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HomeMy WebLinkAbout73-0039 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Henry F. Eisenhower No, 1973-00039 also known as Shirley A. Botts Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) ,Deceased Social Security No. 211-26-5583 A. Probate and Grant of Letters Testamentary and aver that Petitioners} is/are the execut named in the last Will of the Decedent, dated and codicil(s) dated 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 born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: OX B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente life; 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 Relationshi^ Recirlunro Shirle A. Eisenhower, now Botts S ouse 4821 Brian Road, Mechanicsbur PA C thia Cundall Dau hter 700 W. Windsor, Denton, TX 76207 Cor Eisenhower Son 4485 Panza Dr., Mechanicsbur PA Keith Eisenhower Son 1806 S. Market St., Mechanicsbur ,PA Henr F. Eisenhower, III Son 4821 Brian Road, Mechanicsburg, PA (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 4821 Brian Road, Hampden Township, Mechanicsburg, PA 17050 (list street, number, and municipality) Decedent, then 36 years of age, died 11/18/1972 at Lancaster, Lancaster Co. , 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 $ situated as follows: 9,342.00 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: or printed name and residence Shirley A. $otts ~~.. 4821 Brian Road, Mechanicsburg, PA 17050 r Prepared by the Pennsylvania Bar Association Copyright (c) 19% form software only CPSystems, Inc. Form RV1/-1 (7991) Oath of Personal Representative Commonweakh of Pennsylvania County of Ctunberland 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 wetl and truy administer the estate a~~ccordpping to law. Sworn to or affirmed acrd subscribed ~?~""`"`"-7 G~ c~"r ; befor-e me this ! i day of ~i/ y ~i~ ~~~m '-~~V~C Fe' the Register Estate of Henry F. Eisenhower Deceased Social SecAAurrrity No: 211- 26 - 5583 Date of Death: 11/18/1972 AND NOW, IV ~ + ~ _ ,Z~ I , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary [~X Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lice; durante absentia; durante minoritate} are hereby granted to Shirley A. Botts in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters . $ "- t ~ . V O ~_~y~~ /L . - ~ r' r r~ 1~ (,% Register of Wills Short Certificate(s). $ ~. ~~ n Renunciation. . . $ Attorney: ames/D. o r, Es uire Affidavits ( ) $ Extra Pages ( ) • $ Codicil. $ JCP Fee . $ ~. Shiremanstown, PA 17011 Telephone: 717/737 - 8761 Inventory. $ Other $ n ' ~ "~]1 TOTAL. $ ~ V `O D VIMJ lkJ Prepared by the Pennsylvania Bar Associ opyright c 1996 form software only CPSystems, Inc. I.D. No: PA 19475 Address: One West Main St. rley A`. Botts Form RW-1 (7991) WARNING: It is illegal to duplicate this copy by photostat or photograph. C Date No. This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with Act 66, P. L. 304, approved by the General ' Assembly, June 29, 1953. ' ~' aa~.:_ (Fee fo ~i'i§°certi~ic~t~, $2`~0) J. Finton Speller, M.D. ~ ~~~~ Secretary of Health ' ~ ~y~~~4'~'i~l ~'"''"'~~~~'~ ~ Harrisburg, Pennsylvania H 105.144 REV. 4-71 COMMONWEALTH OF PENNSYLVANIA LOCAL REG. NO. DEPARTMENT OF HEALTH , VITAL STATISTICS PRIMARY J/~~~~~ DIST. NO. `~ ~ , CORONER'S CERTIFICATE OF DEATH 1. DEATH aaCounty b. City er borough OCCURRED Z. DECEASED'S ~. o..cc.'°°'c' •~,, -• ••~ •._....,~. MAILING / '~/~~ , RESS ~ 1 tN: ~ `~ ~t . JL, ~T ~ .~ j,-') C ~) G~/" , ADD (~ L f~ Y / (~ /~J ! _`~,`- t e. 11 death did not trecur ie ciq f tornahi h i ~ ~bJ. Pmt Oflicr, //Berate sand Zip Codr '~ ~ p ve name o , g tx boroug / `'' 1 (r ~. (f` raj I L ~ Y~ 'J (Do not nu R.D. a ©oa Number) . . er` 1 hf.~ (~ f/ aj ~ d. Fvll N^me 1 i 3. VETERAN Yes No t i or In+ritutioo (11 oot ie hwpind, give street addre++) r. Which War b. Said No. NAME OF a (First) b. (Fuddle) e, (Lest DATE (Month) (Day) (Year) '4 . DECEASED ~ OF // // ~/~ L' .~~j ~ ~ ~,~ l` ~ /~ n /~. . L(.t l V DEATH `_~ 1%~ i / ll L ~ " 1 /' _ _ .. - nt _ _ _LTYJ,e tx1+r 8. WHERE DID T-'- c. Did Jee eased live in r tnrnship7. DECEASED !'/1 !t ,t !/ ~~-b 1'! ~i ~ /~^1 /~~ r' r ~r~ )'` !~! /j/' . rovnship. ~'~ - -~ ~=1 Yrs, decca+ed lived in r Sntt . _ ACTUALLY f ~ 'T'-~ / /Y` /`F'1- ii~: ~" "~ ^ No, decen+ed lived within actual limits of cuy or borough. nt b C y ou . LIVE1 ~ E MARRIED NEVER MARRIED 9 10. GATE OF BIRTH ~ 1, AGE (ln yenn (( ander (wear if under 21 hour, ~ ~. SEX 8. RAC . ~ ~-~ last birthday) l h Ua s noun Min / t~ ~ `1/f. II / / // (:./~,' ~ TF^ WIDOWED ^ DIVORCED ^ -. (- ~ ~~~.1 ~i ~~~, ont s „4 y . OCCUPATION (even it.tetired) 13: SOCIAL SECURITY NO. 1 12. USUAL 4. BIRTHPLACE (State or foreign country) I5. CITIZEN OF WHAT COUNTRYT V ' FULL NAME OF SPOUSE ~ I15. 17. MOTHER'S MAIDEN NAME ~ ~ ' R'S NAME FAT NF 18 ~ ,- ; t9. ,NF On MA NT'S NAME, ADO RE53 ANO ZIP CODE _ . _ _ r-: / , ~INTER`~AL BETWEEN R' rIF1C.\TION 111{I11l:AL (. F, ONSET AND DEATH ' i ~~ CAUSE OF DEATH: Entry only aee cause pet line for (a), (bl dt (,c). 1 r•~~ PART 1. Deuh .as cau.+ed by: Cn~, ,/~ i ' ~~ ~~'tl/~'SrN~_~"y~ .'~,'~~ y~~~'~-"P~ I 1~!Y,`~~ DIATE CAUSE (^1 1MMF _ ~ , (,:unditirms, if any, trhich DUE TO (b) `~YiSLL~..Lt~.Itl~!M-!! ~-.~ ~~~^-..t+'~--~~},/~r^~- gw+e rise to rbove c^we j (a) ,Wring the underlying DUF. TO (c) i c^u+e I^+t. I PART IL OIIIFR SIGNIFICANT CONITIT1pNC: contributing ro death but not related to the terminal di+ense given in Par[ 1 (a). 21. WAS AUTOPSY ~ pgpFOPMFDI vr+ D No >/ 22. • ACCIDENT ~ 22. b. OF_SCRIBE HOW INJURY OCCURRED 22. e. TIME I1our Alonth Day Year SUICIDE ^ OF m. INJURY F. T. j HOMICIDE Q Z`..1 INJIIRV OCCl1RRE0 22. e. PLACE OF INJURY (e. g., home, (arm, ZZ. f. CITY, 00ROUGH, TOWNSHIP COUN7Y STATE ~'hilr ^t Nnt while ^ factory, +rtret, etc.) at work ,~ ^nrk "9. I, beer Ly ern ily th^t inve+riryiNnn of ,thy loth of the above named dree^sed re+tdted n the findings het! sated, sod that time n( denrh ie a+timatld as . ~ T.; a`n It Jr~ t ed above. (' f i! rlJ!/ , /~ ~ ~.'' m F f . . ~ , . 7 rr'' / ~J 1 D ~ 1 /' ~ ~ ~ ~ ate +iQned f ~ / i•./t. e. t'~ , b. Addre++_ .~{. / /ti,/! -lt~~- r. Gignattre of ctxenn / ) ~ 24, a. OURIAL ~ ~ 24. b. DwrE + 24. e. NAME OF CEMET SRY OR CREMATORY t 24. d. ~s.OCATION (City, hero., firp., A OIounty) (State) / - ~ ~ I CREMATION ~ ~ ~; ~ % ) ~ ~ ~ r _ / V ~j ~~~~~r~ii, ~~ !!" "~ r ~, ( l ~ ///~~~ ~.- ~` i r ~'•-_ /J c.'~/i~ l ~',' ~~~~~, t REMOVAL ^ t < ~( ~. r'Y'--(, ~ ( _ ~ ~ - ~ ~ , ~..c , ~ ~~ ~ ,.,c IN RE: ESTATE OF HENRY F. EISENHOWER, DECEASED JUN. 0 72001 C!' - IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-73-39 PETITION TO AUTHORIZE THE REGISTER OF WILLS OF CUMBERLAND COUNTY TO GRANT LETTERS OF ADMINISTRATION AFTER TWENTY-ONE YEARS FROM DECEDENT'S DEATH PURSUANT TO 20 Pa. C.S.A. § 3152 TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petitioner, Shirley A. Botts, by and through James D. Bogar, Esquire, Attorney for the Estate of Henry F. Eisenhower, Deceased, respectfully represents as follows: 1. Petitioner is Shirley A. Botts, formerly Shirley A. Eisenhower, an adult individual of 4821 Brian Road, Mechanicsburg, Cumberland County, Pennsylvania. 2. Henry F. Eisenhower (hereinafter referred to as "Decedent") died on November 18, 1972, being a resident of, and being domiciled in, Cumberland County, Pennsylvania, having a specific address of 4821 Brian Road, Mechanicsburg, Cumberland County, Pennsylvania. 3. The Decedent died intestate, being survived by Shirley A. Botts, formerly Shirley A. Eisenhower, surviving spouse, and four (4) children, said children now all being adult individuals. The surviving children are as follows: Cynthia Cundall, Cory Eisenhower, Keith Eisenhower and Henry F. Eisenhower, III. WHEREFORE, it is respectfully requested that this Honorable Court authorize the Register of Wills of Cumberland County to grant Letters of Administration upon the Estate of Henry F. Eisenhower, Deceased, to Shirley A. Botts. DATE: June 1 , 2001 Ja es D. Bog , Esquire Attorney for h Estate of Henry F. Eisenhower 3 VERIFICATION I verify that the statements made in this Petition are true and correct. I understand that unsworn statements herein are made subject to the penalties of 18 Pa. C.S.A. Section 4904, relating to unsworn falsification to authorities. DATE : -~Ct.~Z l~ a1C~7~ ....~ Shirley Botts RENUNCIATION In Re Estate of HENRY F. EISENHOWER To the Register of Wills of Cumberland The undersigned Cory Eisenhower , son deceased. County, Pennsylvania. of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Shirley A. Botts WITNESS ,`~J-~~1.. ~~ hand this ~`~ day of +~ ~~`~ f 2 0 01 ,, J Notarial Seal Cynthia L. TFzornas, Notary Public lJa^~r R?i~~~'P•1N)., ~~or;=.uP.ri^?~d Cnunty f ~ ~ _ .~ ., .~ .... .. _, .. _., (Signature) Cory isenhower 4485 Panza Drive Mechanicsburg, PA 17055 (Address) (Signature) (Address) (Signature) (Address) Exhibit "A" RENUNCIATION In Re Estate of HENRY F. EISENHOWER To the Register of Wills of The undersigned Cumberland Keith Eisenhower, son deceased. County, Pennsylvania. of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to Shirley A. Botts \ c WITNESS ~ ~~ ~`- day of ~ 2001 1~~7A~il,~:L 5~A1. f.~.!"t^,i~i~ L. ~)fi+ic'1(~~~i~@f. ~v41$:j! ~Ut)i1C Car;l~ ?-~;? ls~,o, C~~rr~erlar+d C•~~u;~ty Af"~,j Comn~i;s~on ~esa,o, iu,e 24, ~Cr ts...~__. _ ~.______.__~. .~~ (Signature) Keith Eisenhower 1806 S. Market Street Mechanicsburg, PA 17055 (Address) (Signature) (Address) (Signature) (Address) Exhibit "A" RENUNCIATION In Re Estate of HENRY F. EISENHOWER To the Register of Wills of Cumberland deceased. County, Pennsylvania. The undersigned Henry F. Eisenhower, III ~ son of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to ,Shirley A. Botts WITNESS -G~.~. ~~ NOTARIAL SEAL BARBARA STUMP, Notary p~l~ Camp M+tt Boro, C(uriberl~nd County ~Y Contmissfon Expireis Nov. 12, 2002 (Signaturc) Henr Eisenhower, III 4821 rian Road Mechanicsburg, PA 17050 (Address) (Signature) (Address) (Signature) (Address) hand this day of 2 0 01 -- Exhibit "A" RENUNCIATION In Re Estate of HENRY F. EISENHOWER To the Register of Wills of The undersigned Cumberland Cynthia Cundall, daughter of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration be issued to WITNESS :~"~A i E~ :.; r ;' F :6::~ ~,ouNrv ~ar•`~~~`rus SUBSCRI ~ A9'y~'~ ~~~C~i t~EFOFtE T f~AY OF_ _ - 20 " ®O~NA GARRETT '~ lE~taf P~At N Tesae ~~ ,. ~~3 Shirley A. Botts hand this ~ day of 2 0 01 "D ~r,~~y ~ ~z~-~~ (Signature) ~ynthia Cundall 700 W. Windsor Denton, TX 76207 (Address) (Signature) (Address) (Signature) (Address) deceased. County, Pennsylvania. Exhibit "A" IN RE: ESTATE OF ) IN TILE ORPHANS' COURT OF HENRY F. EISENHOWER, ) CUMBERLAND COUNTY, PGNNSYLVAP3IA DECEASED ) NO. 1972 ORDF,R OF COURT r~ AND NOW, this /c.t~ day of ~L~.l~~„,,.„, 1972,, upon consideration of the foregoing Petition, there is awarded to iTIIRLF.Y A. EISENIIUWER, for the purpose of reducing the debts of khe T~atate of henry F. Eisenhower, ttte following items of personal property which In the aggregate do not exceed the value of Five Thousand ($5, 000) 1~ollarR ; (a) Dauphin Deposit Trust Company - checking account $ 10. 00 (b) Farmers Trust Bank of Carlisle - checking account $G00.00 (c) Four used care including one .Jaguar at $3~i0. 00 1968 Scamper at 9;~i00. 00 one MG sedan at $100. 00 and one Volkswagen }3us, 1964, at $500.00 This award is made to the Petitioner, SHIRLEY t~. T'.'1ST'I.1T1OV,~'I;7T, under and by virtue of the Fennaylvania Act of Assembly, known as the Fiduciaries Act of 1949, Section 202, Act of April 18, 1949, F. L. 51Z (20 P. S. 320.202) T3Y Till: COiJRT; c~ ~~:.J. A TRUE COPY fftO;JI t;E•:,UI;D In7estimonywl,^r~ `f. ~ ~~'rc~''~tol, etem~ahand and the seatf,ol ..-_, ~ : ,~ ~' ~ '~ '~ / ` This......:.. ~.~...........d:,',' cf..~~yS ................19...:?.....__ I ~~,,c,.~~:..-fi~~,,~~.~.o.,~ ................... ... Clerk of the Orphans Carr A~~f"`4~~ Cumberland County, Exhibit "B" 4. Petitioner is a party in interest, being the then surviving spouse of the Decedent. 5. The children of the Decedent have ali renounced their respective rights to request the grant of Letters of Administration, said Renunciation being in favor of Shirley A. Botts. The Renunciations of all of the children of the Decedent are attached hereto, collectively marked Exhibit "A" and incorporated herein. 6. By Order of Court dated February 16, 1973 the Petitioner herein, who was then known as Shirley A. Eisenhower, was awarded certain assets being titled in the name of Decedent alone, said award being made pursuant to a Petition for Disbursement of an Estate Less Than Five Thousand Dollars, all in accordance with 20 P.S. 320.202, now 20 Pa. C.S.A. § 3102- Settlement of Small Estates on Petition. A copy of the Order of Court and Petition is attached hereto, marked Exhibit "B" and incorporated herein. 7. Letters of Administration have not been granted with respect to the Estate of Henry F. Eisenhower. 8. Letters of Administration are necessary because Decedent was the owner of stock, the existence of which was discovered after the above-referred to Order of Court and Petition for Distribution in an Estate Less Than Five Thousand Dollars. 2 IN RE : ESTATE OF ) IN TTIE URPTIANS' COURT OF HENRY F. EISENIIOWER, ) CUMBERLAND COUNTY, PENNSYLVANTA DECEASED ) NO. ,.; I - %3 • :`r 1'?9~ PETITION FOR DISTRIBUTION IN AN ESTATE LESS THAN FIVE THOUSAND DOLLARS The Petition of Shirley A. Eisenhower, respectfully represents that; 1. The Petition resigns that the Petitioner is the wife of the Decedent. 2. On the 18th day of November, 1972, the Decedent, Tlenry F. Eisenhower died domiciled in the Commonwealth of Pennsylvania, a resident oP 4821 Brian Road, Mechanicsburg, Cumberland Couuty, Pennsylvania. 3. The Decedent d ied intestate. 4. Letters of Administration have not been granted. 5. No taxes are due by the estate of the Decedent. 8. The following debts are due by the estate of the Decedent; (a) Gil Parthemore, Funeral Home $1,127.f8 (b) Joseph Mahal, Funeral home $ 790. 00 (c) Lancaster General lioapital and ambulance $ 129.85 7. The person entitl ed to receive the estate to Shirley A. Eisenhower, tiie Petitioner, wl~o is tt~e wife and surviving heir of the Decedent. IN RE: ESTATE OF HENRY F. IN THE COURT OF COMMON PLEAS OF EISENHOWER, DECEASED CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-73-39 DECREE AND NOW, this ~ day of 2001, in consideration of the Petition to Authorize the Register of Wills of Cumberland County to Grant Letters of Administration After Twenty-One Years from Decedent's Death Pursuant to 20 Pa. C.S.A. § 3152, it is ORDERED and DECREED, that the Register of Wills of Cumberland County is authorized to grant Letters of Administration upon the Estate of Henry F. Eisenhower, Deceased, to Shirley A. Botts. BY THE COURT: 3 8. The Decedent's estate ak the time of his death consisted and had the value of : (a) Dauphfn Deposit Trust Company checking account $ 10. 00 (b) Farmers Trust Bank of Carlisle checking account $800. 00 (c) Four used care including one Jaguar at $350. 00 1988 Scamper at $500.00 one MG sedan at $100.00 and one Volkswagen Bus, 1968, at $500. 00 9. No estate over and above the $g, 00o family exemption is apparent and no heirs other than the Petitioner are ent[tled to distribution under this estate, and, therefore, no parties to give consent other than the Petitioner. 10. The Petitioner requests the Court. pursuant to Section 202 of the Fiduciaries Act of A prii 18, 1049, P. L. 51l, as amended (20 P. 5. 320. 202), to award distribution of the estate as follows ; "Entire Estate to be distributed by the surviving wife and sole surviving heir, Shirley A. Eisenhower, your Petitioner, and since the assets of the estate are insufficient to pay the debts in full, the debts of the said estate will be pro rata from the available assets of the estate by the Petitioner and from the property of the estate. " ,~ ~ ~ r ey sen ower, e t onlT er COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF DAUPHIN ) Personally appeared before me, a Notary Public, in and for said Commonwealth and County aforesaid, SfiIRLEY A. EISENHOWT'R, who, being duly sworn according to law, deposes and says that she is the Petitioner to the foregoing action, and that the facts set forth in the foregoing Petition are true and correct to the best of her information and belief. 3Tirey ee oni` w~`e`r Sworn to and subscribed to before me this ~~~' day of ~?~ y,~,~~?/~~ 187 ~' ~- t ,7 ~. J; o ary u c (SEAL) ~ . My Commission Expires: G~%`~"` ~L. !~ OFFICIAL USE ONLY REV-1500 EX + (6-00) REV-15~ V ~ ~" g- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER DEPARTMENTOFREVENUE DEPT 280601 RESIDENT DECEDENT 21- 73 - 0039 . HARRISBURG, PA 17128-0601 COUNTYCOOE YEAR NUMBER D DECEDENT'SNAME(LAST,FIRST,ANDMIDOLEINITIAL) SOCIAL SECURITY NUMBER E Eisenhower Henr F. 211-26-5583 ~ DATE OF DEATH (MM-DD-YEAR) GATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE D E 11/18/1972 02/16/1936 REGISTER OF WILLS N IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL SOCIAL SECURITY NUMBER T Eisenhower, now Botts, Shirle A. 191-28-6032 X 1. Original Return 2. Supplemental Return 3. Remainder Return date of death prior to 12-13-82) ^ A P 13 R p ' 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12- 82) $. Federal Estate Tax Return Required ~ P 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes 0 T K (Attach copy of Will) (Attach copy of Trust) _ E $ ~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit ~ 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) ''THIS SECTION MUST BE COMPLETED. ALL_CORFIESPONDENCE i;< CONFJDENTJAG,TAX iNFQRMATION'SHOULD.BE DIRECTED' TO: ` ; P C NAME COMPLETE MAILING ADDRESS R N James D. Bo ar Es uire R E FIRMNAME(IfApplicable) One West Main Street S N Shiremanstown, PA 17011 T TELEPHONE NUMBER 1 3 -8 6 i. Real Estate (Schedule A) (1) None OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 7 , 282.00_ 3. Closely Held Corporation, Partnership or (3) Nair;. Sole-Proprietorship 4. Mortgages 8 Notes Receivable (Schedule D) (4) None E 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2 , 060'.00 ~ C (Schedule E) _ ~~ A P 6. Jointly Owned Property (Schedule F) (6) None -; G ~. I ~ Separate Billing Requested . ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ,_ . None - A T I O N (8) 9 , 342.00 (11) S , 426.85 (12) 3 , 915.15 (13) (14) 3,915.15 c M SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES T ~ 15. Amount of Line 14 taxable at the spousal tax A T X rate, or transfers under Sec. 9116(a)(1.2) X .0 6 (15} 0.00 A T 16. Amount of Line 14 taxable at lineal rate 3 , 915.15 X .0 6 (16) 234.91 0 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 N 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0.00 19. Tax Due (19) 234.91 20. 'CHECK HERE JF YOU ARE AEaUESTiNG: A REFUND OE AN QYERPAYNIENTI" > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE'SIDE AND TO RECHECK MATH 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses 8~ Administrative Costs (Schedule H) (9) 5 , 426.85 10. Debts of Decedent, Mortgage Liabilities, $ Liens (Schedule I) (10) None 11. Total Deductions (total Lines 9 i3< 10) 12. Net Yalue of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 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) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX tae., c_nM Decedent's Complete Address: STREET ADDRESS _ 4821 Brian Road CITY STATE ZIP Mechanicsbur PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 234.91 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 82.55 Total Interest/Penalty (D + E) (3) 82.55 4. {f 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) 0.00 5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 317.46 A. Enter the interest on the tax due. (5A} 401.51 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 718.97 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; X b. retain the right to designate who shall use the property transferred or its income; . X c. retain a reversionary interest; or . X d. receive the promise for life of either payments, benefits or care? X 2. If death occurred after December 12. 1982. did decedent transfer property within one year of death without receiving adequate consideration? . ^ OX 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a 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 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Shirley A Botts DATE ' ~ 4821 Brian Road ~~~~ - ------------------------------------------------ 02/28/02 Mechanicsburg, PA 17050 SIGNAT~EOFPREPARE OTHER THAN REPRESENTATIVE James D. Bogor Esquire DATE /f ! ' '~,. 11~; ~,rv __ One West Main Street 02/28/02 For dates of death on or after`7. my 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 [72 P.S. 9116 (a) (1.1) (ii)]. The statute 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 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 % [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (1-97) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS 8c BONDS INHER{TANCE TAX RETURN ESTATE OF NUMBER Henry F. Eisenhower SS~~ 211-26-5583 11/18/1972 21-73-0039 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 88 shares Minnesota Mining and Manufacturing Company 82.75 7,282.00 (3M), CUSIP ~~604059105 - Common stock TOTAL (Also enter on line 2, Recapitulation) 7 , 282.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) SCHEDULE E M N CASH, BANK DEPOSITS 8c MISC. CO MO WEALTH OF PENNSYLVANIA IN RESIDENTDECEDENTN , PERSONAL PROPERTY ESTATE OF FILE NUMBER Henry F. Eisenhower SS~~ 211-26-5583 11/18/1972 21-73-0039 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Dauphin Deposit Trust Company - Checking account 10.00 2 Farmers Trust Bank of Carlisle - Checking account 600.00 3 1968 Scamper 500.00 4 1968 Volkswagen Bus 500.00 5 Jaguar 350.00 6 MG Sedan 100.00 NOTE: Values of all assets listed on Schedule E were taken from the Petition for Distribution in an Estate less than Five Thousand Dollars and Order of Court dated February 16, 1973, a copy of which is attached hereto and incorporated herein. TOTAL (Also enter on line 5, Recapitulation) ~$ 2 , 060.00 (If more space is needed, insert additional sheets of the same size) IN RE: ESTATE OF ) IN TIIE ORPHANS' COURT OF HENRY F. EISENHOWER, } CUMBERLAND COUNTY, P1;NNSYLVANIA DECEASED ) NO. 1972 ORDF,R Or COURT f ~~~~-. AND NOW, thte !~-rl,. day of ~L~•.1 ~,,,,,,, ~ 1 972, upon consideration of the foregoing Petition, there is awarded to STTIRLEY A. EISENIIOWER, for the purpose of reducing the debts of the Petate of Henry F. Eisenhower, ttie following items of personal property which in the aggregate do not exceed the value of T'ive Thousand (~5, 000) Dollars ; (a) Dauphin Deposit Trust Company checking account ~; 10. 00 (b} Farmers Trust Bank of Carlisle - checking account $600.00 (c) Four used cars including one ,Jaguar at ~;~50.00 1968 Scamper at $500. 00 one MG sedan at ~'>100. 00 and one Volkswagen $ua, 196F3, at $500.00 This award is made to the Petitioner, STIIl1LEY A. Ts'IST'h7TIOGG'I:R, under and by virtue of tl~e Pennsylvania Act of Assembly, known as the Fiduciaries Act of 1949, Section 202, 11ct of April lII, 1949, P. L. 512 (20 P.S. 320. 202) I3Y TTIF. COURT ; i ..I . A TRUE CG?'f f~tO;~t ~:E,UI~D InTestimany wl:^r~ ~f.' :,'rc~~" h set my hand ,;. ~, and the seal u; .. ,. _. .~. • ~t ., :Ilse°, Pa. } t'' `~ . .. ............................... . ... Clerk of the Orphans Court ~i 1 ~ ' j"`~'~ Cwnberiand County. IN RE ; ESTATE OF ) IN THE ORPTIANS ~ COU.RT OF ) FIENRY F. ELSENFIOWER, ) CUMBERLAND COUNTY, PENNSYLVANIA DECEASED ) rTO, ,,; ~ _ •/~ . ;~ ~ ~~ PETITION FOR DISTRIBUTION IN AN ESTATE LESS THAN FIVE THOUSAND DOLLARS The Petition of Shirley A. Eisenhower, respectfully represents that: 1. The Petition resigns that the Petitioner fa the wife of the Decedent. 2. On the 18th day of November, 1972, ttye Decedent, Tienry F. Eisenhower died domiciled in the Commonwealth of Pennsylvania, a resident of 4821 Brian Road, Mechanicsburg, Cumberland County, Pennsylvania. 3. The Decedent d ied intestate. 4. Letters of Administration have not begin granted. 5. No taxes are due by the estate of the Decedent. 8. The following debts are due by the estate of the Decedent: (a) Gil Parthemore, Funeral Home $1,127. fib (b) Joseph Mahal, Funeral Fiome $ 790.00 (c) Lancaster General Hospital and ambulance $ 129.85 7. The person entitl ed to receive the estate is Shirley A. Eisenhower, the Petitioner, wtio Is tt~o wife and surviving heir of the Decedent. ' ~ i 8. The Decedent's estate at the time of his death consisted and had the value of (a) Dauphin Deposit Trust Company checking account. $ 10.00 (b) Farmers Trust Bank of Carlisle checking account $800.00 (c) Four used cars including one Jaguar at $350. 00 1988 Scamper at $500.00 one MG sedan at $100.00 and one Volkswagen Bua, 1968, at $500, 00 9. No estate over and above the $5, 000 family exemption is apparent and no heirs other than the Petitioner are entitled to distribution under this estate, and, therefore, no parties to give consent other than the Petitioner. 10. The Petitioner requoata the Court, pursuant to Section 202 of the riduciaries Act of April 18, 1~J43, P. L. 512, as amended (20 P.5. 320.202), to award distribution of the estate ae lollowa; "Entire Eatake to be distributed by the surviving wife and sole surviving heir, Shirley A. Eisenhower, your Petitioner, and since the assets of the estate are insufficient to pay the debts in cull, the debts of the said estate will b e pro rata from the available assets of the estate by the Petitioner and from the property of the estate. " r ey sen ower, Pet t over COMMONWEALTH OF PENNSYLVANIA ) SS : COUNTY OF DAUPHIN ) Personally appeared before me, a Notary Public, in and for said Commonwealth and County aforesaid, SHIRLEY A. EISENHOWER, who, tieing duly sworn according to law, deposes and says that she le the Petitioner [n khe foregoing action, and that the facts set forth in the foregoing Petition are true and correct to the beat of her information and belief. ~' r ey ~ aen ower Sworn to and ~ub~cr~ibe~d to befor~e~ me this `f ~~' day of !~.L~~°c~ yJ,~tE'~/, 197 ~ ~~ ~' rt Z/ ~ J otary u~ c ~~ {SEAL) My Commleaion Expires; ~C - C j~,~f~~ ~~ REV-1511 EX t (t-97) SCHEDULE H FUNERAL EXPENSES ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Henry F. Eisenhower SS~~ 211-26-5583 11/18/1972 21-73-0039 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Gil Parthemore Funeral Home - Funeral expense 1,127.68 2 Mahal Funeral Home - Funeral expense 200.00 3 Schuylkill Memorial Park Inc. -Memorial 471.32 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) f ElN Number of Personal Representative(s) Street Address City State Zip 2. 3. Year(s) Commission Paid: Attorney's Fees James D. Bogar Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Shirley A. Eisenhower, now Botts Street Address 4821 Brian Road City Mechanicsburg State PA Zip 17050 Relationship of Claimant to Decedent Spouse 4. Probate Fees 5. Accountant's Fees 1,925.00 1,500.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Lancaster General Hospital and Ambulance - Services rendered 129.85 2 Register of Wills - Filing fee for Petition to Authorize Grant of 15.00 Letters 3 Register of Wills - Filing fee for Petition for Grant of Letters 48.00 4 Register of Wills - Filing fee for Pennsylvania Inheritance Tax 10.00 Return TOTAL (Also enter on line 9, Recapitulation) $ 5 , 426.85 (If more space is needed, insert additional sheets of the same size) Coovrinht /rl iaca tn..., ~.,c.,..-,... .-_,.. ~., ~.._._ _. REV-1513 EX r (9-p0) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFtC1ARlES ESTATE OF FILE NUMBER Henry F. Eisenhower SS~~ 211-26-5583 11/18/1972 21-73-0039 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and Vansfiers under Sec. 9116(a)(1.2)] 1 Shirley A. Botts Surviving Spouse One-third 4821 Brian Road (1/3) of rest, Mechanicsburg, PA 17050 residue and remainder 2 Cynthia Cundall Daughter One-sixth 700 W. Windsor (1/6th) of Denton, TX 76207 rest, residue and remainder 3 Cory Eisenhower Son One-sixth 4485 Panza Dr. (1/6th) of Mechanicsburg, PA 17055 rest, residue and remainder 4 Henry F. Eisenhower III Son One-sixth 4821 Brian Road (1/6th) of Mechanicsburg, PA 17050 rest, residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE, ON R EV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 (If more space is needed, insert additional sheets of the same size) Estate of: Henry F. Eisenhower Soc Sec ~~: 211-26-5583 Date of Death: 11/18/1972 Continuation of Schedule J, Part I (Taxable Bequests) Item Name and Address of Beneficiary ~~ Relationship Amount or Share of Estate 5 Keith Eisenhower 1806 S. Market St. Mechanicsburg, PA 17055 and remainder Son One-sixth (1/6th) of rest, residue and remainder NOTE: See 20 Pa. C.S.A. Section 2102 and 2103. Decedent died intestate on November 18, 1972. The language of the applicable proceeding portions of Section 2102 and 2103 appear to indicate the above-referenced disposition of the intestate estate is appropriate. STATUS REPORT UNDER RULE 6.12 Name of Decedent• Henry F. Eisenhower '~ ~-; Date of Death: November 18, 1972 Will No. 21-73-0039 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the pers.anal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. t Date: 02/28~J'02 `~~ ~' -- ~,,/ Signature 4*; James D. Bogar, Esquire Name (Please type or print) _-' One est Main St . Shiremanstown, PA 17011 _. ,, ~`~ Address ,s•. (717 ) 737-8761 Tel. No. Capacity: Personal Representative (MAH:rmf/AM3) 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 BOGAR JAMES D 1 W MAIN STREET SHIREMANSTOWN, PA 17011 -------- fold ESTATE INFORMATION: ssly: 21 ~-26-55as FILE NUMBER: 2173-0039 DECEDENT NAME: EISENHOWER HENRY F DATE OF PAYMENT: 03/01/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 / 1 8/ 1 972 REV-1162 EX(11-96) N0. CD 000902 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5718.97 TOTAL AMOUNT PAID: REMARKS: SHIRLEY A BOTTS C/O JAMES D BOGAR ESQUIRE CHECK# 356 SEAL INITIALS: SK RECEIVED BY: MARY C. LEWIS 5718.97 REGISTER OF WILLS REGISTER OF WILLS ~y ~ ~- ~~~ 7 - ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% ~FP fDl-02) DATE 04-15-2002 ESTATE OF EISENHOWER HENRY F DATE OF DEATH 11-18-1972 FILE NUMBER 21 73-0039 ~~` '`" ; `' - ` !~ COUNTY CUMBERLAND JAMES D BOGAR ESQ ACN 101 1 W MAIN ST Anount Remitted SHIREMANSTOWN PA 17~~r ,.i a MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EISENHOWER HENRY F FILE N0. 21 73-0039 ACN 101 DATE 04-15-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Dwned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) .00 NOTE: To insure proper (2) 7,282.00 credit to your account, (3) .00 submit the upper portion (4) .00 of this form with your (5) 2,060.00 tax payment. (6) .00 (n .00 ($) 9,342.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 5,426 .85 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 5.426.85 12. Net Value of Tax Return (12) 3,915.15 13. Charitable/Governmental Bequests; Nonelected 9113 Trus ts (Schedule J) (13l .00 14. Net Value of Estate Subject to Tax (14) 3,915.15 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate (15) • 00 X 00 _ . 00 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 3,915.15 X 06 - 234.91 17. Anount of Line 14 at Sibling rate (17) • 00 X 00 = . 00 18. Anount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 - .00 19. Principal Tax Due (19)= 234.91 TAY f`DCTITTC• •• DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 01-18-1996 AMNP PEN 82.55 .00 NOTE: AMNESTY NP 03-01-2002 CD000902 484.06- 718.97 PENALTY ASSESSED TOTAL TAX CREDIT 234.91 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THiS FORM FDR TNSTRl1CTTONS l