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HomeMy WebLinkAbout04-0431 PETITION FOR PROBATE and GRANT OF LETTERS · Est,*eof MILDRED L. GILBERT No. ~ - Oq - /--[~l also known as To: Register of Wills for the , Deceased County of CUMBERLAND in the Social Security No. 180106884 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the execut or named in the last will of the above decedent, dated NOVEMBER 4, 1997 and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with h er last family or principal residence at GREENRIDGE VILLAGE. 210 BIG SPRING ROAD, NEWVILLE. CUMBERLAND COUNTY, PENNSYLVANIA 17241. (list street, number and municipality) Decedent, then 84 years of age, died 7/8/1919 , at GREENRIDGE VILLAGE, 210 BIG SPRING ROAD, NEWVILLE, PA 17241 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: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 4,700.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ 4.700.00 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 testamenta~ 7,-~ ,:'. ~:, thereon. (testamentary; administration c.t.a.; admini~'afion d.b.n.~a.) '.~ L~ NEWVILLE PA 17241 ~ '~ LOIS J. BI3RKHOLDER OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF CUMBERLAND~ SS The petitioner(s) above-named swear(s) or afl'mn(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and~...~tmly administer theffe~tate Sworn to or affi ~r~n~e4t and subscribed ,-- C.~ before me this 14- ~ day of / '- - MAY. 2004. .) ~-~F' -~_ Uly~p~~ister 0 L Estate of MILDRED L. GILBERT , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY '1 . 2004 , 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 11/4/1997 described therein be admitted to probate and filed of record as the last will of MILDRED L GILBERT .; and Letters TESTAMENTARY are hereby granted to LOIS d. BURKHOLDER FEES ~. ~ HAROLD S. IRWIN, III Probate, Ee~e°'~, Etc ......... $o~. ~ 29920 Short Certificates ( ) ...... $ i 5. ~ ATTORNEY (Sup. Ct. I.D. No.) Renunciation ............ $ ~. O-'~ 64 SOUTH PITT STREET ...~o~t= $ ib,b-b CARLISLE PA 17013 ADDRESS TOTAL~ $ ~, ~ Filed .'--~..-.H '7 .~..o.c,. ~ ............ 717-243-6090 PHONE REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION Estate of MILDRED L. GILBERT No. ~'~ I -- Oz-~ - L.~ ~ i also known as , Deceased The undersigned,CAROL A. JUMPER, daughter of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters TESTAMENTARY be issued to LOIS J. BURKHOLDER Witness my hand this~ 71 7:7'~ day of APRIL ,2004 % . ,,"/ (Signature) CAROL A. JUMPER ~ 1 WEST PENN STREET, CARLISLE PA 17013 ~ (Address) (Signature) I ~'~' (Address) -" ~ (Signature) (Address) Sworn to or affirmed and subscribed before me this "~ '~]~ day of t,~ar~ublic-- ( My Commission Expires~,..~ (Signature and seal of Notary or other NOTE: Renunciations executed outside the Office of Register of Wills are official qualified to administer oaths. Show required in some counties to be notarized. date of expiration of Notary's commission.) NOTARIAL SEAL ~ ! HAROLD S. IRWIN, III, NOTA.¢~,PUBLIC I BOROUGH, COUNTY CF Cu,~b~.~tLAND J CARLISLE RW ~' COMMISSION EXPIRES OCT~3B~: R ;~2~' -?~06J hi~, is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar ? :i032 42 APR 200~ No. ~ Date {D.i- o~_~t %i COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECOR0$ CERTIFICATE OF DEATH Cumb I~W Pennsb--- I .~'/_.~ /~. /_. //.//~_~ I~ ~u,~. i e ,~.~ Cumb ~? ,,~.D~_~ Newville Harvey L. Noaker ~,~,.s~r,,.~.,~.~ ~--- ,,. Helen Nehf ~ ~~ ~'"'~ m'~" I'~ ' -~ ....... I ~L_April 6 2004 I,~umb Valley Mem Gdns I,Garlisle, Pa ~~ ~ ~' - ] I~ ~ ~ger F~nera / I~ 0 WILL AND TESTAMENT I, MILDRED L. GILBERT, of 1 Chestnut Street, Newville, Cumberland County, Pennsylvania 17241, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever r~tuate to my children, share and share alike, the child or children of any ~.~ deceased~ild taking the share their parent would have taken if living. I 4. ~ I nominate and appoint lois J. Burkholder and Carol ^. ,lumper to be the ~Perso .~1 representatives of my estate, to serve without bond. 5. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of November, 1997. Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ACKNOWLEDGMENT AND AFFIDAVIT WE, MILDRED L. GILBERT, GAY L. IRWIN and JOY S. ZERANCE, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ' MILDRED L. GlibBeRT COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by MILDED L. GILBERT, the testatrix herein, and subscrib, b~.d and sworn to before me by GAY L. IRWIN and JOY S. ZERANCE, witnesses, this -/-/~ day of Nove/Flber, 1997. a~//,/-'~- - ,'"~ ~ ~, ~ ',':o!d S.. h ~./i,i il!, Notary Pub!it I Not ' - ::~ i) ;l)o Cumb,~r an~ County I REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MILDRED L. GILBERT Date of Death: 4/3/2004 Will No. 21-04-0431 Admin. No. 2104-0431 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 8/4/2004 : Name Address LOIS J. BURKHOLDER 54 OAK FLAT ROAD NEWVILLE PA 17241 CAROL A. JUMPER 60 SOUTH HIGH STREET APT 2 NEWVILLE PA 17241 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE Date: 8/4/20~ S~ Name: HARO~ S. IRWIN, Address: ~ SOUTH PiTT STREET CARLISLE PA 17013 Telephone(717) - 24360~Q Capacity: Personal Representative ~ Counsel for Personal Representative REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of MILDRED L. GILBERT No. 21 04 0431 also known as Date of Death 4/3/2004 , Deceased Social Security No. 180-10-6884 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe vedfy that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Personal Representative: Name of IRWIN~ ,..~,__. ' '~" J.,~-~ ~2x""~ / x'/' ~ '/~' ' '~ I.D. No.: 29920 LOIS J. BURKHOLDER Address: 64 SOUTH PITT STREET Dated AUGUST~,~2004 CARLISLE PA 17013 Telephone: 717-243-6090 Description Value ADAMS COUNTY NATIONAL BANK 5,704.67 CD No. 160330 BLUE SHIELD 232.63 Refund ADAMS COUNTY NATIONAL BANK 2,879.14 One-half of joint checking account Total (Attach Additional Sheets if necessary) 8,816.44 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 REV-1500 EX + (6-00} f' COMMONWEALTH OF REV'1500 OFROIAL USE ONLY PENNSYLVANIA OEPARTMENT OF REVENUE INHERITANCE TAX RETURN PILE.U.BER DEPT. 280601 HARR,SBURG, P^ 17128-0601 RESIDENT DECEDENT CO2UN,JOOE - NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAl ~ SOCIAL SECURITY NUMBER Z GILBERT~ MILDRED L. I.U 1 8 0- 1 0-6 8 8 4 ~ DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPMCATE WITH THE 0 04/30/2004 1 07/08/1919 REGISTER OF WILLS III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) (~] SOCIAL SECURITY NUMBER ~-"' r~ 1. Original Return ['--] 2. Supplemental Retum [] 3. Remainder Return (date of death prior to 12-13-82) ~ui~ ~0 4' Limited Estate r'--l~'~4a'FuturelnterestC°mpromiso(da'e°fdeathafler12'12'82) ~]5. Federal Estate Tax Retum Required ~ m ~ 6. Decedent Died Testate (Attach copy of Will) l I 7. Decedent Maintained a Living Trust (A.ach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes < [] 9. Litigation Proceeds Received r'~ 10. Spousal Poverty Credit (date of death between ~2-31-9~ and ~-1-95) [] 11. Election to tax under Sec. 9113(A)(^~ach Sch O) I-- z NAME "' COMPLETE MAILING ADDRESS oz HAROLD S. IRWIN, III 64 SOUT PITT STREET a. FIRM NAME (If Applicable) ILl ,,, IRWIN LAW OFFICE CARLISLE PA 17013 o TELEPHONE NUMBER ° 717-243-6090 1. Real Estate (Schedule A) (1) 0.00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Uiscellaneous Personal Property (5) 5,937.30 (Schedule E) Z 0 6. Jointly Owned Property (Schedule F) (6) 2,879.14 I-- 0 Separate Billing Requested :::::) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 ~1-' (Schedule G or L) ,~ 8. Total Gross Assets (total Lines 1-7) 0.3 (8) 8,816.44 I,LI 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 6,847.10 10. Bebts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 51. 603.78 11. Total Deductions (total Lines 9 & 10) (11) 58,450.88 12. Net Value of Estate (Line 8 minus Line 11) (12) -49~634.44 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) 0.00 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) -49~634.4 4 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES  Line 14 taxable at the spousal tax 15. Amount of ~ rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X __ (15) 0.00 ~ 16. Amount of Line 14 taxable at lineal rate 0.00 X (16) 0.00 ~- 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00 0 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 0.1 (18) 0.00  19. Tax Due (19) 0.00 20. l::)ecedent's Complete Address: STFIEET AD~RES.$ ~' r GREENRIDGE VILLAGE 210 BIG SPRING ROAD NEWVILLE I STATE PA zip 17241 'rax Payments and Credits: Tax Due (Page 1 Line 19) Credits/Payments (1) 0.00 A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable Total Credits ( A + B + C ) (2) 0.00 D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) O.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) O.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This Js the BALANCE DUE. (SD) O.00 Make Check PayabIe to: REGISTER ~!,WILLS, AGENT : ~ : 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 properly transferred or its income; ........................................ [] [] c. retain a reversionary interest; or [] [] d. receive the promise for life of either payments, benefits or care? ................ ' ........... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................. [] [] 3. Did decedent own an "in trust for'' or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benef c ary des gnat on? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare hat I have examined this return, ncluding accompanying schedules and statements and to the best of my knowledge and belief, it true, correct and complete. Declaration ol' preparer other hen the personal representative is based on all intormation of wh ch preparer has any know'ledge, is SIGNATURE OF PERSON RESPONSIBLE FOR FJLING RETURN ADDRESS 54 OAK FLAT ROAD NEV'ji/VILLE PA 17241 ,, SIGNATURE ~I~ DATE ADDRESS ~"~4~OUTH PITT SfREET/ 08/("..,/04 CARLISLE PA 1701 ) 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% F2 P.S. §9116 (a)(1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute ~ a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3).]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GILBERT. MILDRED L. 21 04 0431 All real propei~y' owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real propert7 which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEU NUMBER DESCRIPTION VALUE AT DATE 1. NONE OF DEATH 0.00 TOTAL (Also enter on line 1, Recapitulation) ~ $ 0.O0 (if more space is needed, insert additional sheets of the same size) REV-1503 EX +, (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GILBERT, MILDRED L. 21 04 0431 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. ~NONE OF DEATH 0.00 TOTAL (Aisc enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1504 EX +, (6-98) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER GILBERT. MILDRED L. 21 04 0431 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sote-proprietership. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation $ (If more space is needed, insert additional sheets of the same size) REV-1507 EX +' (6-98) ~ SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RESIDENT DECEDENT RECEIVABLE ESTATE OF FILE NUMBER GILBERT, MILDRED L. 21 04 0431 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE 0.00 TOTAL (Also enter on line 4, $ 0.O0 (If more space is needed, insert additional sheets of the same size) REV-1508 EX .+ (6-98) ~ SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER GILBERT, MILDRED L. 21 04 0431 Include the proceeds of litigation and the date the proceeds were received by lhe estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, ADAMS COUNTY NATIONAL BANK 5,704.67 Certificate of Deposit No. 160330 Value bassed on Exhibit "B" attached 2. BLUE SHIELD Medical Insurance Refund 232.63 TOTAL (Also enter on line ! $ 57937.30 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GILBERT, MILDRED L. 21 04 0431 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS IRELATiONSHiP TO DECEDENT A. LOIS J. BURKHOLDER 54 Oak Flat Road Daughter Newville PA 17241 c JOINTLY-OWNED PROPERTY: L~- ~ ~-H DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. AT]'ACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S JNTERES 1. A. 10/22/96 ADAMS COUNTY NATIONAL BANK 5,758.27 50. 2,879.14 Joint Checking Account TOTAL (Also enter on line 6, Recapitulation) $ ............................. 2,879.14 (If more space is needed, insert additional sheets of the same size) REV-1510 EX +, (6-98) * SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURNMISC, NON-PROBATEPROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GILBERT, MILDRED L. 21 04 0431 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (~F APPUCASLE VALUE 1. NONE 0.00 O.OC TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & NHER TANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GILBERT. MILDRED L. 21 04 0431 Debts of decedent must be reported on Schedule ][. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EGGER FUNERAL HOME 5,761.10 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. Attomey Fees IRWIN LAW OFFICE 1,000.OO 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 REGISTER OF WILLS 61.00 5. Accountant's Fees 6. Tax Retum Preparers Fees 7. REGISTER OF WILLS - File Inventory and Appraisement 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 6~847.10 (If more space is needed, insert additional sheets of the same size) REV-1512 EX .~ (6-98) , SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OFDECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER GILBERT, MILDRED L. 21 04 0431 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. GREENRIDGE VILLAGE Nursing Home Bill 269.62 2. CREDIT CARD ACCOUNT 66.92 3. POSTAGE REIMBURSEMENT 15.42 4. DEPARTMENT OF PUBLIC WELFARE 51,251.82 Medical Bill Lien TOTAL (Also enter on line 10, Recapitulation) $ 51,603.78 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-nm ' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GILBEE , MILDRED L. 21 04 0431 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ~UMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ]'. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. LOIS J. BURKHOLDER Lineal 54 Oak Flat Road Newville, PA 17241 2. CAROL A. JUMPER Lineal 60 South High Street, Apartment 2 Newville, PA 17241 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 1. NONE 0.O0 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. NONE 0.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ O.OO (If more space is needed, insert additional sheets of the same size) ADAMS COUNTY NATIONAL BANK FARMERS NATIONAL BANK OF NEWVILLE A D~V~mON OF AOA~S covNrr NATIONAL BANK CERTIFICATE OF DEPOSIT PRE-RENEWAL NOTICE DEAR CUSTOMER: YOUR ACCOUNT WILL AUTOMATICALLY RENEW 10 DAY(S) AFTER THE STATED RENEWAL DATE. THE INTEREST RATE AND THE ANNUAL PERCENTAGE YIELD HAVE NOT YET BEEN DETERMINED. CALL 888-334-2262 EXT-NONE ON THE FIRST BUSINESS DAY ON OR AFTER THE CURRENT RENEWAL DATE LISTED BELOW FOR CURRENT RENEWAL INFORMATION. IF YOU WISH TO REDEEM THIS ACCOUNT, PLEASE DO SO WITHIN THE 10 .DAY GRACE PERIOD. MILDRED GILBERT BURIAL FUND 54 OAK FLAT ROAD NEWVILLE PA 17241 4-09-2003 *--- DETAIL INFORMATION ...... * CERTIFICATE 160330 CURRENT RENEWAL 4/24/03 ISSUE VALUE 5,619.00 RENEWAL BA/-JLNCE 5,761.10 CURRENT RATE 2.500 NEXT RENEWAL 4/24/04 INTEREST WILL BE ADDED TO YOUR CERTIFICATE BA/~ANCE. FARMERS NATIONAL BANK OF NEWVILLE ,~ Division of Adams Cou,,~_ National Bank May ! 9,2004 To whom it may concern, In regards to Mildred Gilbert accounts, the following information has been gathered for you record. The checking account #117714 on April 3, 2004 had a balance of $5,758.27. This account currently has a balance on this date of $3,887.95. The Certificate of Deposit #160330 had a principal balance on April 3,2004 of $5,619.00 and accrued interest of $85.67. I have also included a copy of the signature cards that show Lois Burkholder a/k/a Lois Glunt was added to her account on 10-25-1985. Newville Office PO. Box 156, Newville, PA 17241 · (717) 776-5312 TO THE REGI.,STER Of WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.61a) Name of Decedent: MILDRED L. GILBERT Date of Death: 4/3/2004 Will No. 2104-00431 Admin. No. 21 - 04 ~ 00431 To the Register: I certify that notice of (beneficial interest) e._state administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 8/6/2004 : Name Address LOIS J BURKHOLDER 54 OAK FLAT ROAD NEWVILLE PA 17241 CAROL A JUMPER 60 SOUTH HIGH STREET APT 2 NEWVILLE PA 17241 WILLIAM GILBERT 1117 DRY POWDER CIRCLE MEWCHANICSBURG PA 17050 ROBERT GILBERT 275 GREENHILL ROAD NEWVILLE PA 17241 all persons entitled thereto under Rule 5.6 Notice has now been given to (a) except: NONE ~:::: I Date: 81612004 Name: HAROLD S. IRWIN, III Address: 64 SOUTH PITT STREET CARLISLE PA 17013 Telephone(717) - 2436090 Capacity: Personal Representative ~ Counsel for Personal Representative -. Continuation of Certification of Notice Under Rule 5.6(a) MILDRED L. GILBERT 4~3/2004 Page 1 Names and addresses Name Address JERRY GILBERT 26 CHESTNUT STREET NEWVILLE PA 17241 RICHARD GILBERT 1632 TAMARACK STREET FAIRBANKS ALASKA 99709 LESTER GILBERT 2698 FOXIANNA ROAD MIDDLETOWN PA 17057 HELEN HOHN 140 CENTER ROAD NEWVILLE PA 17241 DONNA RAE STOUFFER 292 STEELSTOWN ROAD NEWVILLE PA 17241 LARRY GILBERT 14210 RIDGEWAY DEWEY AZ 86327 STATUS REPORT UNDER RULE 6.12 Name of Decedent' MILDRED L. GILBERT Date of Death: 4/3/2004 Will No. 21 - 04 - 00431 Admin. No. 2104 - 0431 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate' 1.State whether administration of the estate is complete: Yes X No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court ? Yes ~ No X b. The separate Orphans' Court No. (if any ) for the personal representative's account is' N/A c. Did the personal representative state an account informally to the parties in interest ? Yes × No ~ 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 t~~j ~,,,,~,A ,,.~ Date' 9/30/2004 S. igna~ture ~ / HAROLD S. IRWIN, III ~ // Name (Please type or print ) 64 SOUTH PITT STREET CARLISLE PA 17013 ?., _ Address ( 717 ) - 2436090 Tel. No. Capacity: ~ Personal Representative ' ::ii c~ :~: X Counsel for personal ' representative