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HomeMy WebLinkAbout03-0772PETITION FOR PROBATE and GRANT OF LETTER~ Estate of ALICE H. LANDIS Also known as , deceased Social Security No. 183-09-62.1~ t To: Register of Wills for the County of Cumberland County in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and the executor named in the last Will of the above decedent, dated September 12, 1991 and codicil dated April 10, 2002. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 801 North Hanover Street, Carlisle, PA 17013. Decedent, then 87 years of age, died September 12, 2003, at Carlisle Regional Medical Center. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $175,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ Situate as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary thereon. (testamentary; administration c.t.a; administration d.b.n.c.t.a) No'(man G. Blod~er 27 West Point Road, Aspers, PA 17304 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND : SS The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed Before me this 24tlday of S,~tember Nort~an G. Bloche; ' ' 2003.cx_ /-'x-T-- /,a/t.~ . M.O~,~ F~uty ' Regi~r No. 21-2003-772 Estate of ALICE H. LANDIS, Deceased DEGREE OF PROBATE AND GRANT OF LETTERS AND NOW, September 2 4 gl-g003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrucment(s) dated September 12, 1991 (Will) and April 10, 2002, (Codicil) described therein be admitted to probate and filed of record as the last will of Alice H. Landis and Letters Testamentary are hereby granted to Norman G. Blocher. FEES Probate, Letters, Etc ............. $ 2 3 5.00 Short Certificates (2) ............ $ 6.0 0 ~m~m~..x...C.9..d..i..c..i.1. .... $ 10.50 ~Pages (5) $ 15.00 JCP ~{~xxx $ 10.00 FiledS.e.p.t. emb. e.r...2.4.t~h., .'~ $.2..7.6.....5..0. 2003 ~egister o.f. Wills '. f/'--t~f~ Donna M.OttO ,lst Deputy ~~ Patricia R. Brown, Esquire 10 West Pomfret Street Carlisle, PA 17013 717-249-3024 27474 Call Attorney Pat Brown on 9/24/03 105.112 REV 8/88 fFEE FOR THIS CERTIFICATE $200) WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH T 5512839 September 15, 2003 Date of Issue of This Certification Name of Decedent Alice Hinlde Landis Female Sex Date of Birth Place of Death First Middle Last 183-09-6251 September 12, 2003 Social Security No. Date of Death 12-11-1915 Birthplace Losh's Run, Perry County, Pennsylvania Carlisle Regioifal Medical Center, Cumberland County, Carlisle Pennsylvania VVhJte Race Marital Status Informant Name and Address of Funeral Establishment Facility Name County City, 8orough or Township Secretary Occupation Armed Forces? (Yes or No) Widowed Decedent's 801 North Hanover Street, Carlisle, PA 17013 Mailing Address Number Street Oily or Town State Troy Landis Allen L. Dugan Funeral Director No Dug. an Funeral Home, Inc., Bendersville, PA 17306 Interval Between Onset and Death Part I: Part Ih Immediate Cause Cardiac arrest. (a) Cardiomyopathy. ASVD. (c) (d) Other Significant Conditions CH~. Manner of Death Natural ~ Accident [] Suicide [] Homicide [] Pending Investigation [] Could not be Determined [] Describe how injury occurred: Name and Title of Certfier Address Kenneth Guistwite, M.D. 522 South Pitt Street, Carlisle, PA 17013 (M.D., D.O., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fili ~~,/. ~n . ~ ~/(~ ~ ..~ 01-010 'L~cat Regislrar of ~ital~Records '~L.~ District NO. September 15, 2003 124 Rice Avenue, Bi~...le, PA 17307 Date Received by Local Registrar Street Address City. Borough, Township CODICIL TO IJAST WILL AND TESTAMENT OF AIJICE H. LANDIS I, ALICE H. LANDIS, a resident of and domiciled at the Church of God Home, Carlisle, Cumberland County, Pennsylvania, declare this to be the first Codicil to my Will dated September 12, 1991. I hereby revoke the paragraph SECOND of my September 12, 1991, Will in its entirety. II I hereby revoke sub-paragraph (a) of paragraph THIRD of my September 12, 1991 Will and substitute the following: (a) One-half (1/2) thereof to my stepson, JACK E. LANDIS, or if he fails to survive me, in equal shares to each his sons, JACK W. LANDIS and TROY H. LANDIS, as may be living at the time of my death and to their issue, per stirpes. The share to be distributed to my stepson, JACK E. LANDIS, if living, shall be held in trust by his sons, JACK W. LANDIS and TROY H. LANDIS, as Co-Trustees. Said Trustees shall distribute the income therefrom to JACK E. LANDIS, in periodic installments as my stepson and the Co-Trustees shall find convenient, but at least annually. In addition, the Co-Trustees shall be fully authorized to pay to my stepson so much of the principal of his share as my Co-Trustees, in their sole discretion, shall deem necessary or desirable from time to time for, among other things, his support, health and/or medical care, taking into consideration all other income and other resources available to my stepson. III I hereby revoke sub-paragraph (b) of paragraph THIRD of my September 12, 1991, Will and substitute the following: (b) One-half (1/2) thereof to my niece, BETTY A. FREDERICK and nephew, NORMAN G. BLOCHER. If BETTY A. FREDERICK and/or NORMAN G. BLOCHER fail to survive me, then their share of my estate shall be added to the other one-half (1/2) of the residue of my estate and be distributed as set forth in the preceding paragraph (a) of this Will. Page 1 of 3 I hereby revoke paragraph FIFTH of my September 12, 1991, Will and substitute the following: FIFTH: I appoint my nephew, NORMAN G. BLOCHER, executor of this my Last Will and Testament. Should my said nephew fail to qualify or cease to act as executor, I hereby appoint my step- grandson, TROY H. LANDIS, as executor of this my Last Will. I direct that neither my said nephew nor my step-grandson shall be required to give bond in order to qualify as or perform the duties of the personal representative of my estate in any jurisdiction. I authorize and empower my personal representative to sell any or all of the assets constituting the rest, residue and remainder of my estate, both real and personal property, at public or private sale or sales, and to make, execute, acknowledge and deliver unto any purchaser or purchasers thereof good and sufficient deeds and bills of sale for the transfer and conveyance thereof. V In all other respects, I do hereby ratify and confirm my Will dated September 12, 1991. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this /'~} ~ April, 2002. ALICE H. LANDIS day of SIGNED, SEALED, PUBLISHED and DECLARED by the above Testatrix, as a Codicil to her September 12, 1991 Will, in the presence of us, who, at her request, in her presence, and the presence of each :. 7?er, have our names as Witnesses. Witness Address Page 2 of 3 COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, ALICE H. LANDIS, VALERIE F. GSELL and PATRICIA R. BROWN, the Testatrix and the wimesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her first Codicil to her Will, and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Codicil as witnesses and that to the best of each witness' knowledge and belief the Testatrix was at that time eighteen years of age or older, of sound mind and under no undue constraint or influence. Testatrix Witness Subscribed, sworn to and acknowledged before me by ALICE H. LANDIS, the Testatrix, and subscribed and sworn to before me by VALERIE F. GSELL and PATRICIA R. BROWN, witnesses, this I C) ~ day of April, 2002. NOTARIAL SEAL DENISE PINAMONTI Notary Public Carlisle Bom. Cumberland Coun Page 3 of 3 enue^v Kpeq!-I ~,se3 ff · ~ol fqJeq!-I u~oJB 'El e!o!J~,ed I, Alice H. Landis, of Oxford Township, Adams County, Pennsylvania, do hereby make, publish and declare the following as and for my last will and testament, and I do hereby revoke and declare void any will or wills by me at l any ~'rte heretofore ra~de. FIRST: I direct that ail my just debts and administration expenses i shall b~ paid from the assets of my estate, arid I wish to note that my funeral !expenses have been prepaid with Dugan Funeral Hc~, Bendersville, Pennsylvania. I direct that all federal, state and other death taxes payable by reason of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of the administration of my estate, and shall be paid frc~ the residue of my estate, without apportionment or right of reimbursement. direct that the sum of Two Thousand Five Hundred Dollars ($2,500.00) be set aside by my personal representative to be used for the care of my pet cat if she survives me. I direct that such amount be paid either . in a lump sum or in such installments as my personal representative deems best ~]ito a person who is willing to provide my said cat with indoor living in a hc~ne iwhere no children reside. Ifmypersonal representative is unable to find a person willing to take my pet cat under the terms specified herein, I direct my personal representative to make the necessary arrangements to have my pet cat put to sleep by a veterinarian and buried in a pet cemetery with an appropriate gravestone, using whatever portion of the $2,500.00 fund as may be necessary to carry out these instructions. If any portion of said $2,500.00 .fund should remain after my aforesaid instructions have been carried out, I ~'~direct that such r~rtaining poz°cion of the fund be addc:~t to ~t~ residue of my estate. · ~rRD: I give, bequeath and devise all of the rest, residue and ~ romainder of my estate, both real and personal proper~y, of whatsoever kind land nature and wheresoever situate, as follows: AIice H. Landis - 1 - (a) One-half (1/2) thereof to my stepson, Jack E. Landis; or if he fails to survive me, in equal shares to such of his sons, Jack W. Landis and Troy H. Landis, as may be living at the time of my death and to the issue then living of such of his said sons as may then be deceased, per stirpes. (b) One-half (1/2) thereof to my sister, Marie Blocher; or if she fails to survive me, to her daughter, Betty A. Frederick. If my said sister, Marie Blocher, predeceases me, and her daughter, Betty A. Frederick fails to survive me, such one-half (1/2) of my estate shall be added to the other one-half (1/2) of the residue of my estate and be distributed as set forth in the preceding paragraph of this will. FO~: I appoint The Gettysburg National Bank, of Gettysburg, Pennsylvania, guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the power to use principal as well as incc~e frcm time to time for any such minor's education, support and welfare, and to make payment for these purposes to such minor or to any person or persons providing education, support or services for such minor without obtaining the approval of any Court whatsoever. FIFT~: I appoint my nephew, Norman G. Blocher, executor of this my last will. Should my said nephew fail to qualify or cease to act as executor, I appoint The Gettysburg National Bank, of Gettysburg, Pennsylvania, executor of this my last will. I direct that neither my said nephew nor the said Bank shall be required to give bond in order to qualify as or perform the duties of the personal representative of my estate in any jurisdiction. I authorize and empower my personal representative to sell any or all of the assets constituting the rest, residue and remainder of my estate, both real and personal property, at public or private sale or sales, and to make, execute, acknowledge and deliver unto any purchaser or purchasers thereof good and sufficient deeds and bills of sale for the transfer and conveyance thereof. Alice H. Landis - 2 - IN ~ ~, I, Alice H. Landis, the testatrix, have to this my last will and testament, subscribed my name and affixed my seal this 12th day of September , 1991; this will being typewritten upon three (3) sheets of paper which are affixed together and each of which bears my signature at the bottc~n thereof. Alice H. Landis (SEAL) Signed, sealed, published and declared by the above named testatrix, Alice H. Landis, as and for her last will and testament, in the presence of us, who, in her presence, and at her request, and in the presence of each other, have hereunto subscribed our names as witnesses thereto. - 3 - We, Alice H. Landis, S.M. Raffensper~er and Helen L. Woerner , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that sh~ executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of the knowledge of each of the witnesses, the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Alice H. Landis Witness Subscribed, testatrix, and subscribed and sworn to before me by and Helen L. Woerner , witnesses, this 12th 1991. sworn to and acknowledged before me by Alice H. Landis, the S. M. Raffensper~er ~ day of September NOTARIAL SEAt. [ My co~mission expires: NANCY K. ~EPNER. N'::~'y P-b!!¢ Gefh/~hur~ 8~ro, Ad~m~ Co'.m'y, Pa. ~ My Co";rr,;s.:, ;, E;':ph ee Nov. 3, 199° J LAST WILL AND TESTAMENT OF ALICE H. LANDIS BIGHAM & RAFFENSPERGER ATTORNEYS AT LAW ADAMS COUNT~ NATIONAL BANK BUILDING 16 LINCOLN SQUARE GL I I I~SBU~, PENNSYLVANIA 17325 CERTIFICATION OF NOTICE UNDER RULES 5.6(a) Name of Decedent: Date of Death: Will No: Alice H. Landis September 12, 2003 21-03-0772 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 October 1, 2003: Norman G. Blocher 27 West Point Road Aspers, PA 17304 Betty A. Bream 188 West Point Road Aspers, PA 17304 Jack E. Landis 6 Hidden Noll Road Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: October 1, 2003 Patricia R. Brown, Esquire 10 West Pomfret Street Carlisle, PA 17013 Phone: 717-249-3024 Capacity: Counsel for personal representatives i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO3971 BLOCHER NORMAN G 27 WEST POINT ROAD ASPERS, PA 17304 ........ fold ESTATE INFORMATION: SSN: 183-09-6251 FILE NUMBER: 2103-0772 DECEDENT NAME: LANDIS ALICE H DATE OF PAYMENT: 05/24/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/1 2/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 (;17,147.23 REMARKS: NORMAN G BLOCHER TOTAL AMOUNT PAID: (;17,147.23 SEAL CHECK//006 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PNC~ANK PNC Bank, N.A. Southcentral PA 040 PAY TO TH E "f"'cr-c'"f-,../- $ e x,,,-e ,,-q ~d 60-1273 --~T~-122 /'7,,~7 ~ DOLLARS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 U.I REV- 1500 TAX RETURN RESIDENT DECEDENT I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [uz~- ILandis, Alice H. ~DATE OF DEATH (MM-DD-YY) IDATE OF BIRTH (MM-DD-YY) tu I 9/12/2003 I 12/11/1915 (IF APPLICABLE) SURVIVING SPOUSE'S NAME n/a U.I I- z z 0 U.I z OFFICIAL USE ONLY FILE NUMBER 21-03-0772 COUNTY COD~ YEAR SOCIAL SECURITY NUMBER 183-09-6251 NUMBER THIS MUST BE FILED IN DUPLICATE WITH THE REGISTER OF Wll I .~ SOCIAL SECURITY NUMBER X---] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Retum '-"] 4. Limited Estate [] 4a. Future interest Compromise [] 5. Fed. Est. Tax Return Req'd X---] 6. Decedent Died Testate [] 7. Decedent had Living Trust 0 8. Total number of SDB's ~ 9. Lit'g'tion Proceeds Rec'd N 10. Spousal Poverty Cmclit ~ 11. Election to tax w/Sec. 9113(A) THIS ~CTK)NI8 ~i DIRECT ~ ~$~,~ CONFIDENT~ · TAX iNFORMaTiON TO: NAME: COMPLETE MAILING ADDRESS: Patricia R. Brown, Esquire FIRM NAME: TELEPHONE NUMBER 717 249-3024 10 W. Pomfret St. Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3.Closely Held Corporation, Partnership or Sole-Prep. (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch. E) (5) 6. Jointly Owned Property (Schedule F) (6) [~1 Separate Billing Requested 7. Inter-Vivos Transfers & Misc. Non-Propate Prop. (7) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administration Costs (Sch H) (9) 10. Debts of Decedent, Mortgage liabilities, & Liens (10) 11. Total Deductions (total lines 9&10) 12. Net Value 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 14. Net Value Subject to Tax (Line 12 minus Line 13) $0;00 $0.00 $80,168.61 $0.00 $108,491.63 :"~.] (8) $188,6~.24 $9,980.50 $2,810.66 (11) $12,791.16 (12) $175,869.08 15. (13) (14) $175,869.08 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x.0m (15) x.045 (16) x. 12 (17) x.15 (18) Tax Due (19) ' [] CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Amnt of Line 14 taxable at the spousal rate, or transfers under Sec.9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate $87,934.54 17. Amount of Line 14 taxable at sibling rate $0 18. Amount of Line 14 taxable at collateral rate $87,934.54 19. 2O $0.00 $3,957.05 $0.00 $13,190.18 $17,147.23 Decedent's Complete Address: [$THEET ADDRE86 CITY 801 North Hanover Street STATE ZIP PA Cadisle Tax Paymeii[s and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts Interest/Penalty if applicable D. Interest E. Penalty (1) 17013 $17,147.23 Total Credits (A+B+C) (2) $0.00 $0.00 $17,147.23 $17,147.23 Total Interesf/Panta#y (D+E) If Une 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (3) (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: yes no a. retain the use or income of the properly transferred: ~ ~ b. retain the right to designate who shall use the property transerred or its income: r--'-I P~ d. retain the promise for life of either payments or cam? r----'l ~ 2. if death occurred after Danembar 12, 1982, did decedent transfer property within one year of death without feseiv~g adequate consideration? ~ ~ 3. Did decedent own an "in trust fo~ or peyabie upon death bank account or security al his or her death? ~ p~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a banermiary disignatio.? ~ F"-"-I IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YE$~ YOU ..a~._~_T COMPLETE SCHEDULE G AND FILE IT AS PANT OF THE RETURN. Under penalties of perjury, I declare that ! have examined this tatum, including accompanying schedules and statemm3ts, and to the best of my ~ and belief, it is true, cermet and complete. Declaration of pmperer other than the personal representative is based on all information of which ~eparar has an]r. knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNA~TU,~.~. PREPARER OTHER THAN REPRESENTATIVE z.9, 204 ADDRESS 10 West Pomfret Street, Carlisle, PA 17013 [ For dates of dse~h 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% [72P.S. Sec. 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. Sec. 9116(aX1.1)(ii)]. The statute does no{ exempt a transfer to a surviving spouse from tax, and the statuto~ requirements for discJosure of assets and filing a tax return are still applicable eve~ 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 fi'om a deseased 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. Sec. 9116(a)(1.2)]. The tax rate imposed on the net value of tmr,.sfem to or for the use of the decadant's lineal beneficiaries is 4.5%, except es noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.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. Sec. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at teast one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF Landis, Alice H. FILE NUMBER 21-03-0772 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH Fidelity Investment Mutual Fund (00689834927) PNC Bank - checking acct no: 5180056708 $56,634.26 $19,954.35 4 Church of God Home - refund of personal account Prepaid Burial Fund (Dugan Funeral Home) $40.00 $3,540.00 TOTAL (also on line S, Recapitulation) $80,168.61 SCHEDULE G TANSFERS ESTATE OF Landis, Alice H. FILE NUMBER 21-03-0772 This schedule to be completed and filed if the answer oftbe q amfion on the reverse of the cover is yes, ITEM DESCRIPTION EXCLUSION TOTAL VALU[ DECD.% DOLLAR VALUE NUMBER OF ASSET INT OF DECD. IN~I 1 Western-Southern Life 49,181.64 100% $49,181.64 (single premium deferred annuity W0020166021) 2 Fidelity & Guaranty Life 47,997.78 100% $47,997.78 (deferred annuity cert no: 001761693) 3 Lincoln Benefit Life Company 11,312.21 100% $11,312.21 (flexible premium deferred annuity no: LBF1100713 TOTAL (also on line 7, Recapitulation) $108,491.63 SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF Landis, Alice H. FILE NUMBER 21-03-0772 Ao Bo (All property jointly-owned with Right of Survivorship must be disclosed on Seh~ule F) I'I'EM DESCRIPTION NUMBER Funeral Expenses: Dugan Funeral Home Tombstone lettering (Dugan Funeral Home) Administrative Costs: Personal Representive Commissions Norman G. Blocker Social Security Number of Personal Representative: Attorney fees to Patricia R. Brown, Esquire Family Exemption Claimant SSN: Address of Claimant at decedent's death: Street: City: State & Zip Probate Fees to Register of Wills 183-18-7739 Tax Return Preparer's Fees: David Weaver (federal and state 2003) TOTAL (also on line 9, Recapitulation) AMOUNT $3,540.00 $84.00 $1,000.00 $5,000.00 $276.50 $80.00 $9,980.50 SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Landis, Alice H. 21-03-0772 ITEM DESCRIPTION NUMBER AMOUNT 1 Masland Associates (balance not paid by insurance) $6.96 West Shore EMS (wheelchair - one way) $38.74 Masland Associates $27.32 Central Penn Med Grp Emergency - drs bill $28.40 CV Nephrology Assoc. $9.88 Andorra Radiology Assoc. $27.00 Church of God - mo bill (sep) $1,075.00 Church of God Home (final bill) $1,085.36 Internal Revenue Service - 2003 taxes $498.00 Pa. Dept of Revenue - 2003 taxes $14.00 2 6 7 8 9 10 TOTAL (also on line 10, Recapitulation) $2,810.66 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Landis, Alice H. 21-03-0772 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER OF ESTATE 1 Jack E. Landis 6 Hidden Noll Road, Carlisle, PA 17013 step-son one-half 2 Betty A. Frederick (nka Bream) 188 West Point Road, Aspers, PA 17304 niece one-fourth 3 Norman G. Blocker 27 West Point Road, Aspers, PA 17304 nephew one-fourth ri'EM NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE NUMBER OF ESTATE B. Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNIvlENTAL BEQUESTS (also enter on line 13, Recapitulation) $0 Patricia H. ~rown Jo v~ P~-,L~.~-~ c-~r,'~Att°rney At Law Libe¢o' Loft · 4--East-t=ibe~t.y-Avenue · Carlisle, PA 17013 (717) 'Z~4-3--7922 29 ~j-__3©zy- CODICIL TO LAST WILL AND TESTAMENT OF Al.ICE H. LANDIS I, ALICE H. LANDIS, a resident of and domiciled at the Church of God Home, Carlisle, Cumberland County, Pennsylvania, declare this to be the first Codicil to my Will dated September 12, 1991. I hereby revoke the paragraph SECOND of my September 12, 1991, Will in its entirety. II I hereby revoke sub-paragraph (a) of paragraph THIRD of my September 12, 1991 Will and substitute the following: (a) One-half (V2) thereof to my stepson, JACK E. LANDIS, or if he fails to survive me, in equal shares to each his sons, JACK W. LANDIS and TROY H. LANDIS, as may be living at the time of my death and to their issue, per stirpes. The share to be distributed to my stepson, JACK E. LANDIS, if living, shall be held in trust by his sons, JACK W. LANDIS and TROY H. LANDIS, as Co-Trustees. Said Trustees shall distribute the income therefrom to JACK E. LANDIS, in Periodic installments as my stepson and the Co-Trustees shall find conveniefit, but at least annually. In addition, the Co:Trustees shall be fully authorized to pay to my stepson so much of the principal of his share as my Co-Trustees, in their sole discretion, shall deem necessary or desirable from time to time for, among other things, his support, health and/or medical care, taking into consideration all other income and other resources available to my stepson. III I hereby revoke sub-paragraph (b) of paragraph THIRD of my September 12, 1991, Will and substitute the following: Co) One-half (V2) thereof to my niece, BETTY A. FREDERICK and nephew, NORMAN G. BLOCHER. If BETTY A. FREDERICK and/or NORMAN G. BLOCHER fail to survive me, then their share of my estate shall be added to the other one-half (1/2) of the residue of my estate and be distributed as set forth in the preceding paragraph (a) of this Will. Page 1 of 3 COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, ALICE H. LANDIS, VALERIE F. GSELL and PATRICIA R. BROWN, the Testatrix and the wimesses, respectively, whose names are signed to the foregoing insmunent, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her first Codicil to her Will, and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the wimesses, in the presence and heating of the Testatrix, signed the Codicil as wimesses and that to the best of each wimess' knowledge and belief the Testatrix was at that time eighteen years of age or older, of sound mind and under no undue constraint or influence. Testatrix Wimess Wimess Subscribed, sworn to and acknowledged before me by ALICE H. LANDIS, the Testatrix, and subscribed and sworn to before me by VALERIE F. GSF. I.I. and PATRICIA R. BROWN, wimesses, this ~ day of April, 2002. ~ NOTARIAL SEAL ' C_~' ~.{~;/~ ! DENISE PINAMONTI. Notary Public ""~NoT~ Pu~- ' ' ! Carlisle Boro Cumberland County Page 3 of 3 I hereby revoke paragraph FIFTH of my September 12, 1991, Will and substitute the following: FIFTH: I appoint my nephew, NORMAN G. BLOCHER, executor of this my Last Will and Testament. Should my said nephew fail to qualify or cease to act as executor, I hereby appoint my step- grandson, TROY H. LANDIS, as executor of this my Last Will. I direct that neither my said nephew nor my step-grandson shall be required to give bond in order to qualify as or perform the duties of the personal representative of my estate in any jurisdiction. I authorize and empower my personal representative to sell any or all of the assets constituting the rest, residue and remainder of my estate, both real and personal property, at public or private sale or sales, and to make, execute, acknowledge and deliver unto any purchaser or purchasers thereof good and sufficient deeds and bills of sale for the transfer and conveyance thereof. V In all other respects, I do hereby ratify and confirm my Will dated September 12, 1991. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this April, 2002. ALICE H. LANDIS day of SIGNED, SEALED, PUBLISHED and DECLARED by the above Testatrix, as a Codicil to her September 12, 1991 Will, in the presence of us, who, at her request, in her presence, and the presence of each oer, have our names as Witnesses. "". "~Xqtness Witness Addres~ ' ! Ad&ess Page 2 of 3 I, Alice H. Landis, of Oxford Township, Adams County, Pennsylvania, do hereby make, publish and declare the following as and for my last will and testament, and I do hereby revoke and declare void any will or wills by me at any time heretofore made. F/RST: I direct that all my just debts and administration expenses shall be paid from the assets of my estate, and I wish to note that my funeral expenses have been prepaid with Dugan Funeral Home, Bendersville, Pennsylvania. I direct that all federal, state and other death taxes payable by reason of my death, with respect to the property fon~uing my gross estate for tax purposes, whether or not passing under this will, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of the administration of my estate, and shall be paid from the residue of my estate, without apportionment or right of reimbursement. S~[X~): I direct that the sum of Two Thousand Five Hundred Dollars ($2,500.00) be set aside by my personal representative to be used for the care of my pet cat if she survives me. I direct that such amount be paid either in a lump sum or in such installments as my personal representative deems best to a person who is willing to provid~ my said cat with indoor living in a home where no children reside. If my personal representative is unable to find a person willing to take my pet cat under the terms specified herein, I direct my personal representative to make the necessary arrangements to have my pet cat put to sleep by a veterinarian and buried in a pet cemetery with an appropriate gravestone, using whatever portion of the $2,500.00 fund as may be necessary to carry out these instructions. If any portion of said $2,500.00 fund should remain after my aforesaid instructions have been carried out, I direct that such remaining portion of the fund be added to the residue of my estate. ~RD: I give, bequeath and devise all of the rest, residue and remainder of my estate, both real and personal property, of whatsoever kind and nature and wheresoever situate, as follows: Alice -- 1 -- (a) One-half (1/2) thereof to my stepson, Jack E. Landis; or if he fails to survive me, in equal shares to such of his sons, Jack W. Landis and Troy H. Landis, as may be living at the time of my death and to the issue then living of such of his said sons as may then be deceased, per stirpes. (b) One-half (1/2) thereof to my sister, Marie Blocher; os if she fails to survive me, to her daughter, Betty A. Frederick. If my said sister, Marie Blocher, predeceases me, and her daughter, Betty A. Frederick fails to survive me, such one-half (1/2) of my estate shall be added to the other one-half (1/2) of the residue of my estate and be distributed as set forth in the preceding paragraph of this will. FO[~: I appoint The Gettysburg National Bank, of Gettysburg, Pennsylvania, guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the power to use principal as well as incc~e frc~ time to time for any such minor's education, support and welfare, and to make payment for these purposes to such minor or to any person or persons providing education, support or services for such minor without obtaining the approval of any Cou~ whatsoever. FIFIIq: I appoint my nephew, Norman G. Blocher, executor of this my last will. Should my said nephew fail to qualify or cease to act as executor, I appoint The Gettysburg National Bank, of Gettysburg, Pennsylvani~ executor of this my last will. I direct that neither my said nephew nor the said Bank shall be required to give bond in order to qualify as or perform ~ duties of the personal representative of my estate in any jurisdiction. I authorize and empower my personal representative to sell any or all of the assets constituting the rest, residue and remainder of my estate, both real and personal propertY, at public or pri~ate sale or sales, and to make, execute, acknowledge and deliver unto any purchaser or purchasers thereof go and sufficient deeds and bills of sale for the transfer and conveyance thereof. Alice H. Landis IN ~ ~, I, Alice H. Landis, the testatrix, have to this my last will and testament, subscribed my name and affixed my seal this 12th day of September , 1991; this will being typewritten upon three (3) sheets of paper which are affixed together and each of which bears my signature at the bQttcm thereof. Alice H. Landis (SEAL) Signed, sealed, published and declared by the above named testatrix, Alice H. Landis, as and for her last will and testament, in the presence of us, who, in her presence, and at her request, and in the presence of each other, have hereunto subscribed our names as witnesses thereto. - 3 We, Alice H. Landis, S.M. Raffens~er~er Woerner , the testatrix and the witnesses, are signed to the attached or foregoing instrument, and Helen L. respectively, whose name~ being first duly sworn, hereby declare to the %undersigned authority that the testatrix signed and executed the ins~-%m~nt as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and heari~ of the testatrix, signed the will as witness and that to the best of the knowledge of each of the witnesses, the testatrix was at that t/me eighteen years of age or older, of sound mind and under no constraint or undue influence. Alice H. Landis Witness Subscribed, sworn to and acknowledged before me by Alice H. Landis, the testatrix, and subscribed and sworn to before me by and Helen L. Woerner , witnesses, this 12th 1991. S. M. Raffensperger day of September , My commission expires: ~"--"~OTARIA[ SEAL NANCY K. KEPNER, N',tar,/Public Getly~rburf:l Boro, Adam.~ Counly, Pa. J~-~n~s!i~.n E;,:pire~ Nov. 3, 1992 FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN ESTATE OF ALICE H. LANDIS, DECEASED (File No: 21-03-0772) KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, ALICE H. LANDIS, late of Carlisle, Cumberland County, Pennsylvania, deceased, died testate on September 12, 2003, having first made her Last Will and Testament, which was duly executed on September 12, 1991, and condicil there to executed April 10, 2002, and are duly recorded at the Register of Wills in Cumberland County, Pennsylvania. WHEREAS, the said Alice H. Landis, by the aforesaid Last Will and Testament and codicil thereto, named Norman G. Blocher, as Executor of said Last Will and Testament; WHEREAS, letters testamentary on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor hereinafter called personal representative; WHEREAS, the said personal representative has gathered the assets of the estate of the said decedent and the assets consists of personal property to a total value of $188,660.24 as set forth in Exhibit A, which is a statement of account of the said personal representative, and which is attached hereto and made a part hereof and marked Exhibit A; WHEREAS, the debts and deductions including the payment of inheritance tax of the said estate, amount to $29,938.39, leaving the sum of $158,721.85 for distribution, also as set forth in the statement of the said personal representative, which is attached hereto and marked Exhibit A; NOW, THEREFORE, KNOW YE, that we, Jack E. Landis, Norman G. Blocher and Betty A. Frederick, the heirs under the Last Will and Testament and Condicil thereto, of the said decedent, and being those persons entitled to inherit under said Last Will and Testament and Codicil thereto, and in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, agree that no account is necessary and do hereby agree that and consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas, Cumberland County. THEREFORE, We, do hereby remise, release, quitclaim and forever discharge the said personal representative, NORMAN G. BLOCHER, his heirs, executors, administrators, and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demand whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the estate of the said decedent, and we do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, do hereby covenant and agree that we will contribute my prorata share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, We have hereunto set our hands and seals this ..,~ r,~. day of 2004. D e ?/~. ,-,, ,'"- , WITNESS: oN;~ee a~s PaieB~CAk~irc'eEI~ :cLUta~sHeir and Beneficiary ~ck E. Eandis, ITteir and Bene-~ciary of the Estate of Alice H. Landis Betty A.-l~ed&~k, ~Ieir and Benefici"ary of the Estate of Alice H. Landis COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) ON THIS, the ~ day of ~~ ,2004, before me, the undersigned officer, personally appeared Norman G. Blocher, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. ~.' ,./~5~~.5 (SEAL) ..... NOTAR~A.t SEAL' ] Notary Public ANN B. SENSENICH, NOTARY PUBLfC J CARLISLE eORO., CUMBERLAND COUNTY[ .MY COMMISSION EXPIRES MAY 13, 2007~ COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) of *'~'~4.-/ 2004, before me, the undersigned ON THIS, the'--q,,~d~ day , officer, personally appeared Jack E. Landis, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. ~..~.~ ~/.~)//~ )o~.r~,~ (SEAL) ' #0TARI~ S~t ] Notary Public ANN B. SENSENICH, NOTARY PUBLIC / CARLISLE BORO., CUMBERLAND COUNTY I MY COMMISSION EXTIRE$ MAY 13, 2007 | COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) ON THIS, the'~/ro~ day of ~7~~ ,2004, before me, the undersigned officer, personally appeared Betty A. Frederick, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. Notary l~ublic ANN B, tlmSENICH, NOTAIff CARLISLE BOlIO. CUMBEmJUID CUUNTY MY COMMISSION EXPIRES MAY t3. 2007 (SEAL) EXHIBIT "A" STATEMENT OF ACCOUNT OF ALICE H. LANDIS Assets: (A) (B) Debts: 1) 2) 3) Annuities Cash and Miscellaneous Personal Property TOTAL Funeral Expenses and Administration Expenses Miscellaneous Expenses PA Inheritance Taxes TOTAL Balance for Distribution to Heirs: Jack E. Landis (One-Half) Betty A. Frederick (NKA Bream) (One Fourth) Norman G. Blocher (One-Fourth) $108,491.63 $ 80,168.61 $188,660.24 $ 9,980.50 $ 2,810.66 $17,147.23 $29,938.39 $158,721.85 FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN ESTATE OF ALICE H. LANDIS, DECEASED (File No: 21-03-0772) KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, ALICE H. LANDIS, late of Carlisle, Cumberland County, Pennsylvania, deceased, died testate on September 12, 2003, having first made her Last Will and Testament, which was duly executed on September 12, 1991, and condicil there to executed April 10, 2002, and are duly recorded at the Register of Wills in Cumberland County, Pennsylvania. WHEREAS, the said Alice H. Landis, by the aforesaid Last Will and Testament and codicil thereto, named Norman G. Blocher, as Executor of said Last Will and Testament; WHEREAS, letters testamentary on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor hereinafter called personal representative; WHEREAS, the said personal representative has gathered the assets of the estate of the said decedent and the assets consists of personal property to a total value of $188,660.24 as set forth in Exhibit A, which is a statement of account of the said personal representative, and which is attached hereto and made a part hereof and marked Exhibit A; WHEREAS, the debts and deductions including the payment of inheritance tax of the said estate, amount to $29,938.39, leaving the sum of $158,721.85 for distribution, also as set forth in the statement of the said personal representative, which is attached hereto and marked Exhibit A; NOW, THEREFORE, KNOW YE, that we, Jack E. Landis, Norman G. Blocher and Betty A. Frederick, the heirs under the Last Will and Testament and Condicil thereto, of the said decedent, and being those persons entitled to inherit under said Last Will and Testament and Codicil thereto, and in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, agree that no account is necessary and do hereby agree that and consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas, Cumberland County. THEREFORE, We, do hereby remise, release, quitclaim and forever discharge the said personal representative, NORMAN G. BLOCHER, his heirs, executors, administrators, and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demand whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the estate of the said decedent, and we do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, do hereby covenant and agree that we will contribute my prorata share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. 2 IN WITNESS WHEREOF, We have hereunto set our hands and seals this ..~_ r~ay of ~ t° pT~ ,~ ~ ~ ,2004. WITNESS: o/]~fian G. Blocker, Executor, Heir and Beneficiary of the Estate of Alice H. Landis t~l~ck E. Landis, I)eir and BenEficiary of the Estate of Alice H. Landis Betty A.-F~red&~k, heir and BeneI~ciXary of the Estate of Alice H. Landis COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) ON THIS, the a~ day of ~04~'-~_,.ea_fl , 2004, before me, the undersigned officer, personally appeared Norman G. Blochcr, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. llt " ' NOTARIAL SEAL ANN !t. SENSENICN, NOTARY PUBLIC RLISLE BORO., CUMBERLAND COUNTY[ COMMISSION EXPIRES MAY 13, 200~ PENNSYLVANIA COUNTY OF CUMBERLAND Notary Public COMMONWEALTH OF ) ) (SEAL) ON THIS, thea3/,rtdd' day of -r,~,e4.,,' ,2004, before me, the undersigned officer, personally appeared Jack E. Landis, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. l' ~IARIAL $~L ' -[ Notary Public NOTARY Fmc / Z~%J. _ ~LE BORO., CUMBERLAND COUNTY I MY COMMISSION EXPIRES MAY 13, PENNSYLVANIA COUNTY OF CUMBERLAND ON THIS, theo~q,,,rt~ day of COMMONWEALTH OF ) (SEAL) ~-rr~ ,2004, before me, the undersigned officer, personally appeared Betty A. Frederick, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. Notary Public (SEAL) EXHIBIT "A" STATEMENT OF ACCOUNT OF ALICE H. LANDIS As sets: (A) (B) Annuities Cash and Miscellaneous Personal Property Debts: 1) 2) 3) TOTAL Funeral Expenses and Administration Expenses Miscellaneous Expenses PA Inheritance Taxes TOTAL Balance for Distribution to Heirs: Jack E. Landis (One-Half) Betty A. Frederick (NKA Bream) (One Fourth) Norman G. Blocher (One-Fourth) $108,491.63 $ 80,168.61 $188,660.24 $ 9,980.50 $ 2,810.66 $17,147.23 $29,938.39 $158,721.85 BUREAU OF TNDZVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-l;47 EX AFP (01-DS) PATRICIA R BROWN ESQ 10 N POMFRET ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-19-200~ LANDIS 09-12-2005 21 03-0772 CUHBERLAND 101 Amount Ram'; t'l:ed ALICE H HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS -'~ REV-15&7 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LANDIS ALICE H FILE NO. 21 05-0771 ACN 101 DATE 07-19-200~ TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2} 3. Closoly Hold Stock/Partnership Zntorost (Schedule C) ($) 4. Hortgagas/Notos Rocoivablo (Schedulo D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Re~urn .00 .00 .00 .00 801168.61 .00 1081~91.65 (8) 9,980.50 2.810.66 (11) (12) 13. lq. Net Value of Estate Sub~ect to Tax NOTE: Z~ an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Amount of Line Zq at Spousal rata (15) 16. Amount of Line lq taxable at Lineal/Class A ra*e (16) 17. Amount of Line lq e~ Sibling rate (17) 18. Amount of Line lq taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) NOTE: To insure proper credit to your account, submit the upper portion of ~his form with your tax payment. 188,660.Zq ;].2.791.16 175,869.08 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. 17,1~7.2:5 .00 .00 .oo ( TF TOTAL DUE ZS LESS THAN $1, NO PAYHENT 1S REI~UZRED. IF TOTAL DUE ZS REFLECTED AS A "CREDTT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCT/OHS.) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 14, 15 ancl~p~ 16, 17, 18 and 19 wlll returns a~ed to date.~ 87,95~ - ~.,~ -:~ X I~ _ ~.,~..~:T~ .05 .0 87,9~ x ~ ~ ~~.~8: AHOUNT ~ ~1 ~' ~'' (15) .00 (~) 175,869.08 RESERVATION: Estates of decedents dying on or before December 1Z, 19BI -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for lifo or for years, the Commonaealth hereby expressly reserves the rlght to appraise and assess transfer Inheritance Taxes at the laeful Class B (collateral) rata on any such future interest. PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To ~ulfill the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Rag[star of Nills printed on the reverse side. --Hake check or money order payable to: RBG/STBR OF N/LLS, AGENT A refund of a tax credit, ehich ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax'" (REV-131$). Applications ara available at the Office of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special Z~-hour answering service for forms ordering: 1-800-~62-Z050~ services for taxpayers w[th special hearing and / or speaking needs: 1-800-~47-5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disalIowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --arittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviaa Unit, Dept. 280601, Harrisburg, PA 1712B-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-leO1) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the dacedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and in[aras[ assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. In[aras[ is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent par annum calculated at a daily rate of .00016~. All taxes ahich became delinquent on and after January l, 1982 will bear interest at a rate ~hich mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq ars: Interest Daily Interest Daily Year Rate Factor Year Rate Factor ~ ZOZ .0005~8 ~'~'~- 1991 llZ .000~01 1985 162 .O00q~8 1992 92 .0002~7 198~ llZ .000501 1995-199q 7Z .OD0192 1985 13Z .000556 1995-1998 92 .0002~7 1986 lOZ .00027q 1999 77. .000192 1987 iOZ .00027~ ZOO0 77. .000192 --Interest is calculated as folloHs: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~'~ 9Z .0002q7 ZOOZ 62 .00016~ 2003 52 .000137 ZO0~ ~7. .000110 X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must bo calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/15/2005 BROWN PATRICIA R 10 WEST POMFRET STREET CARLISLE, PA 17013 RE: Estate of LANDIS ALICE H File Number: 2003-00772 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) 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 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: 9/12/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, .~~ cc: File Personal Representative(s) Judge ~ Ll.._ L., Ll.--': ~:--) ~ L_c- l "n___, .....---' Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Alice H. Landis Date of Death: 09/12/2003 Estate No.: 21-03-0772 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 1XI No 0 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? . th Yes 0 No E9. Filed Family Settlement Agreement WI- Register of Wills 09/20/04 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes.0 No 0 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. Date: 08-26-2005 ./', '~ ' ,':,.) /7 / ~z:;;.._,- L",,----' )'\- .' h..--... Signature Patricia R. Brown Name N 10 West Pomfret Street, Carlisle, PA 17013 Address L- 717-249-3024 t"'---", 1':-'-) Telephone No. r-:--. C.__~ 0-J Capacity: 0 Personal Representative @ Counsel for personal representative cP