compromise, arbitrate
or abandon claims;
F. To make distribution in cash, or in kind at current
values, or partly in each, allocating specific assets to
particular distributees on a non-pro rata basis, and for
such purposes to make reasonable determinations of current
values; and
G.
To
make
elections,
concessions
and
decisions,
settlements in connection \.;ith all income, estate, inheri-
tance, gift or other tax returns and the payment of such
taxes, without obligation to adjust the distributive share
of income and principal of any person affected thereby.
ITEM VI
I appoint my wife, SUSAN E. MOESLEIN, Executrix
of this Will.
If my said wife is unwilling or unable to act or
continue as Executrix, for any reason whatsoever and whether
before or after my death,
I appoint DENNIS J. SHATTO as
successor Executor.
ITEM VII
I appoint DAUPHIN DEPOSIT BANK AND TRUST
COMPANY, Harrisburg, Pennsylvania, Trustee under this Will.
ITEM VIII
All estate taxes, inheri tance taxes, transfer
taxes and other taxes of a similar nature payable by reason of
- 4 -
I .
my death to any property subject to such tax, and any penalties
thereon, shall be paid by the personal representative out of my
residuary estate, and all interest wi th respect to any such
taxes shall be paid by the personal representati ve out of the
income or principal or partly out of the income and partly out
of the principal of such portion of my estate, in the absolute
discretion of the personal representative, without reimbursement
from or apportionment among the beneficiaries, recipients or
owners of such property for any such
taxes, penalties or
interest; provided, however, that the personal representative
shall not pay any such taxes, penalties or interest attributable
to any property included in my estate solely because a power of
appointment thereover vlhich I possess, and such property shall
bear its proportionate share of such
taxes, penalties and
interest.
ITEM IX - It is my des i re that my body be crema ted, and
that my ashes be spread over my family's burial plots.
I direct
that my personal representative make all necessary and appropri-
ate arrangements for my cremation and disposal of my ashes
pursuant to my desire as expressed herein.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last Will and Testament this
;;;1.0
day of IlLt~ue; -(-.
1991.
n.t2. ~ ?~
~N F.' MOESLEIN
(SEAL)
- 5 -
The preceding instrument, consisting of five typewritten
pages, each identified by the signature of the Testator, was on
the date hereof signed, published and declared by the said
Testator, JOHN F. MOESLEIN, to be his Last ItJill and Testament,
and, at his request, in his presence and in the presence of each
other, we, believing him to be of sound mind, memory and
un a e;m:: ~unto
subscribed our names as witnesses.
~^D~I
/,-r.:- ~\,..t1-"\..- -} ,. U I~L~^--'
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of
r l t h:tkI t dM jtd,
~ ~.t?t
I
8'(f~ lJ,li,J~ j{
!::~"iL~:j (71) (,)/ /.3/
r7' '
J 767!J
of
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- 6 -
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.......,..'..
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COMMONWEALTH OF PENNSYLVANIA
5S:
COUNTY OF DAUPHIN
We, JOHN F. MOESLEIN, Testator,
DfIJN/5 J. 5f/1J7TO
and
.) 611 tJ f. l () tJ A r< I C I-I
, witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testator signed and executed the instrument as his Last
Will and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator,
signed the Will as
witnesses and that to the best of their knowledge, the Testator
was at that time eighteen (18) years of age or older, of sound
mind and under no constraint o~ undue influence.
to an( ~"c nowledged before me by JOHN F.
and subscribed and sworn to before me by
and J E/lN p. 2oN/JR / CH
day of fhJ6v'? r , 1991.
Subscribed, sworn
MOESLEIN, the Testator,
kf'ltJJ5 J. SHAm
witnesses, this 20 rn
flJ1fd it'7U K V'I/t.d-ij LG
NCffARY PUBL IC / f .'
C NOTA~I.~L SE,'.J..
SHARor~ K. SHAFF::R. NOTARY PUBliC
H..l,:;MIS8'JRG. nl-,JjPHIN COUNTY
~.WGC~~~:~i(~FIF1'.:~ ~\UG. 17, 1992
M,:,:".~,.....' ~"'.,~. . .;,....:i';~:~I;1 ~., t.k,~:~.r:.~
~~~~J\ .
.........:-;-....--.
':---~~-'7?:~~m\:ri'
'''___'_'''_.~'4U._,''
. .
. . .
,.
,
RICHARD W. CLECKNER
(1926 - 2004)
ROBERT D. HANSON
(1916 - 2006)
RETIRED:
WILLIAM FEAREN
CLECKNER AND FEAREN
ATTORNEYS AT lAW
119 LOCUST STREET
P.O. BOX 11847
HARRISBURG, PENNSYLVANIA 17108-1847
TELEPHONE: (717) 238-1731
FAX: (717) 238-8481
DENNIS J. SHATTO
ANN E. RHOADS
July 18, 2007
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Attention: Glenda Strasbaugh
("')
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Re: Estate of John F. Moeslein
No. 2002-257
Dear Ms. Strasbaugh:
po...)
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Enclosed herewith for filing please find the original and two
(2) copies of the inheritance tax return, together with our check
in the amount of $15.00 in payment of the filing fee.
Also enclosed is the Rule 6.12 Status Report.
If you have any questions or need anything else, please
advise.
Very truly yours,
CLECKNER AND FEAREN
Dennis J. Shatto
DJS : lnm
Enclosures
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Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF e V')I, tJ~L.A JJ 1> COUNTY, PENNSYL V ANlA
Name of Decedent: JOliN F. 110cSLE/N
Date of Death: ,-I-f)'}.. File Number: 2.0DZ- z57
Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration ofthe estate is complete: , . . , . . . . . . . . . . . . . . .. ~s D No
2, lfthe answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court?' . . , . , .. DY es ~
b. The separate Orphans' Court No, (if any) for the personal
representative's account is:
c. Did the personal representative state an account _ /
informally to the parties in interest? "........"...,....,........... [2Yes DNo
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and ma; () attached ~ 1IL...; is r _;ep ,0 __r! __
7..../7'01 ~
Signature of Person Filing this Form
Date
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it/nOO S,NVHdClO
:10 >18318
Bt :zt Wd 61 lOr tOOl
. Capacity: DPersonal Representative ~unseI
Tx:tJWl S J. SHA1m
~ol ;erson Filing this Form
!Jet u>CUS-r S-r
A. ddress . .
. HA {t~,$(3(Jf<6" Jt? A /1/4/
7/7-2-3g -Jt31
Telephone
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 1712B-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NQTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
-
REV-1547 EX AFP (06-05)
DC
-;)
. ': 1\' , 0
~i; i' . 4
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-01-2007
MOESLEIN
03-01-2002
21 02-0257
CUMBERLAND
101
APPEAL DATE: 11-30-2007
( See reverse side under Objections)
Amount Remittedl
MAKE CHECK PAYABLE AND REMIT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
JOHN
F
DENNIS J SHATTO
CLECKNER & FEAREN
PO BOX 11847
HBG
cut.
PA 17108
I
PAYMENT TO:
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MOESLEIN JOHN F FILE NO.21 02-0257 ACN 101 DATE 10-01-2007
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1- Real Estate (Schedule A) (lJ .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
.00 submit the upper portion
3. Closely Held Stock/Partnership Interest (Schedule C) (3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 10,166.60
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 10,166.60
APPROVED DEDUCTIONS AND EXEMPTIONS: 9,086.45
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule IJ (10) 158.70
11- Total Deductions (11) 9.;;'415 115
12. Net Value of Tax Return (12) 921. 45
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 921.45
NOTE: If an assessment was issued previouslY, lines 14, 15 and/or 16, 17, 18 and 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 (15) 921. 45 X 00 = .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00
17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)