HomeMy WebLinkAbout07-29-09 (2)15056051058
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes ~. County Code Year File Number
Po Box 2aosol INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 -~ RESIDENT DECEDENT 21 08 01133
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
176-18-1836 10/31 /2008 05/17/1914
Decedent's Last Name Suffix Decedent's First Name Mt
Benjamin Gertrude
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required
death after 12-12-82)
• 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
Elliot A. Strokoff, Esq (717) 233-5353
Firm Name (If Applicable) REGisTt=~ of vwu_s use oru.,~
Strokoff & Cowden, PC ~-~ '~
?
First line of address _
-' ~ _.
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132 State Street '-? ~~-- f ,-
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Second line of address < -' '4~a _
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City or Post Office State ZIP Code -~~ ,:~ y
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Harrisburg PA 17101 ''" --.. ~ %:~:
N
Correspondent's a-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 preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG . ~ F PERSON NSIBLE FOR F LING RETURN DATE
is ' _ ~ Y ram„) ~s--i ~ i .,.. ~ v-v 07121 /09
ADDRESS ~ `
_230 rough Drive, Harrisburg, PA 17112
- _ _-_
NATURE O REPARE ER THA EPR SENTATIV DATE
07/21 /09
EII' A. trokoff, Esq., rokoff & Cowden, PC, 2 State Street, Harrisburg, PA 17101
PLEASE IQSE ORIGINAL FORM ONLY
Side 1
I.._ 15056051058 15056051058
.,~
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Gertrude Benjamin 176-18-1836
RECAPITULATION
1. Real estate (Schedule A) . ......................................... ... 1. 0.00
2. Stocks and Bonds (Schedule B) .................................... ... 2. 202,228.54
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00
4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0.00
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 198,216.09
6. Jointly Owned Property (Schedule F) Separate Billing Requested .... ... 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested..... ... 7. 0.00
8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 400,444.63
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 14,930.95
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 2,871.60
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 17,802.55
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 382,642.08
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ..................... ... 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 382,642.08
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X .0 45 16, 17,218.90
17. Amount of Line 14 taxable
at sibling rate X .12 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 1g. 0.00
19. TAX DUE ....................................................... .. 19. 17,218.90
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 08 01133
NAME
Gertrude Benjamin
STREETADDRESS
824 Lisburg Rd, Apt. 319
CITY
Camp Hill
DECEDENT'S SOCIAL SECURITY NUMBER
176-18-1836
STATE ZIP -
PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit _
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(3)
(4)
(5)
(5A)
(5B)
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval 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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
17,218.90
14,736.82
0.00
0.00
2,482.08
0.00
2,482.08
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 : ...................................... ...... ^
c. retain a reversionary interest; or .................................................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. ...... ^ ^x
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)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
14,000.00
736.82
REV-1503 EX+ (6-98) ¢
a~
~~.~~` SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gertrude Benjamin 210801133
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets or the same size)
Estate of Gertrude Benjamin
(Addendum to Schedule B)
Merrill Lynch Acct. #872-56926
2000 ML&CO. MXEA ARN @ 6.20
due 10/5/09
2000 ML&CO. STR ACC. Redemp @ 7.39
Sec due 8/31/2010
800 ML&CO. CSCO STRIDES @ 18.575
due 4/28/09
1200 ML&CO. 11% HD STRIDES @ 19.195
due 2/8/10
22.6607 ADVENT CLAYMORE GLOBAL @ 5.855
13 Blackrock Long Term Mun @ 8.505
10 Cohen & Steers Closed OPPY @ 9.735
2850 ML&CO. Rogrer Index ARN @ 6.91
due 1/20/09
$12,400.00
14,780.00
14,860.00
23,034.00
132.68
110.57
97.35
19,693.50
$85,108.10
Page 1 of 5
Estate of Gertrude Benjamin
(Addendum to Schedule B)
Merrill Lynch Acct. #872-54982
149 Consumer Discretionary @ 22.10
247 Health Care Select SPDR @ 26.815
68 IShares CJ US Telcom Sector
Index F und @ 16.235
143 IShares TR DJ Tech
Sector Index F @ 39.28690
27 Materia ls Select Sector Fund @
25.755
340 Sector SPDR Consumers Stpl @ 24.47
70 Sector SPDR Energy @ 50.755
338 Sector SPDR Financial @ 15.085
253 Sector SPDR Industrials @ 24.695
58 Sector SPDR Utilities @ 29.65
$3,292.90
6,623.31
1,103.98
5,618.03
695.39
8,319.80
3,552.85
5,098.73
6,247.84
1719.70
$42,272.53
Page 2 of 5
Estate of Gertrude Benjamin
(Addendum to Schedule B)
Merrill Lynch Acct. #872-54971
60 Caterpillar @ 37.64495
48 Chevron @ 74.09
104 Dupont @ 32.04
50 Exxon Mobil @ 75.305
192 Fidelity Nat'l Info Svcs @ 14.865
38 Franklin Res @ 65.225
68 Hartford Financial Svcs @ 9.90
65 Northrop Grumman @ 46.625
77 PPG Industries @ 49.22
72 United Techs @ 54.06
114.89 American Capital World @ 26.80
$2,258.70
3,556.32
3,332.16
3,765.25
2,854.08
2,478.55
673.20
3,030.63
3,789.94
3,892.32
3,079.05
$32,710.30
Page 3 of 5
Estate of Gertrude Benjamin
(Addendum to Schedule B)
Merrill Lynch Acct. #872-54977
15 Alcon @ 87.135 $1,307.03
87 Amer Int'1 Group @ 1.77 153.99
68 Avon Products @ 23.54 1,600.72
62 Bank New York Mellon @ 32.105 1,990.51
19 Baxter Int'1 @ 60.23 1,144.37
28 Dupont @ 32.04 897.12
49 Emerson Elec. @ 31.5923 1,548.02
42 Enbridge @ 33.160 1,392.72
19 FPL Group @ 47.215 897.09
40 General Mills @ 67.745 2,709.80
35 Halliburton @ 19.625 686.88
54 Hewlett Packard @ 38.20 2,062.80
49 Honeywell Int'1 @ 30.11 1,475.39
12 IBM @ 91.61 1,099.32
32 MacDonalds @ 57.365 1,835.68
42 McKesson Corp. @ 36.47 1,531.74
101 Nokia @ 15.43 1,558.43
37 Pepsico @ 57.12 2,113.44
23 PPL @ 32.20 740.60
Page 4 of 5
Estate of Gertrude Benjamin
(Addendum to Schedule B)
Merrill Lynch Acct. #872-54977 (Con't)
39 Proctor & Gamble @ 63.845
34 SAP AKGSLTT @ 35.035
23 Schlumberger @ 51.775
45 Starwood Hotels @ 22.155
93 Time Warner @ 10.055
31 Touchmark @ 40.43
39 United Techs @ 54.06
64 Vodafone Group @ 19.1275
52 Waddell & Reed Fin @ 13.925
64 Waste Mgt @ 31.27
39 Wyeth @ 32.735
2,489.96
1,191.19
1,190.83
996.98
935.12
1,253.33
2,108.34
1,224.16
724.10
2,001.28
1,276.67
$42,137.61
Page 5 of 5
REV-1508 EX+ (6-98) ~
-~~~~
SCHEDULE E
p
CASH, BANK DEPOSITS & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gertrude Benjamin 210801133
Include the proceeds of Iltigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Merrill Lynch Acct #872-56926 185,572.84
2. Merrill Lynch Acct #872-54982 4,629.04
3. Merrill Lynch Acct #872-54977 4,280.34
4. Merrill Lynch Acct #872-54971 1,045.39
5. Merrill Lynch Acct #872-56927 44.28
6. Woods at Cedar Run (refund) 1,278.20
7. Woods at Cedar Run (refund) 27.56
8. Verizon (refund) 1.34
9. Independence Blue Cross (prescription reimbursement) 896.00
10. Independence Blue Cross (premium refund) 441.10
TOTAL (Also enter on line 5, Recapitulation) $ ~ 198,216.09
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gertrude Benjamin 210801133
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Nathan Shapiro-Headstone engraving 425.00
z. Mt. Sharon Cemetary-Permit for headstone and burial costs 2,950.00
3. Goldsteins-funeral costs 7,850.00
4. Funeral meal 295.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City .State
Year(s) Commission Paid:
z. Attorney Fees $627.22 paid + $1, 800 reserve
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
g. Accountant's Fees
g. Tax Return Preparer's Fees (Income Tax)
7. Patriot News-legal notice
s. Cumberland Law Journal-legal notice
Zip
Zip
2,427.22
0.00
414.00
300.00
194.73
75.00
TOTAL (Also enter on line 9, Recapitulation) I $ 14,930.95
(If more space is needed, insert additional sheets of the same size)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
Gertrude Benjamin 210801133
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
If more space is needed, insert additional sheets of the same size.
j r~ pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gertrude Benjamin 210801133
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 (a) (1.2).]
1. Eileen Forman, 2302 Scarsborough Drive, Harrisburg, PA 17112 Daughter 80%
2. Mindy Forman, 6322 Darlington Rd, Harrisburg, PA 17112 Granddaughter 10%
3. Matthew Forman, 132 Skyview Dr, Cumwell, CT 06416 Grandson 10%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1$ OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, I$
If more space is needed, insert additional sheets of the same size.
r:~
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-_ - ~ - --
LAST WILL AND TESTAMENT ~,~ =i
GERTRUDE BENJAMIN '` -''~ '"~_
-~
I, GERTRUDE BENJAMIN, currently of Phila~e~lphia~,.. `.~
Pennsylvania, being of sound mind, memory and understanding, do
publish and declare this to be my Last Will and Testament, hereby
revoking any and all wills and codicils heretofore made by me.
I.
I direct that all taxes that may be assessed in conse-
quence of my death, of whatever nature and by whatever jurisdiction
imposed, shall be paid from my estate as part of the expense of the
administration of my estate.
II.
I direct that all my just debts and funeral expenses be
paid from my estate as soon after my decease as may be convenient.
III.
I give, devise and bequeath all the rest, residue and
remainder of my estate, whether real, personal or mixed, whatsoever
kind or wheresoever situate, as follows:
a . Ten percent (10 0 ) thereof to my Trustee, for
the benefit of my Granddaughter, Mindy ~ Forman; ~-;~ . f~
b. Ten percent (10%) thereof to my Trustee, for
the benefit of my Grandson, Matthew Forman; and
c. Eighty percent (80%) thereof to my Daughter,
Eileen Forman, provided she survives me by a period of
thirty days. In the event that my Daughter, Eileen
Forman does not survive me for a period of thirty days,
then one-half of this bequest to her shall go to my
Trustee for the benefit of my Granddaughter, Mindy ~_.- ~,, ~~
Forman, and the other one-half of this bequest to Eileen
- Page 1 of 5 - ~ ~` ~~ c "~
Forman shall go to for the benefit of my Grandson,
Matthew Forman.
IV.
I direct that my Trustee shall use whatever income and so
much of the principal from each trust as in her/his sole discretion
she/he shall deem desirable for the health, welfare, support and
education (including vocational, college, graduate or professional
schooling) for said Grandchild.
a. In the event that my Daughter, Eileen Forman,
shall survive me for a period of thirty days, I direct
that when each Grandchild shall reach the age of Twenty-
Seven (27), she/he shall receive One-third (1/3) of the
principal of her/his Trust then remaining; at each
Grandchild's Thirty-third (33rd) birthday, she/he shall
receive One-half (1/2) of the principal then remaining
and each Trust shall terminate at each's Fortieth (40th)
birthday, with the distribution of remaining principal
and undistributed income to said Grandchild at that time.
b. In the event my Daughter, Eileen Forman, does
not survive me by Thirty (30) days, I direct that each
Grandchild shall receive fifteen percent (150) of the
original principal of her/his Trust, on each's Twenty-
seventh (27th), Thirty-third (33rd), Fortieth (40th) and
Forty-fifth (45th) birthdays with each Trust to terminate
upon her/his Fiftieth (50th) birthday respectively, with
the distribution of remaining principal and undistributed
income to said Grandchild at that time.
c. If any of my Grandchildren dies before termina-
tion of his/her Trust, leaving issue, his or her issue
shall succeed to his/her rights under the Trust, per
stirpes, with all of the provisions of said Trust to
apply to said Great-Grandchild(ren), including the
- Page 2 of 5 - Jr~~ ,
.~ ., . ~ r
provisions for partial distribution of principal when
reaching the specified ages.
d. If either of my Grandchildren die without
issue, the balance remaining in her/his separate Trust
shall be distributed to the Trust for the benefit of my
surviving Grandchild unless said Trust has already been
terminated according to the provisions hereof, in which
instance the balance remaining in her/his separate Trust
shall be distributed to my surviving Grandchild outright.
f. These Trusts shall be subject to the laws of
the Commonwealth of Pennsylvania.
V.
I direct that my Executrix and Trustee, or their
successors, shall not be required to enter bond or security in any
jurisdiction in which he or she may act; but, if a bond is required
notwithstanding this direction, I direct that a surety bond shall
not be required.
VI.
My Executrix and my Trustee under this Will or any
Codicil hereto shall have the following powers in addition to those
granted by law and by other provisions of this Will, applicable to
all property, whether principal or income, exercisable without
court approval, and effective under actual distribution of all
property:
a. To retain any or all of the assets of my
estate, real or personal, without regard to any principle
of diversification of risk.
b. To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds,
authorized for Pennsylvania fiduciaries, as he deems
proper.
- Page 3 of 5 -
~'
c. To sell at public or private sale, to exchange
or to lease, for any period of time, any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as he deems proper.
d. To allocate receipts and expenses to principal
or income or partly to each as he from time to time deems
proper.
e. To borrow money from any person or institution,
and to mortgage or pledge any or all real or personal
property, as he is his sole discretion shall choose.
f. To compromise any claim or controversy.
g. To choose the optional valuation date for
federal estate tax purposes.
h. To exercise any law-given option to treat
administrative expenses either as income or as estate tax
deductions, without regard to whether the expenses were
paid from principal or income.
i. To exercise any law-given option to pay death
taxes in installments and to pay interest due on such
installments as a charge against principal.
j. To make distribution in cash or in kind, or
partly in cash and partly in kind, in such manner as he
may deem fair, at valuations finally to be fixed by him.
k. To contract with a qualified investment advisor
for investment advice.
VII.
I direct that all legacies, shares or interest in my
estate, whether principal or income, while in the hands of my
Executrix or Trustee, or their successors, shall not be subject to
executions, attachment sur judgment, sequestration or any other
process for any debt, obligation, contract or engagement of any
beneficiary, and shall not be subject to pledge, assignment,
- Page 4 of 5 -
/~....~
conveyance, or anticipation, and the personal receipts of the
beneficiary shall be the only discharge of my Executrix or Trustee
for payment of either principal or income.
VIII.
I name my Daughter, EILEEN FORMAN, as Executrix of this,
my Last Will and Testament.
I name my Daughter, EILEEN FORMAN, as my Trustee. Should
she fail to survive me, or should she refuse or be unable to serve,
I designate my son-in-law, STEVEN FORMAN, as my Trustee.
IN WITNESS WHEREOF, I, the said GERTRUDE BENJAMIN, have
to his my Last Will and Testament, affixed my hand and seal this
Z~ day of January, 1996.
--- - - ~' ~ n ~y-~)
GER'~'~~ E BE JAMIN ~'
The preceding instrument consisting of five other
typewritten pages, was on the date thereof signed, published, and
declared by GERTRUDE BENJAMIN, the TESTATRIX therein, as and for
her Last Will and Testament, in our presence, who at her request,
in her presence and in the'resence of each other, have subscribed
our names as witnesses her to.
__- ~ ~~ / ~
-~..~,
NAME ~----~
_~~ (~
NAME
ADDRESS '1
ADDRESS
C a M,,p l~~l-; (~ ~~ I~ o i i
- Page 5 of 5 -
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS.
I, GERTRUDE BENJAMIN, Testatrix, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly, and
that I signed it as my free and voluntary act for the purposes
therein expressed.
Sworn or affirmed to and acknowledged before me, by
GERTRUDE BENJAMIN, Testatrix, this ~nLf day of January, 1996.
GERTRUDE BENJAMIN
Not2riai Seal 1V V 4
Diane dl(. SiubblcLine, Plota~~/ Public
Harrisburg, Dauphin Goun;v
ivty Commission Expires Aug. 10, 1993
7dlomber, Pennsy{vania Association of tJotaric
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS.
is
w e , >~ L L1 G I ~ ~S% ~C~~DY ~ ~r'~~' L~--~ t ~Cl ~;l i2/~~'t'`.
the witnesses whose names are signed to the attached or foregoing
instrument being fully qualified according to law, do depose and
say that we were present and saw 'Pestatrix sign and execute the
instrument as her Last Will; 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 the Testatrix was at that time 18 or more years of age,
of sound mind and under no constraint or undue influence.
Sworn or of firmed to "and~sµbscribed to before me by the
.witnesses, this ~~ day of January X1996 .
;` %s~ -
/ , ~/ ~ G , _\ i,, ~,
W.~~i'NESS,_j ``~ '., , ~~ WITNESS
i
i
~ ~ ~ ~, / 'c~ft~ %~ Netariai Seal~~~
:~~ ~ thane i\A. Stub'r,~;~=;bir,e, fVotar`~ ?ul~lic
Notary Pu 1i ~ Harrisburg, DauphinCcunty
v±y Cnir,miss,on F_xpires Aug. 1 U~. 1935
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STROKOFF & COWDEN, P. C.
ATTORNEYS AT LAW
TELEPHONE 132 STATE STREET
(717) 233-5353 P. O. BOX 11903
HARRISBURG, PENNSYLVANIA 17108-1903
www. strokoffandcowden. com
Via Certified Mail
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
July 28, 2009
RE: Estate of Gertrude Benjamin
No. 21-08-01133
Dear Register Strasbaugh:
FAX
(717) 233-5806
Enclosed please find an original and 2 copies of the
Inheritance Tax Return for the above estate, as well as Estate
check #117 in the amount of $2,482.08 (for the balance of tax
due) and Estate check #118 in the amount of $15, (for the tax
return filing fee).
Please clock-in one of the copies transmitted herewith
and return it to me in the self-addressed, postage paid envelope
provided herein.
~s,
Doff
EAS/crd
Enclosure
cc: Eileen
Forman, Executr~
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