HomeMy WebLinkAbout04-0444Estateof J. Fred Weaver
also known as
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
, Deceased Social Security No. 205 - 16 - 3127
Jeffrey P. Weaver
Petitioner(s), who is/are 18 years of age or older, apply(les) for: '04 {~]~¥ -5 ? ] :23
(COMPLETE 'A' or 'B' BELOW:)
the[~]De A. Probate and Grant of Letters Testamentary and ave~h~.~ Petitioner(s) is/are the execut namsd in the last Will of
cedent, dated 07/15/20~h~ codicil(s) dated No~'I~ ~ ~ ~:~'~ ~ ~' ' ~ ....
none
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
none
B. G rant of Letters of Administration
(c.t.a.; d.b.n.c.ta; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
County, Pennsylvania with his/her last family
or principal residence at Messiah Village,
Decedent, then g;~ )/ears of age, died
05/01/200%t
Upper Allen Township, Mechanicsburs, PA
(liststreet, number, andmunicipal~)
Holy Spirit Hospital, PA
(Location)
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
17055
500,000.00
situated as follows: none
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
Si~lnature ..~
Typed orprinted nameandresidence
Jeffrey P. Weaver
512 Wayne Drive, Mechanicsburs, PA 17055
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991)
Oath of Personal RepresentatiVe
Commonwealth of Pennsylvania
County of Cumberland
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 representative(s) of
the Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~
~.~?-,,~ J~ f~ey ~.
before me thls~ day of
Weaver,
NO,
Estateof J. Fred Weaver Deceased
Social Security No: 205 - 16 - 3 l:;][J~te of Death: 05/01/2004
AND NOW, .~__z:~. ~/~~-'~ , ~_~, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters [~tamentary ~ministration
(c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durants minoritats)
are hereby granted to Jeffrey P. Weaver
in the above estate and that the instrument(s) dated
07/15/2003
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
ShoR Ce~ificats(s) ..... $
Renunci~ion ........ $
// ~'~ ' Re(~ster of Wills
Attorney: John E. Sltke
Affidavits ( ) .... $
Extra Pages ( ) .... $
I.D. No: 06262
Saidis, Shuff, Flower & Lindsay
Address: 2109 Market Street
Codicil ........... $
JCP Fee .......... $
Camp Mill, PA 17011
Telephone: 717/737 - 3405
Inventory .......... $
Other ........... $
TO A, .........
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
5.805 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
h)cal 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.
Fee for this cer[ificate, $2.00
HAY 0 2
Date
~105 143 Rev. 2/87
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
~ CERTIFICATE OF DEATH ' k Weaver
Nu~mg
· o~£rrey p. Weaver
B~ [] c~m~ ~ ~m s,ae [] Dr. 7055
,~orktowne Crematory 4 "a"c~
cerbry cause of death, firce of ~alh to
WhO p~'of~O~tlCe$ death.
231.
Yes ' No []
PART I1: significent conditions conbibuting to death, but
no~ resufl~g irt the underlying cause given in PART
Homicide []
, ff Accidenl[] Per~ing Jnvestigeliofl []
Ye, [] No [ Ye, [] No Suicide [] CouJd not I~ dete.nicecl 30,.
30b, M
:, factor/, office
°MEDICAL EXAIdINER/CORONER ......... []
On the ball. of .... In.on .nd/or Inve.flga.on, in my opinion, death OCCurred It the .me, date, end pi ...... d due to the ~ ~.~. 8.e~..8. ! .~ .d.' []
WILL
OF
J. FRED WEAVER
I, J. FRED WEAVER, currently of Upper Allen Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all
prior Wills and Codicils made by me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath all tangible personal property which I own at my death unto my four (4)
children, namely, Jeffrey, Michael, Jane and Barbara, to be divided among them as they see
best.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I bequeath equally
unto my four (4) children, Jeffrey, Michael, Jane and Barbara, or their issue per stirpes. If
any child predeceases me leaving no issue, that share shall lapse and be divided equally
among my other children or their issue per stirpes.
V. I appoint my son, Jeffrey P. Weaver, Executor of this my Will. In the event that he
fails to qualify or ceases to act as Executor, I appoint my son, Michael R. Weaver, Executor
of this my Will.
VI. I direct that no bond be required of my fiduciary for the faithful performance of his
duties in any jurisdiction.
-1-
Last Will, typewritten on two (2) sheets
signatures of witnesses, this/_~-/x, day of
IN WITNESS WHEREOF, I, J. FRED WEAVER, herewith set my hand to this my
of paper including the attestation clause and
~-r'-o c ~' ,2003.
D WEAVER
Signed by J. FRED WEAVER~ by him declared to be his Will in our presence, who
have hereunto subscribed our names as witnesses in his presence and at his request, this
day of ...J'--o ~ q ,2003.
residing at
residing at
-2-
COMMONWEALTH OF PENNSYLVANIA ·
COUNTY OF k-I~l~q/,,/ot4 ·
the testator and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly affirmed, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his Last Will and that he
signed willingly (or willingly directed another to sign for him), 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
our knowledge the testator was at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
J.~F'-RED_WF~AVER
WfTfiESS - - /
Subscribed, sworn or affirmed and acknowledged.before me by J. FRED WEAVER,
the testator, GERALD J. BRINSER and --~r~rc ~.'~)0/'~__ , witnesses, this
l~¥4nday of (~~J--,, 2003·
~'y Public(f)
_WE'lL CRAWFORD, N~a~ ~b~
P~mym Bom., Lebanon Coun~
C~m~ ~ g~ 10, 2~
-3-
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
J. Fred Weaver
Date of Death:
May 1, 2004
Will No. 21-04-0444
Admin. No. 2004-00444
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 beneficiaries of the above-
captioned estate on June "7~'Yh , 2004.
Name Address
Jeffrey P. Weaver
Jane R. Lawrence
Barbara J. Cone
Michael R. Weaver
512 Wayne Drive, Mechanicsburg, PA 17055
108 Main Street, P.O. Box 21, Francestown, NH 03043
307 Tappan Street, No. 2, Brookline, MA 02445
183 Elm Street, New Columbia, PA 17856
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
none
Date:
s~0hn ~-~like, Esquire'
IDIS, SHUFF, FLOWER & LINDSAY
9 Market Street
Camp Hill, PA 17011
(717) 737-3405
Capacity:
Personal Representative
X Counsel for Personal ~--
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OFINDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17228-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11-96)
NO. CD 004203
SLIKE JOHN E
2109 MARKET STREET
CAMP HILL, PA 17011
........ fold
ESTATE INFORMATION: SSN: 205-16-3127
FILE NUMBER: 2104-0444
DECEDENT NAME: WEAVER J FRED
DATE OF PAYMENT: 07/27/2004
POSTMARK DATE: 07/26/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/01/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $35,000.00
REMARKS:
TOTAL AMOUNT PAID:
$35,000.00
SEAL
CHECK# 1005
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, PA 17011
, Wii!s
'~ J~ 27 P2:33
; ?~,~i.s~te~r~o~f ~WjI~)s COUNTY COURTHOUSE
One Courthouse Square
Carlisle, PA 17013
i,,,tll,.llt,.,.Ih,tJ,,,th-lhhi-"hll'h'hh'"lhl
REV-1500 EX+ (6.00)
.
'.
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FilE NUMBER
II 04
cout'JTY CODE YEAR
SOCIAL SECURITY NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Weaver, J Fred
. DATE OF DEATH (MM-DD-YEAR)
205-16-3127
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
0444
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 2. Supplemental Return
[] 4a.
[I 7
I 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (dale ofdealh belween 11 . Election to tax under Sec. 9113(A) (AIlach Sch 0)
12-31-91 and 1-1-95) ,__
hHISSECTI6NMtlSfBECOMPLEle6:':Al.:GCOI!ReSi10l{OeNGIi:~plCpf,li;!!1ef,l:l:i'\ufAX.if,li;oRMA,TIOf,lSHOUi:psli,i:IIfl,ECfEO,lP:
NAME 'COMPLETE MAILING ADDRESS
i John ~.~likeLl=:sq.
FIRM NAME (If applicable)
Said is, Shuff, Flower & Lindsay
DATE OF BIRTH (MM-DD-YEAR)
05-01-2004
05-01-1916
I (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
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L){_!1. Original Return
l__ 3. Remainder Retum (dale 01 death prior to 12-13-82)
'---! 4. Limited Estate
Fulure Inlerest Compromise (date ofdealh after
12-12-82)
Decedent Maintained a Living Trust (Attach
copy of Trust)
5 Federal Estate Tax Return Required
~j 6. Decedent Died Testate (Attach
CDPY of Will)
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rrELEPHONE NUMBER
(717) 737-3405
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
C Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) [J Separate Billing Requested
8. Total Gross Assets (total Lines 1.7)
9. Funeral Expenses & AdministraUve 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)
o 8 Total Number of Safe Deposit Boxes
2109 Market Street
Camp Hill, PA 17011
(1)
(2)
None
OFFICIAL USE ONLY
646,449.18
(3) None
(4) None
(5) 126,374.80
(6) None
(7) 128,375.66
(8)
(9) 17,179.92
(10) 5,562.36
(11)
(12)
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)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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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
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
0.00
x .00 (15)
878,457.36
x .045 (16)
0.00
0.00
x .12 (17)
0.00
x .15 (18)
(19)
>> aE:SURE.TO ANSWERALL.QUESTIONS'ON REVE.RSE SIDE AND RECHECK MATH <( . .
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901,199.64
22,742.28
878,457.36
0.00
878,457.36
0.00
39,530.58
0.00
39,530.58
0-
Copyright 2002 form software only The Lackner Group, Inc.
Form REV.1500 EX (Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
Messiah Village
Mechanicsburg
--,-
I STATE
CITY
PA
ZIP 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
39,530.58
-35,000.00
1,842.11
Total Credits (A + B + C)
(2)
36,842.11
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
2,688.47
2,688.47
Make Check Payable to: REGISTER OF WILLS, AGENT
mu~"""'~':!1W'!1m;IIIi!a!I!&!l~.~;ilimffi!l.I1lWr-"'!:!S_~&l~ID.' i1JlW1 m=1=IIIII~~_
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;... ............................. .....................................
b. retain the right to designate who shall use the property 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? ................................. ........................................... ... ............. ............. ... .... j!
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... L-i
4. Did decedent own an Individual Retirement Account, annuity, or other non~probate property which
contains a beneficiary designation?.............................................................................. ....................................... ~ [J
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 ellamined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and
cEffiplete. Deciaratloo of preparer oth'?U!l~n the personal representatlV_e IS based an alllOformalion of which pr~~~~.~~~y~l}_o~tedQe. __
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Jeffre p.wea~
F P SON RESPONSIBLE FOR FILING RETURN
Yes
,__I
LJ
o
o
No
Xl
~I
x'
L"J
[!]
[!]
'x
~i
DATE
512 Wayne Drive
Mechanicsburg, PA 17055
ADDRESS
9
/
SIGNATURE PREPARER OTHER THAN REPRESENTATIVE
John . Slike Esq.
ADDRESS
<
2109 Market Street
Camp Hill, PA 17011
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net
surviving spouse is 3% [72 P,S. 39116 (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. 99116 (a) (1.1) (ii)l. The statute does not exemot 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. 99116 (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.
39116 1.2) [72 P.S. 39116 (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_15D3EX: (6-98)
'.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX f<ETURN
RESIOENTDECEOENT
FILE NUMBER
21-04-0444
ESTATE OF
Weaver, J Fred
All property jointly-owned with rIght of survIvorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 1,000 sh. Van Kampen Equity Trust, Select Growth 4,520.00
Fund CI B at 4.52 - PNC Investment Acct 86496113
2 10,000 units Bell Atlantic Fin. Services, due 3/15/07, at 11,210.40
12.104 - PNC Investment Accl. 86496113
3 100 sh. AUlant Energy Corp., at 24.86 - PNC Investment 2,486.00
Accl. 86496113
4 120 sh. Amer Electric Power Co., at 30.44 . PNC 3,642.80
Investment Accl. 86496113
5 120 sh. Archer Daniels Midland Co., at 17.56. PNC 2,107.20
Investment Accl. 86496113
6 150 sh. AT&T Corp. at 17.15. PNC Investment Accl. 2,572.50
86496113
7 174 sh. Ford Motor Co., at 15.36. PNC Investment 2,672.64
Accl. 86496113
8 1838 sh. SBC Communications, at 24.90 - PNC 45,766.20
Investment Accl. 86496113
9 1986.577 sh. Scudder US Govl. Securities, CI A, at 8.53 16,945.50
- PNC Investment Accl. 86496113
10 20,000 units Financing Corp. CPN, due 1/27/06, at 18,493.20
92.466 - PNC Investment Accl. 86496113
11 200 sh. FPL Group, Inc., at 63.62 . PNC Investment 12,724.00
Accl. 86496113
12 22000 units Resolution FDG Corp., due 10/15/04, at 21,873.28
99.424 - PNC Investment Accl. 86496113
Total of Continuation Schedule( ) See attached
pagels)
TOTAL (Also enter on Line 2, Recapitulation) 646,449.18
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-15aa Schedule B (Rev. 6-98)
,Rev.15D3 EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J Fred
FILE NUMBER
21-04-0444
ESTATE OF
ITEM CUSIP
NUMBER NUMBER
13
DESCRIPTION
UNIT VALUE
VALUE AT DATE
OF DEATH
24,000 units Financing Corp. CPN, due 6/6/07, at
90.587 - PNC Investment Ace!. 86496113
21,740.88
14
241 sh. AT&T Wireless, at 13.81 - PNC Investment
Ace!. 86496113
3,328.21
15
242 sh. Comcast Corp., CI A, at 30.16 - PNC Investment
Ace!. 86496113
7,298.72
16
2473.498 sh. Blackrock FDS, PA Tax Free Income
Portfolio, CI A, at 10.60 - PNC Investment Ace!.
86496113
26,219.07
17
25,000 units Bear Sterns Co., at 101.725 - PNC
Investment Ace!. 86496113
25,431.25
18
2596.26 sh. Eaton Vance Mutual Fd, Tax Management
Value Fund, at 12.37 - PNC Investment Ace!. 86496113
32,115.73
19
30,000 units Financing Corp. CPN, due 12/6/06, at
92.722 - PNC Investment Ace!. 86496113
27,816.60
20
300 sh. Marshall & IIsley Corp., at 36.77 - PNC
Investment Ace!. 86496113
11,031.00
21
38 sh. CitiGroup, Inc., at 48.09 - PNC Investment Ace!.
86496113
1,827.42
22
4,635 units Van Kampen Focus Portfolio 392, Unit
Select, at 12.0441 - PNC Investment Ace!. 86496113
55,824.40
23
4 sh. Five Star Quality Care, at 4.50 - PNC Investment
Ace!. 86496113
18.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
, Rev-1503 EX+ (6-9B)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANiA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J Fred
FILE NUMBER
21-04-0444
ESTATE OF
ITEM CUSIP
NUMBER NUMBER
24
DESCRIPTION
UNIT VALUE
VALUE AT DATE
OF DEATH
40 sh. Senior Housing Properties Trust, at 14.95 - PNC
Investment Ace!. 86496113
598.00
25 400 sh. Bristol Myers Squibb, at 25.10 - PNC 10,040.00
Investment Ace!. 86496113
26 421 units Van Kampen Focus Portfolio 397, 4,598.24
Competitive Edge, at 10.9222 - PNC Investment Ace!.
86496113
27 489.76 sh. Scudder Portfolio Income Fund, CI A, at 6,259.13
12.78 - PNC Investment Ace!. 86496113
28 5,000 units Federal Home Loan Mtg. Corp., due 566.62
12/15/06, at 100.0128. PNC Investment Ace!. 86496113
29 5,026.273 sh. Eaton Vance Mutual Funds Trust, Tax 32,821.56
Management Int'l Growth, at 6.53 - PNC Investment
Ace!. 86496113
30 5,193.969 sh. Scudder Man. Mutual Bonds, CI A, at 9.08 47,161.23
- PNC Investment Ace!. 86496113
31 500 sh. Merck & Co., Inc. at 47.00 - PNC Investment 23,500.00
Ace!. 86496113
32 546 sh. Assoc. Bane Corp., at 40.98 - PNC Investment 22,375.08
Ace!. 86496113
33 60 sh. Medco Health Solutions, at 35.40 - PNC 2,124.00
Investment Ace!. 86496113
34 600 sh. Pfizer Inc., at 35.76 - PNC Investment Ace!. 21,456.00
86496113
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
,Rev-1503EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
continued
Weaver, J Fred
FILE NUMBER
21-04-0444
ESTATE OF
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
,
,
35 618 sh. Verizon Communications, at 37.74 - PNC 23,323.32
Investment Ace!. 86496113
36 675 sh. MDU Resources Group, at 22.40 - PNC 15,120.00
Investment Ace!. 86496113
37 700 sh. BeliSouth Corp., at 25.81 - PNC Investment 18,067.00
Ace!. 86496113
38 700 sh. VanKampen Income Trust, at 8.68 - PNC 6,076.00
Investment Ace!. 86496113
i
701.11 sh. Seligman Inc. & Growth Fund, CI A, at 11.90 I
39 8,343.20
- PNC Investment Ace!. 86496113
40 733.155 sh. Scudder Hi Income Fund, CI B, at 5.38- 3,944.37
PNC Investment Ace!. 86496113
41 800.282 sh. Blackrock FDS, PA Tax Free Income 9,330.98
Portfolio, CI A, at 10.60 - PNC Investment Ace!.
86496113
42 840.929 sh. Seligman Communications and Info. Fd., 19,332.95
CI A, at 22.99 - PNC Investment Ace!. 86496113
43 Money Market Funds - PNC Investment Ace!. 13,527.00
86496113
44 PNC Investment Ace!. #86496113 - Cash 219.50
i
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule B (Rev. 6-98)
. Rev_150B E)(+ (6-98)
'.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC,
PERSONAL PROPERTY
COMMONWEALTH OF PI:NNSYL V4NIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weaver, J Fred
FILE NUMBER
21-04-0444
JncJude the proc~ds of litigation and the dale Ihe proceeds were received by the estate.
All property Jolntly-owned with the right of survivorshIp must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
American Express credit card balance refund
56.25
2
BCIBS of Minnesota, refunds for medical expenses paid
3,021.64
3
Messiah Village, rebate for appartment
68,020.00
4
PA Dep!. of Revenue, refund of 2003 taxes
430.00
5
Refund, Brokerage Hill
25.20
6
Refund from Patriot News subscription
34.40
7
Verizon refund checks
33.99
8
PNC Bank checking ace!. #5003548285
37,259.57
9
PNC Bank savings ace!. #5002055817
16,113.75
10
Misc. personal property
1,380.00
TOTAL (Also enter on line 5, Recapitulation)
126,374.80
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+(6-98)
'.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNS'11. VANIA
INHERlTANCETAX RETURN
RESIDENT DECEDENT
Weaver, J Fred
FILE NUMBER
21-04-0444
ESTATE OF
This scheudule must be completed and flied if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes
ITEM DESCRIPTIDN OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE
1 Allstate Life Insurance, annuity contract #428537 16,623.46 16,623.46
2 Allstate Life Insurance, annuity contract #428543 31,762.96 31,762.96
3 Equi-Vest, annuity 24,514.66 24,514.66
4 Met Life Investors, annuity contract 44,211.30 44,211.30
#32010132461
5 New York Life Insurance Co., annuity contract 11,263.28 11,263.28
#N3149598
TOTAL (Also enter on Line 7, Recapitulation) 128,375.66
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
. Rev-1502 EX+ (6-9B)
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J Fred
FILE NUMBER
21-04-0444
ESTATE OF
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cremation Authorization fee 25.00
2 death certificates 40.00
3 Funeral Luncheon 205.88
4 Musselman Funeral Home 1,900.48
5 Obituary 510.48
Subtotal
2,681.84
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
REV.1151 EX+ (12-99)
'.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J Fred
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-04-0444
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,681.84
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Said is, Shuff, Flower & Lindsay 13,100.00
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 374.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,024.08
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 17,179.92
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
. Rev-1502 EX+(6-9B)
COMMONWEALTH OF PENNSYLVAN~
INHERITANCE TA.XRETURN
RESIDENT DECEDENT
SCHEDULE H.87
OTHER
ADMINISTRATIVE COSTS
continued
Weaver, J Fred
FILE NUMBER
21-04-0444
ESTATE OF
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
C.O.H. - maintenance for place of disposition of decedent's remains
500.00
2
Clothing for interment
70.93
3
Cumberland Law Journal - estate notice
75.00
4
Death announcements
17.92
5
Photocopy charges
5.28
6
PNC Bank, check fee
97.60
7
Register of Wills - short certificates
9.00
8
The Patriot News - estate notice
248.35
Subtotal
1,024.08
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
, Rev.1512~X+(6.98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COI\IMONWEAL TH' OF PENNSYLVANIA
INHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Weaver, J Fred
FILE NUMBER
21-04-0444
IncludE! unrelmbursed medical 8Kpenses.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE
OF DEATH
Associated Cardiologists
12.18
2
BP, Motor Club - past due bill at death
25.50
3
Central PA Hematology and medical Oncology Assoc.
63.24
4
Central PA Hematology and medical Oncology Assoc.
46.18
5
Internists of Central PA
138.54
6
Internists of Central PA
47.46
7
Jackson Gastroenterology
69.04
8
Messiah Village
755.00
9
National Magazine Exchange - past due bill at death
268.32
10
PA Neurology Assoc.
48.33
11
PNC Bank, checks which cleared decedent's account after date of death
2,788.29
12
PPL Electric
10.68
13
Siegelman, Gunder & Larey Gastroenterology
21.44
14
Smith & Gesteland, preparation of 2003 tax returns
700.00
15
West Shore Pathology
16.16
16
Wisconsin Dept. of Revenue, 2003 tax payment
552.00
TOTAL (Also enter on Line 10, Recapitulation)
5,562.36
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV 1513 EX+ (9.00)
.
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Weaver, J Fred 21-04-0444
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright Sfrousal
distributions, and ransfers
under Sec. 9116(a)(1.2)]
1 Barbara J. Cone Daughter 25% of residue 219,614.34
307 Tappan Street, #2 of estate
Brookline, MA 02445
2 Jane R. Lawrence Daughter 25% of residue 219,614.34
108 Main Street
Francestown, NH 03043
3 Jeffrey P. Weaver Son 25% of residue 219,614.34
512 Wayne Drive
Mechanicsburg, PA 17055
4 Michael R. Weaver Son 25% of residue 219,614.34
183 Elm Street
New Columbia, PA 17856
Total 878,457.36
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule J (Rev. 6-98)
co?""l
WILL
OF
.1. FRED WEAVER
I, J. FRED WEAVER, currently of Upper Allen Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all
prior Wills and Codicils made by me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out ofthe principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath all tangible personal property which I own at my death unto my four (4)
children, namely, Jeffrey, Michael, Jane and Barbara, to be divided among them as they see
best.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I bequeath equally
unto my four (4) children, Jeffrey, Michael, Jane and Barbara, or their issue per stirpes. If
any child predeceases me leaving no issue, that share shall lapse and be divided equally
among my other children or their issue per stirpes.
V. I appoint my son, Jeffrey P. Weaver, Executor of this my Will. In the event that he
fails to qualify or ceases to act as Executor, I appoint my son, Michael R. Weaver, Executor
of this my Will.
VI. I direct that no bond be required of my fiduciary for the faithful perfonnance of his
duties in any jurisdiction.
~
-1-
IN WITNESS WHEREOF, I, J. FRED WEA VER, herewith set my hand to this my
Last Will, typewritten on two (2) sheets of paper including the attestation clause and
signatures of witnesses, this IS 1lo day of J (.) L r , 2003.
'----..... , Q/l J . /(-0k'4"'U..e.~(S'EAL)
.y. RED WEAVER
Signed by J. FRED WEAVER, by him declared to be his Will in our presence, who
have hereunto subscribed our names as witnesses in his presence and at his request, this
l!:fI.., day of J (.) c.. c/ ,2003.
it ~~
"//P.. . .
.... 0~;>c( /'( .~' '" L"t L ,d.e...
Al y? f
~"jlc...lc '~t"'7l ^ .-;( /'1/c
c
residing at
cd~L--.'" t ~2t!" /'}
/~, , i< /,1/.J J' f
/ /i..:,,'/,-/J''--v::.--L~ '-- L----/ /1/--/
residing at
-2-
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF Lr=.aANoN
WE, J. FRED WEAVER, GERALD J. BRINSER and S)lvn,~-K'-!~!?, I{'c
the testator and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly affimled, do hercby declare to the undersigned
authority that the testator signed and executed the instrument as his Last Will and that he
signed willingly (or willingly directed another to sign for him), 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
our knowledge the testator was at that time eighteen years of age or older, of sound mind and
under no constraint or undue influence.
U.J i'
tfc //12// {)/ ?eL~
1. FRED WEAVER
l;:-c-r/~ (l4?-LL~:-
wiTNESS, ,/
/L' :' /,
. ,', '" /0'7 /' ) /
---/- ',,'
/jc..i.Uk I(. / {J:/'L
WITNESSJ
I..
Subscribed, sworn or affinned and acknowledgec!,before me by .T. FRED WEAVER,
the testator, GERALD .T. BRINSER and ,S!' 'I"'L j /2)0 /, /'.0' witnesses this
IrdaYOf~,2003. ,-,Yl"" A'I~ +e... ' ,
U~ Ii 0.:tY"SEALJ
otary Public
NOTARIAL SEAL
WENDYl. CRAWFORD, Notary Public
Palmyra Bora., Lebanon County
Commission Expires Sept. 10,2005
-3-
PdAXA EQUITABLE
STATEMENT OF ACCOUNT
BENEFICIARY/PAYEE
ESTATE OF J FRED WEAVER
C/O JEFFREY P WEAVER
512 WAYNE AVE
MECHANICSBURG, PA 17055
BENEFICIARY
INSURED POLICY FEDERAL 1.0. PAYMENT DATE
J FRED WEAVER 1088504756 I 206-21-8986 I 11/19/2004 I
The following Statement of Account details your,
Allotted Percentage: 100%
Plan Type: NQ
Termination Date: 11/16/2004
Death Benefit: $24,508.62
Voluntary Interest: $6.04
Federal Tax Withholding: $0.00
State Tax Withholding: $0.00
Withholding State:
Non-Resident Tax Withholding: $0.00
Express mail Fee or Transfer Fee: $0.00
Net Cost: $8,500.00
*Taxable Amount: $16,008.62
Amount to Equitable Access:
Total: $24,514.66
*A report of this taxable distribution will be sent to the Internal Revenue Service, as required by law.
Total Account Breakdown for the entire death benefit, inclusive of your allotted share.
NUMBER OF
I ACCUMULATION
FUNDING ACCOUNT UNITS UNIT VALUE CASH VALUE
AXAlMOD 271 .264 53.433267 $14,494.52
GIA $10,014.10
AXA E qlitable Life Insu-ance Company
201) Plaza Drive, Secaucus, N.l1J1094
:_,.~.I~ '_
,-'rLti-;''i1
-'4.I-=.
'-,,-
~ PNCBANC
Septemher 8, 2004
.I011I1 E. Slike
2109 Market Street
Camp Hill, PA 17011
Rf' ES1Hte of J Freo Weaver, deceased
SSN 205-16-3127
DOD: 5!l/2004
Dear Me. Slike:
In re.iponse to your request for Date of Death balances for the customer noted above, our
recoros show the following:
Checking Account
Account #5003548285
Established 04/16/2003
J FRED WEAVER
DOD balance: $37,257.13 + $2.44 accrued interest
Savings Account
Account #5002055817
Established 07/29/2003
J FRED ViE A VER
DODbalancc: SI6,]10.8]" $2.94 accrued interest
The decedent maintained Investment AccOUIlt (rr.\I #86496113) for furUler information
you may call the Bmkerage Department at 1-800-762-6111.
Plea," note that tlus office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not proce05 any financial
transactiou& Or provide statements. If you need assistance with tilly of these item!),
pkasc calJ J-ggR,PNC-BANK (1-888-762-2265) or stop by your local PNC BarJ.: bnlndr
office.
Sincerely,
C?{Jj}/7.t lie (Lilli;;,
Rachdle Well,
]-80(1-762-1775
P7-PFSC-04-F
500 ftna Ave.
Pittsb\ngh PA 15119
McmhcrFDIC
TOTr~:_ P. 01
II
NEW YORK LIFE INSURi\NCE COMPANY
NEW YORK LIFE INSURi\NCE COMPANY AND ANNUITY CORPORATION
(A DELA IN ARE CORPORATION)
PO BOX 6916, CLEVELAND OIl 44101, (800) 695-9873
The Compm~v You Keep
June 16, 2004
John E Slike
Saidis Shuff Flower & Lindsay
2109 Market St
CampHillPA 17011
Re: James Weaver
Policy: N3l49598
Dear Mr. Slike:
I am pleased to forward the following tax information on the above noted annuity contract. As a form
712 in not applicable to a contract other than life insurance, the following should be of assistance to
you.
Issue Date for Annuity m~c].3., 1989
, ~
Cash Value as of May 01,200:1::- $ I 1,263.28 ~
Beneficiary - Barbara J. Cone ~
I hope that this infoffi1ation is of assistance to you. If you have any questions, please feel free to
contact me.
Sincerely,
'"""~ :...,\ .
)_'.~".L,{~)'ll~~~_ J l {'~')~"'---~L>~_,
i
Becky DeBolt. ACS
Sr. Service Associate
Cleveland Service Center
cc: File
:{ Messiah
~~I~L.AGE
Continuing Cm'e Retirement Seruices - Founded 1896
November 12, 2004
Jeff Weaver
512 Wayne Dr.
Mechanicsburg, P A 17055
Dear Jeff:
Enclosed please find a check in the amount of$68,020.00. This is the amount of the refund for
the apartment occupied by J. Fred Weaver at 754 Oak Oval, Messiah Village. If you have any
questions regarding the refund, please call me at (717) 790-8220.
Sincerely,
ill I L(})1Ut 1 V).JJ lCvl. me wi G
Michele Maglich Brown
Manager of Financial Operations
Enc!.
100 Mt. Allen Drive. Mechanicsburg, PA ]7055-6100
(717) 697-4666 . Fax (}17) 790-8200 . ,,'ww.messiahvillage.org
Enhancinf! Life
.'",-lUIUll1\-.:I lj;~~UI...un.-,'-
Your Account
Offi:::e
;4~1 i
Accounj'Shortnarn E'
<;:::',cf;
J01 0002
100e.
Ge.t;
-'
I Vie",' Statement For: I Vveonesda'}.' April 21 _::12U04
~,
~
Go;
Annuities/Insurance
;(
To view available statements, first select year, then select month.
(;jr.~~~Li!~ii1!~"il7rIT:5~~f:~~~Ug~~;:;j:~:<h~;:~:~'Z':~i7::':Z'..:;~~:~i"..-
-Jo Is your" retiremer1: hec:cied in the right dir"e:tior;/
... Find out how tile new lax A:: affects vou.
... Apl-j: Perspective_.; [ED, Retirement Rev'ieVl' ffi
Account Name
Type
Number
J FRED WEAVER
REG
441 010002
Annuities! Insurance
Name
Net Invested
Fixed Rate Premium
Value
SCHC:DUlED ANNUiTY MANAGER.
Poi icy f, 428537 Issue: 2000- i 2-26
As of: 2004-04-20
Carrier: ALLSTATE LIFE
5 -YR i=IYEO ACCOUNT
13.281
16.623.46
7.0%
16,620.39
SCHcDU;..EO ANNUITY MANAGER
Policy # ~28543 Issue: 2000-12-26
,/:"s of 2004-04-20
Carrier: AlLSTA7E LIFE
5 -YIi FIXED ACCOUNT
25,377
31.762.96
7.0%
31.757.08
Totai Annuities I Insurance
$48,386.42
Quotes
As your agreement jor the receipt and use 01 market data provides, the securities markets (1) reserve all rights to the market daia they make available;
(2) do not guaranter, the data; and (3) shall not be liable tor any loss due either to their negiigence or to any cause beyond their reasonable control.
Insurance and annuity products and values are displayed for iniormational purposes only. Values reflect In force Insurance purchased through
1v'lorgan Stanley OW Inc. as of date shown as reported by the Insurance carriel'. Amounts shown may be subjec~ to surrender and other contract
charges, Inves1ed premium is defined as either the original purchase price plus additions minus withdrawals 0: principal withdrawals.
DisDlay of insurance or annuity products on the Morgan Stanley account stalement does no; confer or imply ownership or beneficial interesi on the
pan oj the Iv,organ Stanley account haider. All ownership, rights, benefits and payments are cont;ollcd by the contract between the insurance
co~pany and the contrac1 owner as shown on your policy copy.
Annuilizec Information as provided by the insurance carrier reflects the value of the last payment made as per your instructions and does not imply
that the funds were re-deposited into a Morgan Stanley DW Inc_ accoun: and are provided tor informationai purpose:;, only. Surrendered or
annuitized policies will not appear as assets Oil this statement.
Page Retrieved On: 4/21/2004 11:31:49 Ar<1 EST
Metlife
June 9, 2004
SAlOIS SHUFF FLOWER & LlNDSA Y
ATTN: JOHN SLlKE
2109 lvlARKEN ST
CAMP HILL PA 17011
.CQl2y__IQ:
'TRICIA TOMPKINS
PNC INVESI'MENTS
127 DIM ACRES DR
MECHANICSBURCi PA 17055
RE: Contract Number 3201 0132461
.J Fred Weaver
Dear Mr. Slike:
We have receiv ur r information on the above referenced c.9cn~aceamount
of the contract was $44,876.21. The account value as of May 1. 200iL was $44,211.30) The
beneficiaries wer aver, Barbara Cone, Jane Lawrence and~. All
beneficiaries have been distributed their portion ofthe death benefit.
Thank you again for the opportunity to serve your investment needs. We appreciate your business.
If you have any questions concerning the above. or the contract in general, please call a Variable
Annuity Service Representative at (800) 343-8496. Our staff will gladly assist you between the
hours of 7:30 a.m. and 5:30 p.m., Central Time, Monday through Thursday, and from 7:30 a.m.
until 5:00 p.m" Friday.
Sincerely,
~-/--->--.--:-
~.~
Torn Smithson
Variable Annuity Cuslomer Service
Enclosures
Rev. 02/2001
____ ~-=~~!~e Inv~~_t_~~~~~~a~~_e Com,.,ant~=tl_~~~_I_~~~~~I_~s~:~_~-=- Comp_~_~~ of!=c.w:nf~nio .__~.~tlife Inv~.s~ors~SA '~suran~~5ompany
PieC!56 Send All Correspondence 10: Fot' Expms$ Mail Only: ,DI-,: 8003438.::;9(,
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11111111111111111111111111111111111
JOHN E. SLIKE
ROBERT C. SAlOIS
GEOFFREY S. SHUFF
JAMES D. FLOWER,)R
CAROLj. LINDSAY
BRIAN C. CAFFREY
GEORGE F. DOUGLAS, III
MATTHEW). ESHELMANt
THOMAS E. FLOWER
jACLYN SMITH
LAW OFFICES
SAlOIS, SHUFF, FLOWER & LINOSA Y
A PROFESSIONAL CORPORATION
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EMAIL: attorney@ssfl-Iaw.com
www.ssfl-Iaw.com
January 31, 2005
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: The Estate of J. Fred Weaver
File No. 21-04-0444
Dear Ladies:
CARLISLE OFFICE:
26 WEST HIGH STREET
CARLISLE, PA 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
tBoard Certified Creditors'
Rights Representation
REPLY TO CAMP HILL
.."
1"'''''1
Ct)
r<..)
Enclosed are an original and two additional copies of an Inheritance Tax return in regard to the
above-referenced estate. Also enclosed is a check for the balance of taxes due and for the filing fee.
Kindly return a time-stamped copy to our office in the envelope provided.
Thank you.
Very truly yours,
SAIDlS, SHUF , FLOWER & LINDSAY
/sly
Enclosures
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL I AXES
DEPT. 280601
HARRISBURG, PA 17128-0601
AEV-1 162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SlIKE JOHN E
2109 MARKET STREET
CAMP Hill, PA 17011
___U___ fOld
ESTATE INFORMATION: SSN: 205-16-3127
FILE NUMBER: 2104-0444
DECEDENT NAME: WEAVER J FRED
DATE OF PAYMENT: 02/01/2005
POSTMARK DATE: 01/31/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/01/2004
NO. CD 004908
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,688.47
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1031
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$2,688.47
GLENDA FARNER STRASBAUGH
REGISTER OF WillS
-
000;0
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Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle. PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceNo:
Invoice Date:
E state of:
Estate No:
191
2/1/2005
T. FRED WEAVER
21-04-0444
JOHNE. SLIKE, ESQ.
2109 MARKET STREET
JA
CAMP HILL, PA 17011
Qty
1
Fee Description
Additional Probate
Fee
105.00
Total
$105.00
Total:
$105.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
BUREAU OF INDIVIDUAL TAXES.
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-1607 EX AFP (03-05)
Y 2., P1l12: 4 I
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-09-2005
WEAVER
05-01-2004
21 04-0444
CUMBERLAND
101
A.aunt R_itted
J
F
rj f:~:Y (':
\...'-......., ,,\ ~.i~-
OJ~Dl--t. 1,\ \1'(' /',". linT
I " j,,\, 1 d '- '" )un j
JOHN E sC~KE-ESQ-'"
SAIDIS ETAL
2109 MARKET ST
CAMP HILL PA ~ 7011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper cradi to your account, submit the upper portion of this for. with your tax pay..nt.
CUT ALONG THIS LINE .~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
................................ ...............................................................................
REV-1607 EX AFP (03-05) KKK INHERITANCE TAX STATEMENT OF ACCOUNT KKK
ESTATE OF WEAVER F FILE NO.21 04-0444 ACN 101 DATE 05-09-2005
THIS STATEHENT IS PROVIDED TO AD ISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NANED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TA DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-11-2005
PRINCIPAL TAX DUE: 39,435.09
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-26-2004 CD004203 1 ,842 . 11 35,000.00
01-31-2005 CD00490E .00 2,688.47
04-25-2005 REFUND .00 95.49-
TOTAL TAX CREDIT
. IF PAID AFTER THIS DATE, SE REVERSE
SIDE FOR CALCULATION OF ADD TIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $ ,
NO PAYHENT IS REQUIRED.
TOTAL DUE
39,435.09
.00
.00
.00
BALANCE OF TAX DUE
INTEREST AND PEN.
1:F TOTAL DUE IS REFLECTED A A "CREDIT.. (CR) I
YOU HAY BE DUE A REFUND. SE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent: J. Fred Weaver
Date of Death: May I, 2004
will No.
21-04-0444
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans I
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
complete:
1. State
Yes ~i
whether
No
administration
of
the
estate
is
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 I 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 ~i No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date:
I J.Lz1/ u5~
I
.~f")
C)
S nature
ame: John E. Slike, Esquire
(I.D. No. 06262
SAIDIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
'--
Capacity:
Personal Representative
x
Counsel for Personal Representative
- )
I
I ~-. (~
(-..J
v~
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
SLlKE JOHN E ESQUIRE
SAlOIS SHUFF FLOWER ET AL
2109 MARKET STREET
CAMP HILL, PA 17011
-.--.----- fo,ld
ACN
ASSESSMENT
CONTROL
NUMBER
101
REV-1162 EX(11-96i
NO. CD 008829
AMOUNT
$1 ,461 . 1 5
ESTATE INFORMATION: SSN: 205-16-3127
FILE NUMBER: 2104-0444
DECEDENT NAME: WEA VER J FRED
DATE OF PAYMENT: 10/18/2007
POSTMARK DATE: 1 or1 7/2007
COUNTY: CUMBERLAND
,'. I
DATE OF DEATH: 05/01/2004
( ,
TOTAL AMOUNT PAID:
HEMARKS: SAlOIS FLOWER & LINDSAY
CHECK# 5078
SEAL
INITIALS: OM
RECEIVED BY:
REGISTER OF WILLS
$1 ',461 . 1 5 '
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
-.J
1SDSbDlf11lf7
REV.1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX,280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
.
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 4
0444
Date of Birth
205163127
05012004
05011916
Decedent's Last Name
Suffix
Decedent's First Name
MI
WEAVER
J.
F
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
o 1. Original Retum
n 4. Limited Estate
lRJ
6. Decedent Died Testate
(Attach Copy of WUI)
~ 2. Supplemental Retum 0 3. Remainder Return (date of death
prior to 12-13-82)
0 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
0 10 Spousal Poverty Credit (date of death [J 11. Election to tax under Sec. 9113(A)
. between 12-31-91 and 1-1-95) (Attach Sch. 0)
o
9. Litigation Proceeds Received
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JOHN E. SLIKE ESQ. 7177373405 . "
Firm Name (If Applicable)
SAIDIS, FLOWER & LINSAY
REGISTER OF WILLS USE:QNL Y
" ~-',
First line of address
C~J
2109 MARKET STREET
, I
Second line of address
. _J
UJ
CAMP HILL
State
PA
ZIP Code
17011
DATE FILED
City or Post Office
Correspondent's e-mail address;
Under penalties of perjury, 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge.
SIG ATURE OF PERSON R ONSIBL OR FILING RETURN DATE
Jeffrey P. VVeaver
John E. Slike Esq.
/ ~ IS-/t>?
DATE
/o/s- t> 7
17055
21 Market Street, Camp Hill, PA 17011
L
Side 1
15D5bDlf11lf7
15D5bDlf11lf7
-.J
d'-^
--..J
15056042146
REV-1500 EX
Decedent's Name: J. F re d We a v e r
Decedent's Social Security Number
205163127
RECAPITULATION
1. Real Estate (Schedule A}.......................................................................................... 1.
2. Stocks and Bonds (Schedule B}............................................................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C}.......... 3.
4. Mortgages & Notes Receivable (Schedule D}.......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E}................
6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7}....................................................................... 8.
9. Funeral Expenses & Administrative Costs (Schedule H}......................................... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I}................................ 10.
11. Total Deductions (total Lines 9 & 10}...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11}............................................................. 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J}................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13}................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a}(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
o .00
15.
32,470.00
16.
0.00
17.
o .00
18.
19. Tax Due..................................................................................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042146
5.
34,000.00
34,000.00
_...~-----
1,530.00
1,530.00
32,470.00
32,470.00
o . 0 0
1,461.15
o . 0 0
o . 0 0
1,461.15
D
15056042146
--..J
Rev-150S EX+ (6-9S)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J. Fred
FILE NUMBER
21-04-0444
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Supplemental Asset - Estate of Malura Thomas
Probate 04-2196-P3
Dallas County, Texas
VALUE AT DATE
OF DEATH
34.000.00
TOTAL (Also enter on Line 5, Recapitulation)
34.000.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule E (Rev. 6-98)
REV.1151 EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J. Fred
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-04-0444
ESTATE OF
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Said is, Shuff, Flower & Lindsay 1,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 30.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 1,530.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
Rev.1502 EX + (6-98)
.
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
~HERrrANCETAXRETURN
RESIDENT DECEDENT
Weaver, J. Fred
FILE NUMBER
21-04-0444
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Register of Wills-Cumberland County
30.00
Subtotal
30.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
REV 1513 EX+ (9-l1D)
ESTATE OF
NUMBER
I.
1
2
3
4
*'
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Weaver, J. Fred
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions.... and transfers
under Sec. l::I116(a)(1.2)]
FILE NUMBER
21-04-0444
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
RELATIONSHIP TO
DECEDENT
Do Not List Trusteels)
Barbara J. Cone
307 Tappan Street, #2
Brookline, MA 02445
Daughter
25% of residue
of estate
7,752.22
Jane R. Lawrence
108 Main Street
Francestown, NH 03043
Daughter
25% of residue
7,752.21
Jeffrey P. Weaver
512 Wayne Drive
Mechanicsburg, PA 17055
Son
25% of residue
7,752.21
Michael R. Weaver
183 Elm Street
New Columbia, PA 17856
Son
25% of residue
7,752.21
Total 31,008.85
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
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\VILL
OF
J. FRED \VEA VER
I, J. FRED \VEA VER, currently of Upper Allen Township, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament. hereby revoking any and all
prior Wills and Codicils made by me.
1. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this \Vill shall be free and clear thereof.
III. I bequeath all tangible personal property which I own at my death unto my four (4)
children, namely, Jeffrey, Michael, Jane and Barbara, to be divided among them as they see
best.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate, including property over which I hold a power of appointment, I bequeath equally
unto my four (4) children, Jeffrey, Michael, Jane and Barbara, or their issue per stirpes. If
any child predeceases me leaving no issue, that share shall lapse and be divided equally
among my other children or their issue per stirpes.
V. I appoint my son, Jeffrey P. Weaver, Executor of this my Will. In the event that he
fails to qualify or ceases to act as Executor, I appoint my son, Michael R. Weaver, Executor
of this my Will.
VI. I direct that no bond be required of111Y fiduciary for the faithful perfonnance of his
duties in any jurisdiction.
--~
~
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,,{I/':i20-veL---
IN 'WITNESS \VHEREOF,l J. FRED \VEA VER herelvith set my hand to this my
Last \Vill, typev.;rit1en on 1:1\10 (2) sbeets of paper including tbe attestation clause and
signatures of witnesses, this ;.511, day of .Tv L I ,2003.
\" 1;:1- ," ' /) , /'
--/; \ / /f / .~ / i/U _.e--d>L.r~--{s"EAL )
1/ RED \VEA VER
/
Signed by 1. FRED WEAVER hy him declared lO be his \Vill in our presence, Ivho
have hereunto subscribed our names as Ivitnesses in his presence and at his request, this
/{;~ da:y of J v L- '-I ,2003.
0/ " , (2/' ,
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residing at
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COMMONWEAL TE OF PE1\1NSYL VANIA
COUNTY OF L~2>A t~o,,!
~/ /) . /'
" /-, -_. / 1-
ViE, J. FRED \IlEA VER, GERALD J. BRINSER and ,:J/JtLi'/J )'\____ -r-... It)!) . TL-
the testator and the witnesses, respectively, whose names are signed to the attacbed or
foregoing instrument, being first duly affim1ed, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as his Last Will and that he
signed willingly (or willingly directed another to sign for him), and that he execmed it as his
free and voluntary act for the purposes therein expressed, and that each of the Iyitnesses, in
the presence and hearing of the testator, signed the \Vil1 as v.'itnesses and that to the best of
our knowledge the testator was at that time eighteen years of age or older, of sound min d and
under no constraint or undue influence.
UJ/
/1"~ )'/124 ,f{/;;:: e~
L.j. FRED \VEA VER
li (Jl /J
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WITNESS
L/
Subscribed, sworn or affirmed and ackn9wledgeq,before me by J. FRED WEA VER,
the testator, GERALD J. BRlNSER and "SAd/fifL fj)o /f2. ' witnesses, this
J:)thdayof q~,2003. . .
Ulx~jL~SEAL)
NOTARIAL SEAL
WENDYL CRAWFORD, Notary Public
Palmy"! Bora., Lebanon County
CommIssion Expires Sept. 10, 2005
-3-
INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
Jeffrey P. Weaver
Personal Representative(s) of the Estate of
} SS
}
File Number
21-04-0444
J. Fred Weaver
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in ttie 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 of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this i ventory.
I verify that the statements made in this Inven- } A
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. ~ 4904 relating to unsworn falsification to }
authorities.
Attorney - (Name)
(Firm)
(Address)
(Telephone)
John E. Slike Esq.
Saidis, Shuff, Flower & Lindsay
2109 Market Street, Camp Hill, PA 17011
(717) 737-3405
(Supreme Coultl.D. No.)
06262
DATE OF DEATH
05/01/2004
LAST RESIDENCE Messiah Village
Mechanicsburg, PA 17050
FIGURES MUST BE TOTALED
DECEDENTS SOC. SEC. NO.
205-16-3127
Personal Property
Cash.............................................................................................. .
Personal Property.........................................................................
Stocks/Listed. ...... ........................................... ..... ..... ..... .......... ......
Stocks/Closely Held. ....... ....... .... ... ........... ..... ..... .......... ..... ... .........
Bonds............................................................................................ .
Partnerships and Sole Proprietorships .....................................
Mortgages and Notes Receivable.... ...........................................
All Other Property..... ....... ....... .... ...... ........ ..... ... ....... ............... ... ...
34,000.00
(~? ----
.-:>
....~~~.
---..;
C)
Total Personal Property............ .............................
34,aO.O.00
;".....)
Total Real Property........... ................. ............... .....
OJ
Total Personal and Real Property.........................
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. (See 20 Pa. C.S. ~ 3301 (b))
Form RW-09 Rev. 10-13-2006
dV\.
INVENTORY
REGISTER OF WILLS OF
CUMBERLAND
COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
File Number 21-04-0444
DATE OF DEATH
05/01/2004
LAST RESIDENCE
Messiah Village
Mechanicsburg, PA 17050
DECEDENTS SOC. SEC. NO.
205-16-3127
Cash
Supplemental Asset - Estate of Malura Thomas
Probate 04-2196-P3
Dallas County, Texas
34.000.00
Total Cash
34.000.00
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
34.000.00
JOHN E. SLIKE
ROBERT C. SAlOIS
JAMPS D. FLOWER, JR
CAROL J. LINDSAY
JOHN B. LAMPI
MICHAEL L. SOLOMON
GEORGE F. DOUGLAS, III
DEAN E. REYNOSA
THOMAS E. FLOWER
MARYLOU MATAS
SUZANNE C. HIXENBAUGH
LAW OFFICES
SAIDIS, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
CAMP HILL, PENNSYL VANIA 17011
TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EMAlL: attorney@sfl-Iaw.com
www.sfl-Iaw.com
CARLISLE OFFICE:
26 WEST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
TELEpHONE: (717)243-6222
FA~MILE: (717)243-6486
",--,
REl!I:-Y TOCAMP HILL
C;)
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October 17,2007
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Cumberland County Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Dear Ms. Strasbaugh:
Enclosed are two original copies of the Supplemental Inheritance Tax Returns (the
"Return") and the Inventory for the Estate of J. Fred Weaver and a copy of both the Return and
the Inventory to be time-stamped and returned to me in the enclosed self-addressed stamped
envelope.
A check in the amount of$30.00 is included to pay for the filing fees and a check in the
amount of $1 ,461.15 is included to pay the additional inheritance tax due.
If you have any questions or comments, please call.
Sincerely,
SAID IS, FLOWER & LINDSAY
~
(,Jo/Ann Seker
Paralegal for
John E. Slike
Enclosures
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
COMMONWEALTH QF PENNSYLVANIA
DEPARTMENT OF REVENUE
R;:CO~~~~NCE TAX
Q~~LI\ll":-,~~~'~\m.. ,,"... (OF ACCOUNT
tl.t...\.JIV,~_jj...J1 '~l"'s...V
'*
REV-1607 EX AFP (03-05)
JOHN E SLIKE ESQ
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
2001 NOV 16 PH I: 35~:~:TE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
CLERK OF
ORPHAN'S COURT
CUMBERU,\JO CO.. PA
11- 05-2007
WEAVER
05-01-2004
21 04-0444
CUMBERLAND
101
J
F
Amount Remitted
PA 17011
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
---------------------------------------------------------------------------
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
....
REV-1607 EX AFP (03-05)
*** INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF WEAVER
J
F FILE NO. 21 04-0444
ACN 101
DATE 11-05-2007
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-11-2005
PRINCIPAL TAX DUE: 39,435.09
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
07-26-2004 CD004203 1,842.11 35,000.00
01-31-2005 CD004908 .00 2,688.47
04-25-2005 REFUND .00 95.49-
10-17-2007 CD008829 .00 1,461.15
TOTAL TAX CREDIT 40,896.24
BALANCE OF TAX DUE 1,461.15CR
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1,461.15CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN *1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
c;
29 r:, !~): .!TE 03-03-2008
ESTATE OF WEAVER J F
DATE OF DEATH 05-01-2004
FILE NUMBER 21 04-0444
~~OUNTY CUMBERLAND
ACN 501
APPEAL DATE: 05-02-2008
( See reverse side under Objections)
Amount Remittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +--
-------------------------------------------------------------------------------------------
REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WEAVER J F FILE NO. 21 04-0444 ACN 501 DATE 03-03-2008
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
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'NotIC~ OFliilHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF~DEDUCTIONS AND ASSESSMENT OF TAX
!-
JOHN E SLIKE ESQ
SAIDIS HAL
2109 MARKET ST
CAMP HILL PA 17011
.1""\1
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1)
2. Stocks Jnd Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
.00
.00
.00
. DO
34.000.00
.00
.00
(8)
8.
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
(9)
(10)
1,530.00
.00
(11)
(12)
(13)
(14)
13.
14.
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
Net Value of Estate Subject to Tax
NOTE:
(15)
(16)
(17)
(18)
. DO X
32,470.00 X
.00 X
.00 X
19. Principal
TAX CREDITS:
PAYMENT
DATE
10-17-2007
Tax Due
RECEIPT
NUMBER
CD008829
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
AMOUNT PAID
1,461.15
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
REV-1547 EX AFP (06-05)
NOTE: To insure proper
credit to your account.
submit the upper portion
of this form with your
tax payment.
34,000.00
1.1i30.00
32,470.00
. DO
32,470.00
00
045 =
12
15
.00
1,461.15
.00
.00
1,461.15
(19)=
1,461.15
.00
.00
.00
* IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
/~ ,
IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. ~
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE, .
A REFUND. SEE REVERSE SIDE OF THIS FORM FDR INSTRUCTIONS.)
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: J. Fred Weaver
Date of Death: 05/01/2004
File Number: 21-04-0444
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 of the estate is complete: 0 Yes ^ 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 Q No
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest?
Yes ^ No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of Orphans' Court and may be attached to this report.
~ ~; `
Date 07/03/2008 ~(~; ~ ~'
Signature fd% erson Filing this Form
:,'~ ~J ,
` Capacity: ^ Personal Representative ~ Counsel
John E. Slike Esq.
_„ ~ Name of Person Filing this Form
2109 Market Street
;~ .
r-~ 4-
'- Address
Camp Hill, PA 17011
City, Sfate, Zip
(717) 737-3405
Telephone
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LAW OFFICES
SAIDIS, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
JOHN E. SLIKE CAMP HILL, PENNSYLVANIA 17011
ROBERT C. SAIDIS TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407
JAMES D. FLOWER, JR EMAIL: attorney~sfl-law.com
CAROL J. LINDSAY www.sfl-law.com
JOHN B. LAMPI
DANIEL L. SULLIVAN
DEAN E. REYNOSA
THOMAS E. FLOWER
MARYLOU MATAS
JASON E. KELSO
March 16, 2010
CARLISLE OFFICE:
26 WEST HIGH STREET
CARLISLE, PENNSYLVANIA 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
REPLY TOCAMP HILL
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Dear Ms. Strasbaugh:
Enclosed are two original copies of the Supplemental Inheritance Tax Returns (the
"Return") for the Estate of J. Fred Weaver and a copy of both the Return to be time-stamped and
returned to me in the enclosed self-addressed stamped envelope.
A check in-the amount of $15.00 payable to the Register of Wills is included to cover the
filing fees and a check in the amount of $866.66 payable to the Register of Wills, Agent is
included to cover the additional inheritance tax due.
If you have any questions or comments, please call.
Sincerely,
SAIDIS, FLOWER & LINDSAY
t,~
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~o Ann Seker, Pa. C.P.
~s
Enclosures
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 7 1 28-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SLIKE JOHN E ESQUIRE
SAIDIS SHUFF FLOWER ET AL
2109 MARKET STREET
CAMP HILL, PA 1701 1
-------- fold
ESTATE INFORMATION: SSN: 205-16-3127
FILE NUMBER: 2104-0444
DECEDENT NAME: WEAVER J FRED
DATE OF PAYMENT: 03/ 1 7/2010
POSTMARK DATE: 03/16/2010
COUNTY: CUMBERLAND
DATE OF DEATH: 05/01 /2004
REV-1162 EX(11-96)
NO. CD 012485
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ $866.66
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 7249
SEAL
INITIALS: JN
5866.66
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
15056071120
~-J REV'-1500 OFFICIAL USE ONLY
EX (OS-05)
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box.2sosol RESIDENT DECEDENT 21 0 4 0 4 4 4
Harrisburg, PA 17128-OS01
ENTER DECEDENT INFORMATION BELOW Date of Birth
Social Security Number Date of Death
205 16 3127 05 O1 2004 05 O1 1916
Decedent's Last Name Suffix Decedent's First Name MI
WEAVER J. F
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a, Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date ofrldeath attf~tter 12-12-82)
6 Decedent Died Testate ~ ~• ~gttach Copy Hof Trust)a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wilt) Q Y C
9. Litigation Proceeds Received ~ 10• b~tween12V~1 91 a dt~lat8es~f death ~ 11,Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JOHN E. SLIKE ESQ. (717) 737 3405
Firm Name (If Applicable)
SAIDIS, FLOWER & LINSAY
First line of address
2109 SET STREET
Second line of address
City or Post Office
CAMP HILL
State ZIP Code
PA 17011
REGISTER OF~~S USE OY
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Correspondent's a-mail address:
Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
E OF PERSON RESP SIB F FILING RETURN DATE
~~ _ _, ~~/J~G-~ Jeffrey P. Weaver _ ~ /~ ~®
512 a ne Drive Mechanicsbur PA 1
~NATUR OF PREPARER OTHER TH EPRESENTATIVE
~ ~~
John E. Slike Esq.
DATE
.~ ~ ,~ /~~
21`9 Market Street, Camp Hill, PA 17011
Side 1
15056071120 1505607112D J
J
15056072120
REV-1500 EX Decedent's Social Security Number
Decedents Name: J. Fred Weaver 2 05 16 312 7
RECAPITULATION
1. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................. 2.
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)......... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 2 0 , 17 4 . 2 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers, & Miscellaneous fin; Probate Property
arate Billing Requested
Se
7
............
p
(Schedule G) u ,
8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 2 0 , 17 4 . 2 0
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 915.0 0
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) .............................. 10.
11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 915.0 0
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 19 , 2 5 9.2 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ............................................... 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 19 , 2 5 9.2 0
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 15.
0 0
0
(a)(1.2) X .00 .
16. Amount of Line 14 taxable
at lineal rate X .045 19 , 2 5 9. 2 0 16.
8 6 6. 6 6
17. Amount of Line 14 taxable
0 0
0
17'
0. 0 0
.
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0
18'
0. 0 0
19. Tax Due .................................................................................................................. 19. 8 6 6. 6 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
15056072120 15056072120
REV-1500 EX Page 3
nn~-nriont°c rmm~lr~tp Address:
File Number 21-04-0444
DECEDENT'S NAME
J. Fred Weaver
STREET ADDRESS
Messiah Village
CITY
Mechanicsbur STATE
P,A ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 866.66
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
p. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 866.66
A, Enter the interest on the tax due. (5A)
g, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) $66.66
Make Check Pa able to: REGISTER OF WILLS, AGENT
;. , ,~
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :............................................................................... ^
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ 0
c. retain a reversionary interest; or ............................................................................................................... x
.............................................................
f r life of either a ments benefits or cares ^
d. receive the promise o p y ,
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without ^ ^
receiving adequate consideration? .................................................................................................................... x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property 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.
,,
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 three (3) percent [72 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 zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child 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 zero (0) percent [72 P.S. §9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
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 twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Weaver . J. Fred _ 21-04-0444
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
(If more space is needed, additional pages of the same size)
REV-1151 EX+ (10-06)
COM IN RESI~NT DECEDENL~/ANIA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Weaver . J. Fred 21-04-0444
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
R
A, FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s) Commission paid
2, Attorney's Fees Saidis, Flower & Lindsay
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
900.00
Street Address
City State Zia
Relationship of Claimant to Decedent
4. I Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
15.00
TOTAL (Also enter on line 9, Recapitulation) I 915.00
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE J
COMINV~_4TQIFN~R~ANIA
~t`- BENEFICIARIES
ESTATE OF FILE NUMBER
Weaver , J. Fred 21-04-0444
NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUN T OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
f
• ers
distributions, and trans
under Sec. 9116 a 1.2
1 Barbara J. Gone Daughter 25% of residue 4,814.80
307 Tappan Street, #2 of estate
Brookline, MA 02445
2 Jane R. Lawrence Daughter 25% of residue 4,814.80
108 Main Street
Francestown, NH 03043
3 Jeffrey P. Weaver Son 25% of residue 4,814.80
512 Wayne Drive
Mechanicsburg, PA 17055
4 Michael R. Weaver Son 25% of residue 4,814.80
183 Elm Street
New Columbia, PA 17856
Total 19,259.20
Enter dollar amaunts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
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1. J. F~~.EI~ V~'EA~'~~, L'UI7-eI]t1}' 0~ L1ppe]" ~illen ~Tou'nSlllp. CU111beI"land ~.C)Llllty;
I~eIlI1S)'lVil111a.. deClal'e t111S 1.0 ~~~ Il]~' L~1st Vi'l11 alld TestGullellt. lle]'eb~' re~~U1LII1~' aI1:~~ a1.1d all
prior Vi~ills and Codicils made bt' Ine.
L I direct that all m}' -just. debts and f-uneral expenses be paid Ii-om the assets of l~n~%
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may' be assessed In consequence of
nl~° death. shall be paid out of the principal of n1}' general estate to the same effect as if said
takes ~~~ere expenses of adnlinistratioll and. all pI-opel-t~' includable in n1y tamable estate
whether or not passin~i under this Vl'ill shall be free and clear thereof.
ILI. I bequeath all tangible personal property- which I own at Iny death unto zn~ four (4)
children;llalnel~~; Jeffrey; I~~IichaeL Jane and Barbara, to be di~~ided among them as they see
best.
1V. All the rest, residue and remainder of my estate; of ~~llatever nature and u~here~'er
situate; including property' o'er which I hold a power of appointment, I bequeath equally
L111t0 I1]y four (4) children, Jeffrey, Michael, Jane and Barbara, or then- issue per stirpes. If
any child predeceases me leaving Ito issue, that share shall lapse and be di~~ided equally
among my other children or then- issue per stirpes.
~T. I appoint my son, Jeffre}J P. V~Ieaver, Executor of this I11y Will. In the event that lle
fails to qualify or ceases to act as Executor, I. appoint my son, Michael R. 1~~eaver, Executor
of this Illy V,Till.
~rl. I d1I"eC1: that I1U 110114 be requll'ed of lny fiducial~' foI' the faltllful per {~Or111aI1Ce Of 111S
dUtles lI1 any ~U1'15d1Ct1011.
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h~~~e heI-eunto subscribed our names as \~~itnesses in his presence and at leis request.. this
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the testa~or alld the ~7,~itnesses, respecti~~ely. -~~~llose names are sicned to the a~tacl7ed yr
, Clare to the undersigned
f~ore~~oin~~ instrument. being ~irs~ dull aFtil-Illed;, do 1lereb~- cle ~-
authori ~ tl~la~ the testaiol- signed and e~~ecuted the lllstl"U111e111 as Ills Last VrTill and tl~lat he
si~Tned ~n~illin~l}' (or ~~~lllln~ly d1I'eCted a11Ot11ert0 Sl~I7 ~07~111111~. and t11a111e e~~ecutLd It aS 111S
~re(; a17d VUIuI1ta7~' aCt f0I" the pUrpoSeS thel'elll e?:pressed., and that. each of the ~~,~itnesses; lIl
the presence and hearing of the testatvr; signed the VtiTill as ~~'imesses and that to the best of
our l~llowledae the testator ~c~~as at that tlme elUhteen years of aUe or older, of sound 7r1u7 d and
under no constraint: or undue influence.
J . FRED V,~EA VER
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WITNESS ~;%
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Subscribed, sworn or afflrn~ed and acl~rlowledged,before me by J. FRED V~TEA~rER;
the testator, GERALD J. BRINSER and ~~~~;;1,;.~ ~~~L'r~ %, , -witnesses; this
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1~'day of ~ , 200.
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Notaly Public
NOTARIAL SEAL
iNENDYi., CRAWFORD, Notary Public
Palmyra Boro., Lebanon County
Commission expires Sept, 10, 2005
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DEPOSIT TICKET 60-184-313
SAIDIS, FLOWER & LINDSAY
IOLTA ACCOUNT
26 WEST HIGH STREET
CARLISLE, PA 17013
Commerce
CBanl ~r Atnerfcs's Moat Convenient Banh•
'J-88&837-0004
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DEPOSITS MAY T 9E AVAILABLE FOR IfA EDlATE WITHDRAWAL
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TOTAL FROL1 OTHER SIDE
OR ATTACHED LIST
RRPLEEEASE
TOTALRE ~~J
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Checks and other items are received for de sit
subject to the provisions of the Undorm Commerdal
Code or any applicable collection agreement.
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NOTICE OF INHERITANCE TAX penns~ V~nl~
-,d4R~R~~~~~~LOWANCE OR DISALLOWANCE DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES ~;?~ w 4
r-..s
INNERITANCE TAX DIVISION Ofi,'w i1C AND ASSESSMENT OF TAX REV-1547 EX AFP C12-09)
PO BOX 250601 n~4~ r ~ ! ~ ~ ;' ,... ', ~' ~ # ~"~
HARRISBURG PA 17126-0601 "~"` ` `'` ' `v+ . ~ iL ,. ~M
~O~Q'~~~ ~~ ~~ ~' ~ ~ ESTATE OF WEAVER2010 J F
DATE OF DEATH 05-01-2004
(',LE~~( {~ FILE NUMBER 21 04-0444
~~'~~f"'~1~`~ C{~~JRT COUNTY CUMBERLAND
JOHN E SLIKE ESQ ~~~R~ti~ ~~,, PA. ACN 502
2109 MARKET ST APPEAL DATE. 08-27-2010
CAMP H I L L P A 17 011 (See reverse side r~n~er Ob,~ictliins )
A~ount Re~itted ~ --1
MAKE (NECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONC THIS LINE ~- RETAIN LOWER PORTION FOR YQUR RECQRDS !~
- r - - - - - - - - - ~ .. - - - - - - - - - - - - - - - -- - - r - - - -.- - - - - r - - - - r - - - - - - - - ~ -i • - ~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
REV-1547 EX AFP C12-09) NOTICE OF INHERITANCE TAX APPRAISEMEMiT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: WEAVER J FFILE NO.s21 04-0444 ACN: 502 DATE: 06-28-211010
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: LITIGATION RETURN
1. Real Estate (Schedule A) (1) .0 0 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) C2) .0 0 credit to your account,
.00 sub~ait the upper portion
3. Closely Hfld Stock/Partnership Interest (Schedule C) L3) of this form with your
4. Mortgages/Notes Receivable (Schedule D) C4) •0 0 tax payMent.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 20,174.20
6. Jointly Owned Property (Schedule F) (6) .0 0
7. Transfers (Schedule G) C7) •O 0
8. Total Assets cs) 20.174.20
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adw. Costs/Misc. Expenses (Schedule H) C9) 9 1 5.0 0
10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) .0 0
11. Total Deductions Cil) _.~:' Oi0
12. Net Value of Tax Return C12) __ 1 99.2 0
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13)
14. Net Value of Estate Subject to Tax C14) 19:259.210
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect fiaurss that include the total of ALL retuhns assessed to date.
ASSESSMENT OF TAX:
15. A~eount of Line 14 at Spousal rate C15) .00 X 00 _ _00
16. Amount of Line 14 taxable at Lineal/Class A rate C16) ~9. 259.2D x 045 = 866.616
17. A~aount of Line 14 at Sibling rate C17) _ 00 X 12 a _OT
18. Amount of Line 14 taxable at Collateral/Class B rate C18) .0 0 X 15 = .._QIQ
14. Principal Tax Due C19?= 866.616
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT C+)
INTEREST/PEN PAID t-) AMOUNT PAID
03-16-2010 CD012485 .00 866.66
TOTAL TAX PAYMENT 866.61
BALANCE. OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .Oq
* IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY B~ DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
~~
Pa. O.C. Rule 6.12 STATUS REPORT
RE~ISTER OF W1LLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Name of Decedent: J. Fred Weaver
Date of De~th: 05/01/2004 File Number. 21-04-0444
~, ~, i
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Pursuant t~ Pa. O.C. Rule 6.12, I report the following with respect to completion of the administraation of
the above-captioned estate: ',
i
1. I State whether administration of the estate is complete: I ®Yes ^ No
2. I, If the answer is No, state when the personal representative
reasonably believes that the administration will be complete: ',
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 ~ No
I, 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 acr.~unts may be
filed with the Clerk of Orphans' Court and may be attached to this report. j
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brecn FiNng fhls Form v
^ Personal Representative ® Counsel '
John E. Slike Esq.
Name o1 Peraon FiAny lhia Form
x109 Market Street
PA 17011
737-3405
Form RW-10 rtev. ~a~s-zoos
Copyright (c) 2006 form eoftvvare ony The Lackner Group, Inc.
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