HomeMy WebLinkAbout02-0102 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of_ MARLI~ W. CULP
also k,o,,, a, No..2/-
To:
Register of Wills f_or the .
Social Security No. _t ~~-~ 1 Deceased. County of Cumberlan~
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
in the last will of the above decedent, dated March 23
and codicil(s) dated '
in the
. named
,19,,70
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
.Decendent was domiciled at death in Cumborland
_ County, Pennsylvania, with
IL~.S. . last familyor principal .r~ts. id.ence at ~ Westfields ~r~.ve,
~ecnan~csourg, r~ 17070 '
(list street, number and muncipality}
Decendent, then_ 8~ ~ years of age, died Ja.mlary 17 2002
Except as follows, decedent did not marry, was not divorced aud did not have a cltild 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 estinmted values as follows:
(lf domiciled in Pa.) All personal property $..
(If not domici,'ed in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $..
Value of real estate in Pennsylvania
situated as follows: None $~
280,000.00
WHEREFORE, petitioner(s) respectfully request(s) th.e probate of the last will and codicil(s)
presented herewith and the grant of letters Testamentary
theron.
3o
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.}
OenevSeve. Ann Fettr0
8 Westfields Drive
Mechanic.sburg, PA 170~0
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUM23 ERLA ~[D ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the k~owledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer t~ esttate az~ording to law.
Sworn lo or affirmed and subscrib,,,~ ~ .......
before e lhis _. c.~ ~ c_~ da ~ [~ ~'~~
-
NO. 21-02-102
Estate of MARLIN W. GULP , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
JANUARY 29,
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated March. 23, lC)TO
described therein be admitted to probate and filed of record as the last will of
Marlin ~1. Culp
and Letters To s t ament ary
are hereby granted to Genevieve Ann Fettro
2002, in consideration of the petition on
l~SLter el' Wills-
FEES
Probate, Letters, Etc .......... $. 270.00
Short Certificates(6) .......... $ 18.00
5.00
TOTAL __ $. 301.00
Filed . .~.A.~..V.A~...2.9 .... 2. 99.2. ..............
J. Robert Stauf£ev (N0. 06356)
ATTORNEY (Sup. Ct. I.D. No.)
Market Square Bldg.
Mechanicsbur~; PA 170~
ADDRESS
717-766-9673
PHONE
MAILED LETTERS TO ATTORNEY, JANUARY 29, 2002
21-02-102
REGISTER Or WILLS Ol~ ~ ~ ~,¼,,,,~ ~ ~ COUNTY
OATH OF SUBSCRIBING WITNESS
) a subscribing withes e will presented herewith, (each) being duly qualified according to
· law, depose(s) and say(s) that .A~ &J~ ~- present and saw
the testat 0 'F- , sign the same and that.~/. M signed as a witness at the
request of testatow- in h i % presence and (in the p~esence of each other) (in the presence of the
other subscribing witness(es)). ~/~ ~
Sworn to or affim,ed and subscribed before ~, ~ "///~~~~~
m~i~ ~ ~ ~ ~ay o~ ~ ~a~7
Register
(Name)
(Address)
OATH OF NON-SUBSCRIBING WITNESS
testator of (one
that ,,_~'
to the best of
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
~%J1~ ir familiar with the signature of '-~.~ L~. (/3~-~_, ,
ce~iril Q/
of the subscribing witnesses to) the will presented herewith and
codicil
believes the signature on the will is in the handwriting of
knowledg~ and
Sworn to or affirmed and subscribed before
me this 2. ~ ~ day of
.xa.
Register
belief.
rName)
~ ~,. ~/ (Address)
t/ (Name;
(Address)
RENUNCIATION
21-02-102
In Re Estate of MARLIN W. CULP
deceased.
To the Register of Wills of Cumberland
County, Pennsylvania.
The undersigned M~ o~] ta~.~ of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testamentary
be issued to Genevieve Ann Fettr. o
WITNESS our
s 't%' o .~'?-'~l/,, ~ 200~
. hand/this ,r~ ~J/ day c~ U -
(Signature)
5401 Oxford Drive
Mechanicsburg, PA 17055
/~~Address)
(Signature)
111 North Lockwitlow Ave.
Harrisburg, PA i7//2-
(Address)
(Signature)
(Address)
I05.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local R, egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 8010556
No.
Local Registrar
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
Marlin W. Culp pMale ,. 184 -- 09 -- 3961 ,January 1'7~' 2002
,- I j
I[ iCEm~'s Pe~sylv~ia
8 Westfiel~ ~t~ ~,u~ ,..m.,. .
~_ __cs_~=, PA. 17050
,,. Jo~ GI~ ~lp
~.s~,~,~ [,L . Mel~ Wes~f~
~.~ ~ ~--o ~--,..o I'~.~,.~, 1.~,--~.~ ..... c ..... l~.~.~.,,~
~U"~"~Et~.~E~T~S~. ~.*E.~.~. ~ ' , .... 7~:7:27~ ..... - ~I l~'d~J~n~CSD~t ~ 17050
....... ~ ~l~zz~ ral H~
PERFORMED?
' I
21-02-102
LAST WILL AND TESTAMENT OF MARLIN W. CULP
21-02-102
I~ MARLIN W. CULP, of the Borough of Mechanicsburg, County
of Cumberland and State of Pennsylvania, being of sound and dis-
posing mind, memory and understanding, do make, publish and de-
clare this my Last Will and Testament.
I direct the payment of all my just debts and funeral expenses
as soon after my decease as the same can conveniently be done.
I give, devise and bequeath all the rest, residue and remainder
of my estate, of whatsoever nature and wheresoever situate, to my
wife, Charlotte G. Culp, absolutely and unconditionally.
In the event that my said wife should predecease me or should
she die at about the same time as I do, such as in an accident
common to both of us, then in such event, I give and bequeath my
entire estate, of whatsoever nature and wheresoever situate, to my
three children, to wit, Genevieve Ann Fettro, Joan Marie Lebo
and Jack E. Culp, share and share alike.
Should my wife so predecease me, then in such event, I nominate,
constitute and appoint my daughter, Genevieve Ann Fettro, guardian
of the person and estate of my son, Jack E. Culp, for and during
the term of his minority.
I further direct my said daughter as guardian of the estate
of my son, Jack E. Culp, to apply the principal as well as income
with particular emphasis to the application of said funds to his
college education and/or technical training after his graduation
from high school, without the necessity on the part of said guardian
in securing prior authority or leave of Court to do so.
LASTLY, I nominate, constitute and appoint my wife, Charlotte
G. Culp, Executrix of this my Last Will and Testament, and in the
event my said wife, Charlotte G. Culp, predeceases me or should for
any reason be unwilling or unable to serve in such capacity, then
in such event, I nominate, constitute and appoint my three children,
to wit, Genevieve Ann Fettro, Joan Marie Lebo and Jack E. Culp,
Co-Executors of this my Last Will and Testament in her place and
stead.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
_~2~ '~ day of March, A. D. 1970.
Marlin W. Culp /
Signed, sealed, published and declared by the above named
Marlin W. Culp, as and for his Last Will and Testament, in the
presence of us who have subscribed our names hereto as witnesses,
at the request of said testator, in his presence and in the presence
of each other. /~~
( . _
n []
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Marlin W. Culp
Date of Death: January 17, 2002
Will No. 2002-00102 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beueficiaries of the above-captioned estate on February 4-~ 2002, :
Name Address
Genevieve Ann Fettro-8 Westfields Drive, Mechanicsburg, PA
Joan Marie Lebo-5401 Oxford Drive, Mechanicsburg~ PA 17055
17050
Jack E. Culp-lll North Lockwillow Ave., Harrisburg, PA 17112
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None
Date: 2002
February 8,
I
~gnature j/
Name J. Robert Stauffer
Address Market Square Bldg.
Mechanicsburg, PA 17055
Telephone ( 71)7-766-9673
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
NO.
CD
REV-1162 EX(11-96)
000834
STAUFFER J ROBERT
MARKET SQUARE BUILDING
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 184-09-3961
FILE NUMBER: 2102-0102
DECEDENT NAME: CULP MARLIN W
DATE OF PAYMENT: 02/07/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 01/1 7/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $10,000.00
TOTAL AMOUNT PAID:
$10,000.00
REMARKS: GENEVIEVE ANN FETTRO
C/O J ROBERT STAUFFER ESQUIRE
SEAL
CHECK# 0091
INITIALS: CW
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT, 280601
HARRISBURG, PA 17128-0601
J OFFI~I^I
REV-1 500 /?- 3
INHERITANCE TAX RETURN ..EUUM.ER
RESIDENT DECEDENT -o_2
COUNTY CODE YEAR
I!qF (')N! Y
0 O1 02
NUMBER
I--
Z
U.I
LLI
(.1
ILl
DECEDENT'S NAME (LAS1', FIRST, AND MIDDLE INI11AL)
CULP, ~'-'Iarlin W.
DATE OF DEATH (MM-DD-YEAR)
Jam:mr7 !7, 2002
DATE OF BIRTH (MM-DD-YEAR)
,Ts.t~nr¥ 20, '19!(;
SOCIAL SECURITY NUMBER
.'l.I.~/[ 09 - 3961
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAS1,, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
T,~/A _ _
[~1. Original Return
[~4. Limited Estate
~-'] 6. Decedent Died Testate (Atlach copy of Will)
[~9. Litigation Proceeds Received
[~2. Supplemenlal Return
[~4a. Future Interest Compromise (dale of death after 12-12-82)
[~7. Decedenl Maintained a Living Trusl (Altach copy of Trust)
] 10. Spousal Poverty Credit (dale of denlh between 12-31-91 and 1-1-95)
[~3. Remainder Return (date of death pdor to 12-13-82)
--"]5. Federal Estate Tax Return Required
O 8. Total Number of Safe Deposit Boxes
[~]11. Election to tax under Sec. 9113(A) (A~ach Sch O)
N'i. li~'al~,'tlbH MUI~? 'l~E CONIPL~TED. ALL CORRESPONII:J~I',ICIE AND bOHFI§EHIIX~TA~l~i~I~AYIO~::8HO'O£~ IIE'IIi'I~EI3~ ;'tO.
NAME
J. ]lobe't,t ,:,"t;aufPer, /\tt:;ort~ev.,
FIRM NAME ~l~Applicable)
TELEPHONE NUMBER
7!7-766-9673
COMPLETE MAILING~DDRESS
J"~ arke ~,, ~:, q],l a r e Eli 1 d ,~!;.
[']'e chan'i, c s bufF, ~ PA 170p¢~
1, Real Eslate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation. Partnership or Sole-Proprietorship (3)
4. Modgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Properly (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
o; o0
0.00
0.00
0.00
268
0.00
0.00
(8)
17,J.~96.37
1,093.39
(11)
(12)
(13)
OFFICIAL USE ONLY
28:]., 268.55
10,589.76
262,675.79
0.00
(14)
262,678.79
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
20.
0.00 x.0__ (15)
2(,2,678.79 x.O/I.5 (16)
O oOO x .12 (17)
O. O0 x .15 (18)
(19)
0.00
02o. 45
o .0o
0.00
].l, o20.45
Decedent's Complete Address:
STREET ADDRESS
8 hrestfields Drive
ISTATE PA
CITY
He c hani c sbur g,
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0. O0
10,000. O0
~oo. oo
Interest/Penalty if applicable
D. Interest
E. Penalty
0. O0
0.00
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( O + E ) (3)
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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
Iz'P 17050
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
82o.45
lO~O0.O0
O. O0
Oo O0
3.,320.45
0.00
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 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 properly 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 properly which
contains a beneficiary designation? ........................................................................................................................ [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and stalements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUF~.,DF PERSON RESPONSIBL..F~O[R FIL~J~ RETURN DATE .- ·
ADDRESS
8 Westfields ].)rive, I, Iechanicsbur~ PA 170~0
SIGNAT~~PA~ER OTHER ~EP~EIENTATIVE ~T~ / ~ '~
~ Market Squ~ Bld~Iechanicsbur~ PA 170~
For dates of death on or after July 1, 1994 and before Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sullying spouse is 3%
[72 RS ~9~6 (a) ¢.~) 0)1.
For dates of death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the su~iving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute d~s not exemp~ a transfer ~oa sullying spouse from tax, and the statuto~ requirements for disclosure of assets and filing a tax return are still applicable even if
the sullying spouse is the only beneficial.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child ~enty-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% [12 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-I,~ EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
2O02-00102
!'.IAF~L'.F.N W. CULP 21-02-0102
Include the proceeds of liti§ation and the date the proceeds were received by the estate. All property jointly-ow.ed with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
?.
8.
9.
10.
!~%T Bank, Accounts as follows: No. 3100391].371076.
No. 31003911371084.
No. 31003911377024.
Uo. 31003911409900.
Fulton Bank, 0]') No. l~00-1923319.
Interest accrued to 1/17/02.
Wa~point Bank, Accounts as follows: CD 186621~399.
Interest accrued to ]./17/02.
CD 18662220~8.
Interest accrued to 1/].7/02.
CD ].866239~10.
Interest accrued to 1/17/02.
CD 1866242~39.
Interest accrued to 1/17/02.
A].lfirst Bank, Money Fund Alternative Account No.
09~0280974.
Interest accrued to 1/17/02.
Citizens Bank, Checking Account No. 142-272-0332.
Interest accru, ed to 1/17/02.
}~&T Bank, interest pa~uent.
Verizon, refund.
Bethany Village, refund of prepaid room and care.
United States Treasury, 20Ol Income Tax refund.
Capital Blue Cross/Blue Shield.
Capital Blue Cross/Blue Shield.
Capital Blue Cross/Blue Shield.
Capital Blue Cross/Blue Shield.
29,064.80
3o, 077.75
10,018.50
10,016.94
5,000. O0
22.4.6
7,000.00
18.99
10,000.00
26
20,000. O0
4.i. 99
5,000.00
lO.5O
146,144.54
212.96
7, oo5.31
13
2,11.79.50
3,034. O0
9.00
9.00
9.00
9.00
TOTAL (Aisc enter on line 5, Recapitulation) $ 2 81,268..~
(If more space is needed, insed additional sheets of the same size)
REV-15t1 EX+ (t2-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
ITEM
NUMBER
8.
9.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Malpezzi t%neral ltome,
funeral, expenses.
I',le chan i c s burg,
Peons yl vani a,
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) ~ 0 n e
Social Security Number(s)/EIN Number of Personal Representative(sl
Street Address
City State ____ Zip
Year(s) Commission Paid:
Attorney Fees J, Robert Stauffer, Esq., Attorney Fee.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant ~/A
Street Address
City State__Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills of Cumberland
Pennsylvania, Letters Testamentary.
Accountant's Fees
County,
Tax Return Preparer's Fees
B&'.R Block, preparation of 2001 Income Tax Returns.
Register of Wills, two (2) Short Certificates.
Cumberland] I.,aw .Tourrml, Estate Notice.
PA Department of I~even~e, balance due on 2001 Tax.
The Sentinel, Estate Notice.
Bloomfie].d Honuments, inscribing Tomb Stone.
Register of Wills, filing Account.
Register of Wi].ls, fi].i~g Inventory a~c] Pe~usylva~:ia
Inheritauce Tax Return.
TOTAL (Aisc enter on line 9, Recapitulatior
(If more space is needed, insert additional sheets of the same size)
AMOUNT
9,361.50
0.00
7,000. OO
301. O0
159. O0
6.oo
75.oo
288.00
80.87
90.co
110.00
2F. co
$ 17,496 · 37
'REV. 1512 EX .("l 97)
COMMONWEALTH OF PENNSYLVANI^
INtiERItANCE TAX RETURN
RESIDENt DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER 2002-00102
HA. RT..,IN ?.I.CI.!I,P
21-02-0102
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Alert Phys:~_c:i. ans of Bethany V-[llage,
2. Flob.~.le X-Ray Imaging Inc., X-Rays.
Med.].cal expenses
TOIAL (Also enter on line 10, Recapitulation)
(If more space is needed, insed additional sheets of the same size)
. ¢
AMOUNT
223.39
870.00
1,093.39
REV-1513 EX, (I-97) ~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
~',,~A]}.1~,~?,.,1 W. C1TI,]:~ FILENUMBER 2002-00102
21-02-0102
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
II.
GENEVIf~VE ANN FETTRO
8 Westfield. s ]Drive
Mechanicsburg, PA 170~0
JOAN ~'&AR I E
~l..t01 Oxford. Drive
Mechaniosburg, PA 17()5~
JA(,I~ ~E. C ILP
111 North ~.,ookwi].~ow A~e.
Harrisburg, PA 1~112
Daughter
.Daughter
O13
One third shat
of Estate.
One third shat
of Estate.
One third shat
of Estate.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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 []- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insed additional sheets of the same size)
Inventory of the real and personal estate of
~LRRIf.F. N W . CUL P
deceased
(7)
(8)
(9)
(10) Blue Cross/Blue Shield,
(11) Blue Cross/Blue Shield.
(12) Blue Cross/Blue Shield.
(13) Blue Cross/Blue Shield.
(1) l"1,%;T Bant<:, Accounts as follows:
No. 33-00391]_.371076.
No. 3].00391137108~.
No. 31003911377024.
No. 31003911409900.
(2) Fulton Bank, CD No. ~IO0-].923319.
Interest Accrued to ]./]7/02.
(3) Waypo~.nt Bank, Accounts as follows:
(;iD 1866217399,
Interest accrued to 1/17/02_.
CD ].8662_220~8.
Interest accrued to 1/17/02.
CD 1866239310.
Interest accrued to 1/17/02-.
CD 1866242439.
Interest accrued to !/].7/02.
(4) Allfirst Bank, Money Fund Alternative 'Account No. 09~02-80974.
Interest accrued to 1/17/02.
(5) Citizens Bank, Checking Account ~:!o. 142-272-0332.
Interest Accrued to 1/17/0.2_.
Verizon, refund.
HfcT Bank, interest pa~,ent.
]3ethan.7 Village, refund of prepaid room and care.
Unite~ States Treasury, 2001 Income Tax refund.
Total .........
25,06! 8C
30,07 75
10,01 ~C
10,01' 94
5,00( O0
2~ 46
7,00C O0
1~ 99
10, 00( O0
2~ 5a
20, 00( 00
5,00( O0
i~ 50
i46, 5~
21~
7,00( 00
cc l~
I .52
l: 83
2,4.391 50
3,0 O0
O0
O0
O0
oo
.2.81,26~ 55
COMMONWEALTH OF PENNSYLVANIA ].
COUNTY OF CUMBERLAND
SS:
Genevieve Ann Fettro
being duly S~4orrt according to law, deposes and says that She is the Executrix____
of the Estate of ~Igtl~lilq ~' (Ju, lp
late of _~_~i~veT' opz° ,~..~.ng Township ...... Cumberland County, Pa., deceased and that the
within is an inventory made by Ge~.v.~.eve Ann Fettro ., the said Executrix
of the enf;re estate of said decedent, consisflng of all ~l~e personal property and real estate, except real estate outs;de
the Commonwealth of Penn,sylvania, end that ll~e figures opposite each item of the Inventory represent it's fair value
as of the date of decedent s death.
~V70~ and subscribed before me, [ ~ ~~.Executor - --S~T
llechanicsburg~ PA 170~0
Address
Date of Death
17th January
2002
Day
Month Year
INSTRUCTIONS
I. An inventory must be filed within three months after appo;nfmenf of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Addiflonal sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949. ,
0 ,.
Z ~ 0
Z 0 o
M ~ Z
H
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DTVI'STON
DEPT. ID0601
HARRTSBURG, PA 17118-0601
CONNONgEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERZTANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
J ROBERT STAUFFER ATTY
NARKET SQUARE BUILDING
NECHANZCSBURG
REV-I~47 EX &FP (al-D2)
DATE 05-15-2002
ESTATE OF CULP HARLZN N
DATE OF DEATH 01-17-2002
FILE NUNBER 21 02-0102
p,-~TY CUNBERLAND
~=ACN 101
PA 17055
Amount
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF gILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOHER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-02) NOTICE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR
DZSALLO#ANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF CULP HARLZN gFZLE NO. 21 02-0102 ACN 101 DATE 05-13-2002
TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORTGZNAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Zntarast (Schedule C) (3)
~. Mortgages/Notes Receivable (Schedule D)
$. Cash/Bank Deposits/Nisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
B. Total Assets
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expansas/Adm. Costs/Nisc. Expenses (Schedule H) (9)
10. Dabts/Hortgaga Liabilities/Liens (Schedule I) (10)
11. Total Deduct ~.ons
12. Nat Value of Tax Return
281z268.55
.00
.00 NOTE: To insure proper
.00 credit to your account,
.00 submit the upper port,on
.00 of this form with your
tax payment.
.00
(8) 281,268.55
17,~96 .$7
1~093.$9
(11)
(12)
262,678.79
Charitable/Governmental Bequests; Non-eZectad 9113 Trusts (Schedule J) (1:5)
Nat Value of Estate Subject to Tax (1~)
Zf an assessment ~as issued previously, lines 1~, 15 and/er 16, 17,
13.
lq.
NOTE:
reflect figures that include the total of ALL returns assessed to date.
.00
262,678.79
18 and 19 will
(Is) .00 x O0 = .00
(16) 262,678.79 x 0~5 = 11,820.~5
(17) .00 x 12 = .00
(18) .00 x 15 = .00
(19)= 11,820.~5
ASSESSHENT OF TAX:
15. Amount of L/ne Zq at Spousal rata
16. Amount of L/ne lq taxable at Lineal/Class A rate
17. Aaount of Line lq at Sibling rate
18. Amount of Line lq taxable at Collateral/Class B rata
19. Principal Tax Due
[AX CREDITS:
PAYMENT RECEZPT DI~uUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
02-07-2002 CDOOO85q 526.32
0~-01-2002 CDOOZOZO 6q.70
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
ANOUNT PAID
10,000.00
1,320.q5
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
11,911.~7
91. OZCR
.00
91.02CR
ZF TOTAL DUE ZS LESS THAN $1~ NO PAYHENT ZS REI~UZRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR)~ YOU HAY BE DUE
REFUND. SEE REVERSE SIDE OF THZS FORN FOR ZNSTRUCTZONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates cf decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possession ar enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration cf any estate for
life or far years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rata an any such future interest.
To RJlfill the requirements of Section Il40 of tho Inheritance and Estate Tax Act, Act 23 of ZOO0. (TI P.S.
Section 9140).
Detach tho top portion of this Notice and submit aith your payment to tho Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, 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-1313). Applications are available et the Office
of the Register of #ills, any of tho Z3 Revenue District Offices, or by calling the special [4-hour
ansaaring service for forms ordering: 1-8gO-36Z-2050; services for taxpayers mith special hearing and / or
speaking needs: 1-800-447-3020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disalloeance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. [8lOll, Harrisburg, PA 17128-1021, OR
--election to have tho matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should bm addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Ia0601, Harrisburg, PA 171Z8-0601
Phone (7[7) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Oacadan~' (REV-150i) for an explanation of administratively correctable errors.
If any tax duo is paid within three (3) calendar months after tho dscodsnt's death, a five percent (SI) discount of
the tax paid is allowed.
The 15X tax amnesty non-participation penalty is computed on the total cf the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in tho same manner and in the tho same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
lntarost is charged beginning with first day of delinquency, or nine (9) months and one (1) day from tho date of
death, to the data of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (SZ) percent par annum calculated at a daily rata of .000164. All taxes ehich became delinquent on and after
January l, 19DZ will bear interest at a rate ehich mill vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 19DZ through ZOOZ ara:
Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor
1982 20Z .000548 199Z 9Z .000247
1983 16Z .000438 1993-1994 7Z .O0019Z
1984 Ill .000301 1995-1998 9Z .000Z47
1985 13Z .0003S6 1999 7Z .00019Z
1986 lOX .000Z74 ZOO0 az .000219
1987 9Z .000247 2001 9Z .000Z47
1988-1991 llZ .000301 ZOO[ 6Z .000164
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAllY 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. [f payment is made after the interest computation date shown on tho
Notice, additional interest must bo calculated.
BUREAU OF ZNDTVZDUAL TAXES
ZNHERTTANCE TAX DIV]'STON
DEPT. 280601
HARRTSBURG, PA 17128-0601
*O2
J ROBERT STAUFFER ATTY
MARKET SQUARE BUILDING
MECHANICSBURG PA 1~055
COMHONNEALTH OF PENNSYLVAN'rA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
DATE 06-03-2002
ESTATE OF CULP
DATE OF DEATH 01-17-2002
FILE NUMBER 210Z-010Z
dUC --] ':!j;{ii::l~ COUNTY CUHBERLAND
ACN 101
Amoun~ Remi~ed
REV-].&07 EX AFP (0~-0~)
MARLIN W
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credi~ ~:o your account, submit: ~he upper por~ion of ~hi; form #i~h your ~ax peymen~.
CUT ALONG THIS LINE ~ RETA'rN LONER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (01-OZ} -#. INHERITANCE TAX STATEHENT OF ACCOUNT
ESTATE OF CULP
HARLIN W FILE NO. Z1 02-0102 ACN 101 DATE 06-03-2002
THIS STATEMENT ZS PROVIDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHOWN BELOW
ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APPL/CATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPL[CABLE,
A PROJECTED /NTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-13-2002
PRINCIPAL TAX DUE:
PAYMENTS CTAX CREDITS):
11,820.q5
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
526.32
02-07-2002
Oq-01-ZOOZ
05-20-2002
CDOOO83q
CDO010ZO
REFUND
6q.70
.00
10,000.00
1,320.fi5
91.02-
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR),
TOTAL TAX CREDIT 11,820.q5
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
PAYNENT:
Detach the top portion of this Notice and submit aith your payment made payable to the name and address
printed on the reverse side.
-- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS~ AGENT.
-- If NON-RESIDENT DECEDENT make check or money order payable to: COHHONNEALTH OF PENNSYLVANIA.
REFUND (CR): A refund of a tax credit, mhich Has not requested on the Tax Return, may ba requested by completing an
· 'Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at
the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Z4-hour
ansHaring service for forms ordering: 1-800-36Z-lOS0; services for taxpayers Hith special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
REPLY TO:
Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau
of Individual Taxes, ATTN: Post Assessment Reviea Unit, Dept. lB0601, Harrisburg, PA 17liB-0601, phone
(717) 787-6505.
DISCOUNT:
If any tax due is paid aithin three [$) calendar months after the decedant's death, a five percent (SI) discount
of the tax paid is allaHad.
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.
[NTEREST:
Interest is charged beginning Hith first day of delinquency, or nine (9) months and one ([) day from the date of
death, to the date of payment. Taxes ehich became delinquent before January l, 198Z bear interest at the rata of
six (6Z) percent par annum calculated at a daily rate of .OOOl6~. AIl taxes Hhich became delinquent on and after
January l, [982 Hill bear interest at a rata Hhich Hill vary from calendar year to calendar year Hith that rata
announced by the PA Department of Revenue. The applicable interest rates for [98Z through 200Z are:
Year Interest Rate Daily Interest Factor Year Interest Rata Daily Interest Factor
198Z 20Z .0005~8 1992 9Z .000247
1983 [6X .000438 I993-199~ 7X .000192
1984 11Z .000301 1995-1998 9Z .000247
1985 13Z .000356 1999 7Z .00019Z
1986 IOZ .O00ZT~ ZOO0 8Z .000Z19
1987 9Z .000Z47 ZOO1 9Z .000247
1988-1991 llZ .0D0301 ZOOZ 6Z .00016~
--Interest is calculated as folloHs:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DEL/NQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent Hill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sheen on the
Notice, additional interest must ba calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
MARLIN W. CULP
Date of Death: January 17~ 2002
Will No. 2002-00102
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, ! report the following with respect to completion of
the administration of the above-captioned estate:
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 x 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
Cerk of the Orphans' Court and may be attached to this report.
Date: Dec. 12~ 2002
/
J. Robert Stauffer
Name (Please t~pe or print)
~_. Market Square Blag.
- Mechanicsburg, PA 17055
'' Address
~17 )766-9673
Tel. No.
Capacity: _
_ Personal Representative
(MAH:rmf/AM3)
x Counsel for personal
representative
FAMILY SETTLEMENT AGREEMENT
AND FINAL RELEASE IN THE
ESTATE OF ISABELLE H. MILLER, DECEASED
SOCIAL SECURITY NUMBER 159-24-9029
DATE OF DEATH: NOVEMBER 3, 2002
CUMBERLAND COUNTY NO. 21-02-1002
KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, ISABELLE H.
MILLER (Social Security Number 159-24-9029), late of 100 Mt. Allen Drivel Mechanicsburg,
Cumberland County, Commonwealth of Pennsylvania, deceased, died testate on November 3,
2002, having first made her Last Will and Testament, which was duly executed and witnessed on
February 2, 1998, and was duly probated and recorded in Cumberland County, Register of Wills;
WHEREAS, the said ISABELLE H. MILLER, by the aforesaid Last Will and
Testament, named G. DAVID GERMEYER as Executor and Personal Representative of her
Last Will and Testament;
WHEREAS, Letters Testamentary on the Estate of the Decedent were duly issued by the
Register of Wills of Cumberland County, Commonwealth of Pennsylvania, to the Executor G.
DAVID GERMEYER on November 8, 2002;
WHEREAS, the said ISABELLE H. MILLER was survived by two (2) children: G.
DAVID GERMEYER and DONALD RODERICK GERMEYER; a niece: FRANCES
FELTON; and a sister: LIBBY FELTON.
WHEREAS, the said Executor (hereinafter referred to as personal representative) has
gathered the assets of the Estate of the Decedent and the assets consist of personal property with
a total Gross Taxable Estate of $515,873.28 (Five Hundred Fifteen Thousand Eight
Hundred Seventy Three and 28/100 Dollars), as set forth in detail in Schedule "A" and the
Inventory filed with this Family Settlement Agreement, which is a statement of account of the
said personal representative and which is attached hereto.
WHEREAS, the debts, expenses of administration, deductions, family exemption (if
applicable) and attorneys' fees, including the payment of inheritance tax and fees in the said
Estate as set forth in detail in the following Schedules leave a net balance of $438,058.85 (Four
Hundred Thirty Eight Thousand Fifty Eight and 85/100 Dollars) in assets for distribution
pursuant to Decedent's Last Will and Testament. The heirs, however, have agreed to maintain an
Escrow of approximately $50,000.00 (Fifty Thousand and 00/100 Dollars) until November 15,
2003, leaving for immediate distribution the sum of $388,058.85 (Three Hundred Eighty Eight
Thousand Fifty Eight and 85/100 Dollars).
WHEREAS, the net balance for distribution shall be distributed as indicated herein in
accordance with the Last Will and Testament of said Decedent which directed that all remaining
real estate and personal property owned by the Decedent at the time of death together with all
insurance policies naming the Estate as beneficiary shall be distributed as follows:
(1) Fifty (50%) Percent to G. DAVID GERMEYER;
(2) Twenty Five (25%) Percent to DONALD RODERICK GERMEYER;
(3) Fifteen (15%) Percent to FRANCES FELTON; and
(4) Ten (10%) Percent to LIBBY FELTON.
NOW, THEREFORE, KNOW YE, that we: G. DAVID GERMEYER, DONALD
RODERICK GERMEYER, FRANCES FELTON AND LIBBY FELTON being the only
heirs of the Decedent and being the persons entitled to inherit under the Last Will and Testament
hereby acknowledge that they have on this day received from the aforesaid personal
representative, in full satisfaction and payment of all sum or sums of money, legacies, bequests,
and devises as are given, devised and bequeathed to me respectively by the Last Will and
Testament, the full and complete amount due us under the said statute, which we have received
this day, and which items are set forth in the Table and Schedule of Distribution attached hereto
as Schedule "C".
AND we do hereby stipulate that in order to avoid the expense and time involved in the
filing of a formal account and schedule of distribution, we agree that no final account is
necessary and do hereby agree that we do consent to distribution being made without the filing of
an account, inventory and schedule of distribution, the same to be with the same force and effect
as if they had been filed and confirmed by the Orphans' Court Division of the Court of Common
Pleas for Cumberland County.
THEREFORE, we do hereby remise, release, quitclaim and forever release and
discharge the said personal representatives, G. DAVID GERMEYER, his heirs, executors,
administrators, employees, agents, servants, attorneys and assigns of and from all actions, suits,
payments, surcharge actions, accounts, reckonings, claims and demands whatsoever for or by
reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the Estate
of the Decedent, and we do further hereby covenant and agree that should any legally enforceable
liability come due to the Estate of the Decedent after the signing of this Agreement, we do
hereby covenant and agree that we shall contribute our share of the Estate to satisfy any and all
claims, demands, suits, or causes if action which may be successfully prosecuted against the said
Estate or the aforesaid personal representatives after the signing, sealing and delivery of this
Family Settlement Agreement and Final Release.
We acknowledge that we have had the opportunity to review these documents and
Schedules prior to signing them on the date set forth below.
IN WITNESS WHEREOF INTENDING TO LEGALLY BOUND, we have hereunto
set our hands and seals this t0 day of
BY:
~~,. WITNESS:
G. DAVID GERMEYEI~, Executor
and in his individual capacity as Heir
BY:
~ _.,._ 0.1.. ~0. ,~l.~.~--~-_- -_;: *~_-~/ WITNESS:
DONALD RODERICK GEI~VIEYER
FRANCES FELTON
g~q ~'~/ ,2003.
WITNESS: ~~
BY:
LIBBY FE~TON
WITNESS:
STATE OF Q~.tttXSq~ [~tl~4~'~./~
COUNTY OF C--u. ~
On this, the (~'T [~day of
IC'LIyfcL~ 2003, before me, a Notary
Public, the undersigned officer, personally appeared G. DAVID GERMEYER (known to me or
satisfactorily proven) to be the persons whose names are subscribed to the within document and
acknowledged that they executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal
Notary Public
My Commission Expires:
Notarial Seal
Befit T Howell, Notary Public
New CumberlaBd Bom. Cumberland County
My Commission Expires May 10, 2005
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ¢~,,~ 4,. [ ,~ d
On this, the ~' ~"~day of
SS
2003, before me, a Notary
Public, the undersigned officer, personally appeared DONALD RODERICK GERMEYER
(known to me or satisfactorily proven) to be the persons whose names are subscribed to the
within document and acknowledged that they executed the same for the purposes therein
contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal
Notary Public
My Commission Expires:
Notarial Seal
Befit T. Howell, Notary Public
N,,w Cumberland Bom, Cumberland County
My Commission Expires May 10, 2005
IV{~m~0~, ~ ~on ot Notan~
SS
Public, the undersigned officer, personally al~peared FRANCES FELTON (known to me or
satisfactorily proven) to be the persons whose names are subscribed to the within document and
acknowledged that they executed the same for the purposes therein contained. IN WITNESS
WHEREOF, I hereunto set my hand and official seal
BY:
Notary Public
My Commission Expires:
s~rxr~ o~ ~o .
co~r¥ o~ 't) 0,,, i~:,,~,, i
SS
On this, the { Ow` day of 2003, before me, a Notary
Public, the undersigned officer, personally appeared LIBBY FELTON (known to me or
satisfactorily proven) to be the persons whose names are subscribed to the within document and
acknowledged that they executed the same for the purposes therein contained. IN WI-,TNESS
WHEREOF, I hereunto set my hand and official seal
Notary Publi~/ ~////~
My Commission Expires:
My Commission Expires JAN. 27', 2001
SCHEDULE A: LIST OF DECEDENT'S ASSETS ON DATE OF DEATH
Real Estate: Total Value Tax Value
None
Personal Property; Total Value Tax Value
1. Waypoint Bank Account $ 95,562.60 $ 95,562.60
2. Citizens Bank Account (6100716783) $122,301.94 $122,301.94
3. Citizens Bank Account (6100706273) $ 29,802.93 $ 29,802.93
4. Decedent's Cash $ 89.60 $ 89.60
5. Verizon Refund $ 10.44 $ 10.44
6. Nathan & Lewis Securities (Brokerage Account) $232,480.43 $232,480.43
7. Fackler Refund $ 3.00 $ 3.00
8. Series E Savings Bond $ 25.00 $ 25.00
9. Series E Savings Bond $ 25.00 $ 25.00
10. Harris (now Waypoint) CD 244428 $ 17,206.91 $ 17,206.91
11. Harris (now Waypoint) CD 244427 $ 17,247.70 $ 17,247.70
12. Heritage Medical Group Refund $ 188.55 $ 188.55
13. United Healthcare Refund $ 854.71 $ 854.71
14. Deposit Closing Debit $ 24.45 $ 24.45
15. Stock Dividend $ 50.02 $ 50.02
$515,873.28 $515,873.28
SCHEDULE B: DEBTS, DEDUCTIONS,
ADMINISTRATION EXPENSES, ATTORNEYS' FEES, AND OTHER
DEDUCTIBLE ITEMS
Costs
7.
8.
9.
10.
11.
12.
13.
and Deductions Paid By or For the Estate:
Payee Amount
Steven Howell, Esquire
$10,250.00 Legal Fees
$ 34.50 Reimburse Costs (276 Copies at. 125¢ Per Copy)
$ 188.59 Reimburse for Patriot News Ad (12/19/02)
$ 75.00 Reimburse for Cumberland Reporter (12/13/02)
$ 398.00 Reimburse for Register of Wills (11/8/02)
$ 120.00 Federal Express Packages (6)
$ 15.85 Reimburse Costs (Postage)
$11,081.94
Executor's Commission
Payable to G. David Germeyer (3.0% of Gross Estate)
Register of Wills
Filing Fee for Family Settlement Agreement $ 17.00
Additional Fee Since Estate Exceeded Initial Estimate of
$450,000.00 (See Petition for Probate) $ 35.00
Pharmerica $ 440.22
Messiah Village $ 5,866.40
$5,449.90 (12/9/02)
$ 416.50 (12/11/02)
$5,866.40
Paul Dalbey $ 30.00
Susquehanna Surgeons $ 8.98
G. David Germeyer $ 8.84
Heritage Medical Group $ 179.57
Funeral Home (Wiedeman) $ 1,545.00'
Funeral Home (Wiedeman) $ 97.00
United States Treasury (2002 Federal Income Tax) $ 9,416.00'*
Pennsylvania Department of Revenue (2002 Income Tax) ~
TOTAL ESTATE EXPENSES $45,726.95
$11,081.94
$15,475.00
Prepaid.
$3,000.00 Paid Through Estimated Tax Payments While $6,416.00 Due by
April 14, 2003.
SCHEDULE C: TABLE OF DISTRIBUTION FOR PROPERTY
DISTRIBUTION TO HEIRS
Fifty (50%) Percent of $388,058.85 to G. DAVID GERMEYER or $194,029.42.
Cash from Estate Checking Account $176,756.72
Series EE Bond $ 25.00
CD 244472 $ 17,247,70
$194,029.42
Twenty Five (25%) Percent of $388,058.85 to DONALD RODERICK GERMEYER or
$97,014.71.
Cash from Estate Checking Account $ 79,782.80
Series EE Bond $ 25.00
CD 244472 $ 17.206.91
$ 97,014.71
Fifteen (15%) Percent of $388,058.85 to FRANCES FELTON or $58,208.83.
Cash from Estate Checking Account $ 58,208.83
Ten (10%) Percent of $388,058.85 to LIBBY FELTON or $38,805.89.
Cash from Estate Checking Account $ 38,805.89
CALCULATION OF INHERITANCE TAX OWED
Gross Assets $515,873.28
Less Estate Expenses $ 45.726,95
Net Assets Subject to PA Inheritance Tax $470,146.33
75% of Assets Subject to 4.5% Tax for $352,609.74
(Assets passing to children or lineal decedents are taxed at 4.5%)
10% of Assets Subject to 12% Tax for $47,014.64
(Assets passing to sibling are taxed at 12%)
15% of Assets Subject to 15% Tax for $70,521.95
(Assets passing to collateral heirs are taxed at 15%)
TAX DUE AND PAYABLE TO THE COMMONWEALTH
$ 32,087.48
4.5% of $352,609.74 is $15,867.44
12% of $47,014.64 is $ 5,641.75
15% of $70,521.95 is $10,578.29
$32,087.48
ESCROW FOR CONTINGENT LIABILITIES
NET AMOUNT FOR IMMEDIATE DISTRIBUTION
$ 50.000.00
$388,058.85
SCHEDULE OF DISTRIBUTION FROM ESTATE ACCOUNT
Payee
1.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Steven Howell, Esquire
$10,250.00 Legal Fees
$ 34.50
$ 188.59
$ 75.00
$ 398.00
$ 120.00
$ 15.85
$11,081.94
Executor's Commission
Reimburse Costs (276 Copies at. 125¢ Per Copy)
Reimburse for Patriot News Ad (12/19/02)
Reimburse for Cumberland Reporter (12/13/02)
Reimburse for Register of Wills (11/8/02)
Federal Express Packages (6)
Reimburse Costs (Postage)
Amount Check #
Payable to G. David Germeyer (3.0% of Gross Estate)
Register of Wills
Filing Fee for Family Settlement Agreement
Additional Fee Since Estate Exceeded Initial Estimate of.
$450,000.00 (See Petition for Probate)
Pharmerica
Messiah Village
$5,449.90 (12/9/02)
$ 416.50 (12/11/02)
$5,866.40
Paul Dalbey
Susquehanna Surgeons
G. David Germeyer
Heritage Medical Group
United States Treasury (2002 Federal Income Tax)
$ 11,081.94
$ 15,475.00
$ 17.00
$ 35.00
$ 440.22
$ 5,866.40
Pennsylvania Department of Revenue (2002 Income Tax)
G. David Germeyer
Donald R. Germeyer
Frances Felton
Libby Felton
Pennsylvania Department of Revenue (Inheritance Tax)
TOTAL CHECKS
$ 30.00
$ 8.98
$ 8.84
$ 179.57
$ 1,000.00'
$ 6,416.00
$ 1,526.00
$176,756.72
$ 79,782.80
$ 58,208.83
$ 38,805.89
$ 32,087.48
$427,726.67
101 (12/9/02)
102 (12/9/02)
106 (12/11/02)
103 (12/9/02)
104 (12/9/02)
105 (12/9/02)
107 (12/17/02)
108 (1/11/03)
Prior to Death Decedent made estimated tax payments of $500.00 on 4/9/02; $500.00 on
6/8/02 and $1,000.00 on 9/7/02 towards her 2002 Federal Income Tax Liability. On
1/11/03 another payment of $1,000.00 was made by the Estate towards this liability due
April 15, 2003.
ESTATE CHECKING ACCOUNT TRANSACTIONS
Date of Deposit
11/15/02
11/15/02
11/15/02
12/4/02
12/4/02
12/4/02
12/14/02
12/27/02
1/31/03
2/1/03
2/28/03
Amount
$ 29,802.93
$122,301.94
$ 95,562.60
$ 89.60
$ 10.44
$232,480.43
$ 3.00
$ 24.45
$ 854.71
$ 188.55
$ 50.02
$481,368.67
Checks
101
102
106
103
104
105
107
108
109
110
111
112
113
114
115
116
117
118
119
Amount
$ 440.22
$ 5,449.90
$ 416.50
$ 30.00
$ 8.98
$ 8.84
$ 179.57
$ 1,000.00
$ 15,475.00
$ 11,081.94
$ 17.00
$ 35.00
$ 6,416.00
$ 1,526.00
$ 32,087.48
$176,756.72
$ 79,782.80
$ 58,208.83
$ 38.805.89
$427,726.67
SURPLUS LEFT IN ACCOUNT
Source
Citizen Bank Account
Citizen Bank Account
Waypoint Bank
Decedent's Cash
Verizon Refund
Nathan & Lewis Securities (Brokerage Proceeds)
Fackler Refund
Deposit Closing Debit
United Healthcare Refund
Heritage Medical Group Refund
Stock Dividend
TOTAL DEPOSITS
Reason
Pharmerica (12/9/02)
Messiah Village (12/9/02)
Messiah Village (12/11/02)
Paul Dalbey (12/9/02)
Susquehanna Surgeons (12/9/02)
G. David Germeyer (12/9/02
Heritage Medical Group (12/17/02)
U.S. Treasury (1/11/03)
G. David Germeyer (Executor's Commission)
Steven Howell, Esquire (Fees & Costs)
Register of Wills (Filing Fee)
Register of Wills (Surplus Filing Fee)
U.S. Treasure (2002 Income Tax)
PA Department of Revenue (2002 Income Tax)
PA Department of Revenue (Inheritance Tax)
G. David Germeyer (50% Distribution)
Donald R. Germeyer (25% Distribution)
Frances Felton (15% Distribution)
Libby Felton (10% Distribution)
CHECKS WRITTEN ON ACCOUNT
$481,368.67
$427.726,67
$ 53,642.00*
TOTAL DEPOSITS
TOTAL CHECKS WRITTEN
* Difference Between $50,000.00 Escrow Listed on Schedule "C" and Surplus is described
in the following paragraph. Certain expenses for the Estate are deductible when calculating
Inheritance Tax. For example, the funeral expenses of $1,642.00 to Wiedeman Funderal Home
were prepaid before Decedent's death, however, they are deductible to the Estate, Naturally, the
Estate did not have to "pay" the $1,642.00 out of the Estate Checking Account. Therefore, it
operates as a "surplus" in the account. Also, the Estate is entitled to deduct the $2,000.00 in
estimated tax payments made by the Decedent during her life but which is a debt due the Estate.
Adding the $2,000.00 in estimated tax payments in 2002 and the prepaid funeral expenses of
$1,642.00 comes to $3,642.00. This is why the Estate Account has a balance of $53,642.00
instead of $50,000.00
WORKSHEET FOR CLIENT TO DRAFT CHECKS
BALANCE IN ACCOUNT $473,834.66 STATEMENT ENDING 2/19/03
109 $ 15,475.00
110 $ 11,081.94
111 $ 17.00
112 $ 35.00
113 $ 6,416.00
114 $ 1,526.00
115 $ 32,087.48
116 $176,756.72
117 $ 79,782.80
118 $ 58,208.83
119 $ 38.805.8~
$ 53,642.00
G. David Germeyer (Executor's Commission)
Steven Howell, Esquire (Fees & Costs)
Register of Wills (Filing Fee)
Register of Wills (Surplus Filing Fee)
U.S. Treasure (2002 Income Tax)
PA Department of Revenue (2002 Income Tax)
PA Department of Revenue (Inheritance Tax)
G. David Germeyer (50% Distribution)
Donald R. Germeyer (25% Distribution)
Frances Felton (15% Distribution)
Libby Felton (10% Distribution)
ACCOUNT BALANCE AFTER ABOVE
CHECKS ARE WRITTEN
SURPLUS LEFT IN ACCOUNT
$481,368.67
$ 53,642.00
TOTAL DEPOSITS
TOTAL CHECKS WRITTEN