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HomeMy WebLinkAbout04-0454Register of Wills of~ Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Marcella A. Headdings No. ~-~- ~q- also known as Marcella A. Headings , Deceased Social Security No. 207-28-8125 Petitioner(s), who is/are 18 yea~s of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix L~ Decedent, dated 10/16/03 and codicil(s) dated NONE named in the Last Will of the 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 incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minodtate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship (COMPLETE IN ALL CASES:) Attach additional sheets if necessary, c~ Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 275 High Road, Shippensburg, PA 17257 (list street, number and municipality) Decedent, then .89 years of age, died April 13 ,2004 , at Chambersburg, Pennsylvania (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 ........................................................................................ $ Total ..................................................................................................................... $ 30,000.00 30,000.00 Real Estate situated as follows: 275 High Road, Southampton Township, Cumberland County, Pennsylvania 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: I ~[2~.,~.~.~-_....._ "/ ~/.~?-Signature ~:~.~ Typed or printed name and residence Patricia M. Ott 275 High Road Shippensburg, Pa. 17257 RW-7 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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 and affirmed and subscribed before me this ~'ff'-"~- day of DECREE OF REGISTER Estate of Marcella A. Headdinqs Deceased No. ~:~,~ - O~- ~5 ~ also known as Marcella A. Headings IT IS DECREED that Letters [~ Testamentary [] of Administration are hereby granted to Patricia M.Ott Social Security No: 207-28-8125 Date of Death: 4/13/04 AND NOW, May \ [ , 2004 in consideration of t~Petition on the reverse side hereon, satisfactory proof having been presented before me, , (c.t.a.. d,b.n.c.t.; pendente lite; durante absen,~tia; durante minoritate) in the above estate and that the instrument(s), if any, dated October 16, 2003 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... $-'"~ , ~ Short Certificate(s) ............... $ I_t _ b0 Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages( ) .............. $ ~. ~)0 Codicil ................................. $ bb JCP Fee ................................. $ IO, Inventory & Tax Forms ............. $ Other ...................................... $ Attorney Attorney: I.D. No: Address: RW-7A TOTAL ............................. $ qc~-00 Telephone: DATE FILED: LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, MARCELLA A. HEADDINGS to Pennsylvania being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all my property be it real, mixed or personal to my daughter, Patricia M. Ott. I make no provi~l~ns in Bis will~f~t my son, Larry Stine since he has a home and it is my intent that bot ~ll:~n_~ y children be secure. THIRD: I nominate and appoint my daughter, Patricia M. Ott~i~s .r.. Executrix of this my Last Will and Testament. The said Executrix shall serve without bond of any nature or kind. IN WITNESS WHEREOF, I, MARCELLA A. HEADDINGS this my Last Will and Testament set my hand and official seal, this 16th day of October, 2003. Marcella A. Headdi~gs - - - C] Sworn to and subscribed, declared and Published by Marcella A. Headdings, as Her Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at her request, And in her presence, and in the presence Of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND · I, Marcella A. Headdings, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly and that I signed it as my free and voluntary act for the purpose therein expressed. Marcella A. Headdings -~' Sworn to and acknowledged, before me, By Marcella A. Headdings, Testatrix This 16th day of October,2003. Notary Public I Notarial Seal I H, Anthony Adams, Notary Public ~hippensburg Boro, Cumberland County My Commission Expires May 15, 2006 M~1111~, PermayNania Association of Notaries COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND · WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this 16th day of October, 2003. Notary Public ~ Notarial Seal I _. H. Anthony Adams Not p , Shi ri , ary ublic ~ , umt~rland County / *~Y Commission Expires May 15. 2006 Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 08/02/2004 ADAMS H ANTHONY 49 W ORANGE ST SUITE 3 SHIPPENSBURG, PA 17257 RE: Estate of HEADDINGS MARCELLA A File Number: 2004-00454 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 08/21/2004 Your prompt attention to this matter will be appreciated. Thank You. cc: File Personal Representative(s) Judge Sincerely, Clerk of the Orphans' Court Cumberland County - Register Of wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 08/02/2004 OTT PATRICIA M 275 HIGH ROAD SHIPPENSBURG, PA 17257 RE: Estate of HEADDINGS MARCELLA A File Number: 2004-00454 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHAi~S' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 08/21/2004 Your prompt attention to this matter will be appreciated. Thank You. CC: File Counsel Judge Sincerely, Clerk of the Orphans' Court CERTIFICATION OF NOTICE UNDER RULE 5.6(a1 Will No. Admin. No. ~[ t - (i) ~'/- O ~{ -~ %/ To the Register: I certify that notice of (beneficial interest) ~ 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 {~,oq~ o%4, } [ i ~O/hV : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except. Capacity: __ Personal Representative ~Counsel for personal representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, Cumberland In re Estate of Marcella A. Headd ngs aka Marcella A. Headings File No, TO: Patricia M. Ott , PENNSYLVANIA , deceased, (beneficiary) 275 High Road Shippensburg, PA 17257 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent, Marcella A. Headdings aka Marcella A. Headings , died on 4/13/04 in Cumberland County X The Decedent died testate (with a Will) __ The Decedent died intestate (without a Will) Name(s), address(es) and telephone number(s) of all personal representatives appointed: Name Address Patricia M. Ott 275 High Road, Shippensburg, PA 17257 Telephone 717-532-2860 If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of: If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of: A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. X A copy of the Will or Petition is attached. Date I I Capacity: X Personal Representative Counsel for Personal Representative Signature Name Address Telephone H. Anthony Adams 49 W. Orange Street, Suite 3 Shippensburg PA 17257 717-532-3270 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, MARCELLA A. HEADDINGS to Pennsylvania being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all my property be it real, mixed or personal to my daughter, Patricia M. Ott. I make no provisions in this will for my son, Larry Stine since he has a home and it is my intent that both my children be secure. THIRD: I nominate and appoint my daughter, Patricia M. Ott, as Executrix of this my Last Will and Testament. The said Executrix shall serve without bond of any nature or kind. IN WITNESS WHEREOF, I, MARCELLA A. HEADDINGS this my Last Will and Testament set my hand and official seal, this 16th day of October, 2003. Marcella A] Headdings Sworn to and subscribed, declared and Published by Marcella A. Headdings, as Her Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at her request, And in her presence, and in the presence Of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : I, Marcella A. Headdings, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly and that I signed it as my free and voluntary act for the purpose therein expressed. Marcella A. Headdings Sworn to and acknowledged, before me, By Marcella A. Headdings, Testatrix This 16th day of October,2003. Notary Public Notarial Seal H. Anthony Adams. Notary Public Shippensburg Born, Cumberland County My Corem ss on Exp res May 5, 2006 Mel~bet, P~nWtv~nie AssoOation of Notaries COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND : WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each Of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this 16th day of October, 2003. Notary Public Notarial Sea~ ] REV-1500 EX + (6-00) '* I- Z W C W o W C W I- :.c $en Uo:::.c WQ.U ::r:OO " O::...J ~ Q.1XI Q. c( COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Headdin 5 DATE OF DEATH (MM-DD-Year) Marcella A DAfE OF BIRTH (MM-DD-Year) 11 OFFICIAL USE ONLY FILE NUMBER a L-il~_()'-Ls=.~ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 2 0 7 - 2 8 - 8 1 2 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required Q... 8. Total Number of Safe Qleposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o 5 ~ I- Q: oCt o w 0:: 04/13/2004 09/24/1914 (IF APPliCABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [RJ 1. Original Return D 4. Limited Estate [RJ 6. Decedent Died Testate (AttachcopyofWiH) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date 0' death between 12-31-91 and 1-1-95) I- Z W C Z o Q. en w 0:: 0:: o U NAME H. Anthon Adams FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS 49 W. Orange Street Suite 3 TELEPHONE NUMBER 717-532-3270 Shi (1) (2) (3) (4) (5) (6) (7) 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o < I- ~ a.. :IE o o ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X _(15) 37,696.36 X .045 (16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTiNG A REFUND OF AN OVERPAYMENT (8) (11) (12) (13) (14) r 43,890_00 () PA 17257 OFFI~1 USE ONLY , :-, , -'") I .~ . ") c.t. ") 4,879.93.j. : -I I l_ _ [.(! 48,769.93 11,073.56 11 ,073.56 37,696.37 37,696.37 1 ,696.34 1,696.34 Decedent's'Complete Address: STREET ADDRESS 275 HiQh Road CITY I STATE T ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) _I 6 q b. 3 <j , Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 4. Total Interest/Penalty ( 0 + E) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) (4) (5) (5A) (5B) to: REGISTER OF WILLS, AGENT \ 6 9 {" ~l( 5. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check 16q~. 3Y 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; ........................................................................... D IXl b. retain the right to designate who shall use the property transferred or its income; ........................................ D I&l c. retain a reversionary interest; or ...................................................................................................... 0 I&l d. receive the promise for life of either payments, benefits or care? ............................................................. D I&l 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................................................................................... D I&l! 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D I&l 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D I&l 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 pe~ury, 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. SIGN URE OF PERSON ~ESPONSIBLE FOR FIL'.W ~N DA E 02 ~ &-.. . () ADDRESS Patricia att 275 High Road, Shippensburg SIGNATURE PREPARER OTHER THAN RE~~IVE __ ADDRESS H. Anthony Adams For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). 'D. ;', p C:;;I-' '-' '- C-A-J C.) 0 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 th . The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of PC\. 'l 0 (3.:) the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: f.\ P'i::::> The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death 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%, eXCE The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1'''JJ. p. SlDmTg '''=nn-.., w._ --.__. . 102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1.1) (ii)). Ible even if to . (,) ('.:) )tive parent, J L\ (ASt 9116(a)(1 )]. REV-1502 EX + 1.6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Headdings Marcella A All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with ri!lht of survivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 43,890.00 275-277 High Road Shippensburg, PA 17257 as per deed of January 19, 1972 in Deed Book "R" volume 24 page 1021 map # 39-13-0104-018A Land Value (less than 1 acre) $39,000.00. Improvement 1968 Mobile Home 4890. Total 43890 X Common Level ration Factor of 1.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 43 890.00 ! I REV-1509 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Headdings FILE NUMBER Marcella A If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIOtilSHIP TO DECEDENT A. Cindy Barklow 275 High Road Shippensburg, PA 17257 grand-daughter B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1/28/80 M& T Bank -Checking Account #97282278 9,759.86 50. 4,879.93 TOTAL (Also enter on line 6, Recapitulation) $ 4 879.93 (If more space is needed, insert additional sheets of the same size) REV-!'" EX.". SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Headdin9s FILE NUMBER Marcella A Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Fogelsanger-Bricker Funeral Home 6,138.40 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney Fees H. Anthony Adams Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Patricia Ott Street Address 275 High Road City Shippensburg State PA Relationship of Claimant to Decedent daughter 1,250.00 3,500.00 Zip 17257 4. Probate Fees 142.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. Chambersburg Hospital (Expense of Last Illness) 43.16 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11 073.56 '''''''''''''w COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF H dd' M SCHEDULE J BENEFICIARIES II A ! I FILE NUMBER ea me 5 arce a 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 transfers under Sec. 9116 (al (1.2)] 1. Patricia M. Ott daughter 100% 275 High Road Shippensburg, PA 17257 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: , A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REL426D CUMBERLAND COUNTY Public Inquiry Cntl Number 39 734 Map Number 39-13-0104-018A Old Ref Grantor Grantee(l) (2 ) Address HEADINGS, PAUL C & MARCELLA A 275 HIGH ROAD SHIPPENSBURG PA 17257 SITUS: Desc. (1) 277 HIGH ROAD (2 ) Property Desc. (1) (2) LAND LESS THAN 1 ACRE (3) Mobile Home - With Land Preferred Land Val Land Val 39000 Total Value Improvement Val 4890 43890 Mineral Val F12=Cancel F10=Sales F5=Taxes Acreage SOUTHAMPTON TOWNSHIP SHIPPENSBURG AREA S.D. Land Use Code Consideration Sale Date Deed Bk/Pg Taxable/Exmpt Clean&Green? Sqft Bldg Area Gross Area Dimensions Year Built Initial Struct Mobile Home Code Mobile Home Park Mobile Home Mfg. Mobile Home Year Mobile Home Unit II .800 RT TAXABLE 690 100 350 1968 BURLINGTON II rlM&I'Bank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 August 3, 2005 Law Office H Anthony Adams 49 West Orange Street, Suite 3 Shippensburg, Pennsylvania 17257 Re: Estate of Marcella A Headdings Social Security: 207-28-8125 Date of Death: April 1], 2004 Dear Sir or Madam: Per your inquiry dated July 27, 2005, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 97282278 Ownership (Names oj) Cindy A Bark/ow * Marcella A Headdings * Patricia M Ott, POA Opening Date 01/28/80 Balance on Date of Death $9,759.86 Accrued Interest $ 0.00 Total _...._.....__..... .."'_0_.. $9,759.86 Please be advised, there was no safe deposit box found for the above decedent. * For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please call the Walnut Bottom Office # 717-532-2414. Sincerely, ~~/t?~ Nancy Clagett Records Management I' LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, MARCELLA A. HEADDINGS to Pennsylvania being of sound and disposing mind, memory and understanding~ I do make, publish and declare this my Last Will and Testament hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses including my grave marker and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all my property be it real, mixed or personal to my daughter, Patricia M. Otto I make no provisions in this will for my son, Larry Stine since he has a home and it is my intent that both my children be secure. THIRD: I nominate and appoint my daughter, Patricia M. Ott, as Executrix of this my Last Will and Testament. The said Executrix shall serve without bond of any nature or kind. IN WITNESS WHEREOF, I, MARCELLA A. HEADDINGS this my Last Will and Testament set my hand and official seal, this 16th day of October, 2003. '-~l 0- k(""%~ 4. 4~X--;~~~ fFAL) Marcella A. Headdings . I' Sworn to and subscribedr declared and Published by Marcella A. Headdingsr as Her Last Will and Testamentr and so Done in the presence of we the Witnessesr who sign at her requestr And in her presencer and in the presence Of each other. //fi (/ .' I{ Ai/~1 '--./ COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND Ir Marcella A. Headdingsr whose name is signed to the foregoing instrumentr having been duly qualified according to lawr do hereby acknowledge that I signed it willingly and that I signed it as my free and voluntary act for the purpose therein expressed. I'. " . )1.Jc'i...\.-"'-' ,:"",,- c~._., Marcella A. Headdings J.D Sworn to and acknowledgedr before mer By Marcella A. Headdingsr Testatrix This 16th day of Octoberr2003. ~-9 Notary Public ~ Notarial Seal H. Anthony Adams, Notary Public Shippensburg Boro, Cumberland County My Commission ElIpires May 15, 2006 Member, PoonS'y'lvania AsSOCiation 01 Notaries II , . COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whosel names are signed to the foregoing instrument, being duly qualified according to! law, do depose and say that we saw the Testatrix sign and execute the i I instrument as her Last Will and Testament; that she signed willingly and that sh~ executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and ' under no constraint or undue influence. iJf1A ~-/Lk- -17J.(3[:viA) J /, .\C:jjuuoc C'i' - (i-' _-;~~IC4tC/ -l~tt<~ /- Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this 16th day of October, 2003. ~~ Notary Public ~ H Notarial Seal ShjpPe~~~~nYB Adams, Notary Public My Comm.g. oroE, Cumberl:1nd County ISSlOn Xp1res May 15. 20()6 Member, PennsY'val1ip AOs~(, ,\,,~;;;-I - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT_ 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ADAMS H ANTHONY 49 WEST ORANGE STREET SUITE 3 SHIPPENSBURG, PA 17257 _~__nn fold ESTATE INFORMATION: SSN: 207-28-8125 FilE NUMBER: 2104-0454 DECEDENT NAME: HEADDINGS MARCELLA A DATE OF PAYMENT: 09/06/2005 POSTMARK DATE: 09/06/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 NO. CD 005765 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,696.34 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 2407 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $1,696.34 GLENDA FARNER STRASBAUGH REGISTER OF WILLS 11-14-2005 HEADDINGS 04-13-2004 21 04-0454 CUMBERLAND 101 APPEAL DATE: 01-13-2006 ( See reverse side under Objections) Amount Remitted I 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:is47-Ex-AFp-coj:osi-NOTICE-OF-INHERITANCE-TAX-APPRAIsEHENT:-ALLowANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARCELLA A FILE NO. 21 04-0454 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX H ANTHONY ADAMS STE 3 49 W ORANGE ST SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17257 ESTATE OF HEADDINGS REV-1547 EX AFP (06-05) MARCELLA A TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 11-14-2005 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (5) (6) (7) 43,890.00 .00 .00 .00 .00 4,879.93 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) llO) ll, 073.56 .00 (11) ll2) ll3) ll4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 48,769.93 11 .073 56 37,696.37 .00 37,696.37 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = 37,696.36 X 045 = .00 X 12 = .00 X 15 = ll9)= .00 1,696.34 .00 .00 1,696.34 Kt.\;U.'" (+J AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 09-06-2005 CD005765 .00 1,696.34 BALANCE OF UNPAID INTEREST/PENALTY AS OF 09-07-2005 TOTAL TAX CREDIT 1,696.34 BALANCE OF TAX DUE .00 INTEREST AND PEN. 54.85 TOTAL DUE 54.85 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. (]( IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ADAMS H ANTHONY 49 WEST ORANGE STREET SUITE 3 SHIPPENSBURG, PA 17257 __nhn fold ESTATE INFORMATION: SSN: 207-28-8125 FILE NUMBER: 2104-0454 DECEDENT NAME: HEADDINGS MARCELLA A DATE OF PAYMENT: 11/23/2005 POSTMARK DATE: 11/22/2005 COUNTY: CUMBERLAND DATE OF DEATH: 04/13/2004 NO. CD 006029 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $54.85 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: H ANTHONY ADAMS, ESQ CHECK# RSK SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS $54.85 GLENDA FARNER STRASBAUGH REGISTER OF WILLS w () > o <( w () z <( l- I- ::;; w a: ..-J ('0 <..D ..-J ..-J Ul a:: <C ...l ...l o C (~ <8 t:J ~i~ ,I- jc( iZ i~ ,Ul 10 ,W !N !~ .1: ,I- '::l ;c( ~ecurity ItaMes Included. 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LL 0&::1 Z D=::<CW W...J...J ~D=::V'I VlWI-l 1-l=...J (!):lE:D=:: W::)< D=::UU 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 :".~- -, i_. j t I DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN c:q "-JU (\ H ANTHONY"iADAMS STE 3 49 W ORANGE ST SHIPPENSBURG *' REV-1607 EX AFP (03-05) 12-12-2005 HEADDINGS 04-13-2004 21 04-0454 CUMBERLAND 101 AIIount R_1 tted MARCELLA A PA 17257 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF HEADDINGS MARCELLA A FILE NO.21 04-0454 ACN 101 DATE 12-12-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED SSTATE. SHOWN BELOW IS A SUHKARY 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: 11-14-2005 PRINCIPAL TAX DUE: 1,696.34 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-06-2005 CD005765 .00 1,696.34 11-22-2005 CD006029 54.85- 54.85 . TOTAL TAX CREDIT 1,696.34 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 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 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/06/2006 ADAMS H ANTHONY 49 WEST ORANGE STREET SUITE 3 SHIPPENSBURG, PA 17257 RE: Estate of HEADDINGS MARCELLA A File Number: 2004-00454 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) 'Co Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/06/2006 OTT PATRICIA M 275 HIGH ROAD SHIPPENSBURG, PA 17257 RE: Estate of HEADDINGS MARCELLA A File Number: 2004-00454 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 4/13/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel {i Re2:ister of Wills ofCllrnhprbnil Coun~T STATUS REPORT UNDER RULE 6.12 Name of Decedent: \"Y'\ll f Oe \ \~ ~, C>..- \'" c.. \Y\~ C...Q \ \6- Date of Death: <...{ I i ~ I d-.c:J:) Y Estate No.: dDC> \.{ - D (J ~r 5 y \~:',()~~lb,~"{ <; 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. Statwther administration of the estate is complete: YesR NoD 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. I is Yes, state the following: Did the person~presentative file a final account with the Court? Yes D No Y\. b. The separate Orphans' Court No. (if any) for the personal representative's account is: a. c. Did the person;\!(epresentative state an account informally to the parties in interest? Yes A No D c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. , \ ~CCos,"~ ~ J\. Ar ~o~ 1~c;:Jc~s. Name Y9~'~~c~ Add,ess 9 \ ~O<;> N .~ lN~ I~' \ (7;-;;$7 {l/~ S 3d- ~ 3;.}7 Telephone No. Signature Dat"~ Capacity: ~ersonal Representative ~ounsel for personal representative ~, / \1>.' t ! , I ^"~ ! -V ,\,11 .