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Home My WebLink About02-0220PETITION FOR PROBATE and GRANT OF LETTERS Estate ~ MARJORIE R. HESS No. also known as To: Social Security No. 16 0 - 16 - ~ 3 f ~ceased. .2, Register of Wills for the County of CUMBERLAND Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut in the last wilt of the above decedent, dated May 16, and codicil(s) dated in the or ,19 nagrn~d (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at Claremont Nursing Home 375 Claremont Drive (Middlesex Town~h~?): ~ar]~!e. PA ' (list street, number and muncipality) Decendent, then 85 )~ears of age, died February 9, ,19 2002, at Claremont Nursn_nq Home Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $. Value of real estate in Pennsylvania $ situated as follows: 40,215.00 None WHEREFORE, petitioner(s) respectfully ~q~lU~St(S). th.e probate of the last will and codicil(s) pre~ented herewith and the grant of letters k'W~ ~c~ (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. Michael Hess 3508 Marqo Road Camp Hill, PA 17011 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 kfiowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed ~n~ subscribed ~-~ ~ before me this 27th day of [ · Michael Hess ~' /~)~e~rt2az~ ~ L z9!9 2 O0 2_ J/ ~ ~"~ ~_.......'lv/aryC.//LewI'~ ~7-Register C ~ NO. 21-2002- 220 Estate of MARJORIE R. HESS ,,Deceased DECREE OFPROBATEANDGRANTOFLETTERS AND NOW February 28th, i~r2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated May 16, 199 0 described therein be admitted to probate and flied of record as the last will of Marjorie R. Hess and Letters Testamentary ; are hereby granted to Michael Hess FEES Probate, Letters, Etc .......... $..80.00 Short Certificates(2) .......... $ 6.00 Renunciation x-Pages (5 ~ ............... $ 15.oo JCP $ 5.O0 TOTAL $. 106.00 Filed February 28th, 20--~ · ' / ~e~ster~f Wil~ ~/M~ry C. Lewis Edmund G. Myers (20558) Johnson, Duffie, Stewart & Weidner A~ORNEY ~up. Ct. I.D. No.) 301 Market St., P. O. Lemoyne0 PA 17043-0109 ADDRESS (717) 761-4540 Box 109 PHONE MAILED LE%~YER$ TO ATTORNEY EDMUND G. MYERS ON 3-1-2002 his is to certify that the in£ormation here given is correctly copied £rom an original certificate o£ death duly filed with me as Local Registrar. The original certificate will be £orwarded to the State Vital Records O£fice £or permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8029624 No. Local Registrar FEB 1 Date 43Rev 2/87 COMMONWEALTH OF PENNSYLVANIA ' DEPARTMENT OF HEALTH ' VITAL RECORDS CERTIFICATE OF DEATH · Female '. 160 ~ 16 --~,347 ,- 2-9-2002 Allentown, r^/-. ' Mar 'orie R. Hess 85 ' Cla~em ,,.. s,,,. PA J 12-18-1916 Su~, Cett~*. ~. Z~ Codel 4833 East Trindle Road FJ~'HER'S NAME (Fi;;t, Mk$dle, LaS~) OJa,b' 2-13-2002 PA Crematory Harrisbu~.q, PA Cremation Societg of PA 17109 DUE 10 (OR A~ A CONSEOUENCE OF): lb'h- L ~ FG ~ INJURY ~f WORK? I]~JBE HOW INJURY C"C~ Ila"qEO' DATE SIGNED {Mom~. (~y, YoaO 0~' ~' ~ J3'~d. ~ - II-~ ) ~RESS ~ PERSON WHO C~PL~EO C~ ~ ~ATH r Print 21-220-220 LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, MARJORIE R. HESS, presently residing at 1112 Columbus Avenue, Lemoyne,Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my debts, expenses of my last illness and funeral expenses shall be paid by my Executor hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: I bequeath my automobiles and personal effects, such household goods if any as may be my individual property and not the property of my husband or owned jointly by me with him, and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, to my husband, EDWIN E. HESS, if he survives me by thirty days. Should my husband, EDWIN E. HESS, not be living on the thirty- first day after my death, I bequeath such tangible personalty and insurance thereon to my issue, per stirpes, living on the thirty- first day after my death, to be divided among them with due regard for their personal preferences in as nearly equal shares as practical. THIRD: I give, devise and bequeath the rest, residue and remainder of my estate, whether real, personal or mixed, and of any nature whatsoever and wherever situated, unto my husband, EDWIN E. HESS, providing he shall survive me by thirty days. FOURTH: In the event that my husband, EDWIN E. HESS should predecease me or die within thirty days of the date of my death, then I give, devise and bequeath the rest, residue and remainder of my estate, whether real, personal or mixed, and of any nature whatsoever and wherever situate, unto my son, MICHAEL HESS. Should my son, MICHAEL HESS, predecease me, then I give, devise and bequeath the rest, residue and remainder of my estate, whether real, personal, or mixed, and of any nature whatsoever and wherever situate, unto my daughter-in-law, CAROL HESS. Should my daughter-in-law, CAROL HESS, predecease me, then I give, devise and bequeath the rest, residue and remainder of my estate of every nature and wherever situate to COMMONWEALTH NATIONAL BANK, IN TRUST, for the following uses and purposes: 1. To accumulate the net income and to expend and apply so much of the net income, accumulated income, and principal of this trust as trustee in its sole and absolute discretion deems advisable for the support and education (including college education, both graduate and undergraduate) of my grandchildren after taking into consideration their other readily available assets and sources of income, or during illness or emergency. Trustee shall expend the funds as equitable among my grand- children as is practicable but not necessarily equally, having in mind that the main purpose of this trust is to make possible an adequate education for all such grandchildren. 2. When I have no grandchild living and under the age of twenty-five or upon the death of the survivor of my grandchildren shall they all die prior thereto, then this trust shall terminate and the then remaining principal and accumulated or undistributed income shall be distributed to my then-living grandchildren, per stirpes, without regard to distributions made under paragraph 1 of this ITEM FOURTH. FIFTH: I hereby nominate, constitute, and appoint my son, MICHAEL HESS, as Executor of this, my Last Will and Testament. In the event that my said son shall predecease me, or be un- willing or unable to act as my Executor, as aforesaid, then I nominate, constitute and appoint COMMONWEALTH NATIONAL BANK, without necessity for posting security regardless of state of residence, as Executor of this, my Last Will and Testament. All references to the Executor herein shall be applicable to said substitute Executor. SIXTH: My Executor shall have, in and authority conferred upon them additional powers and authority: addition to by law, the the powers following 1. To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, at any time constituting a portion of a trust or my estate, and upon such terms and conditions as the Executor shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, mutual funds and money market deposit accounts, including those funds and accounts operated or offered by my corporate executor or any affiliate of it, real estate, mort- gages, life insurance, annuities or other securities, or such property, real or personal, as the Executor shall deem wise, without being limited by any statutes or rule of law regarding investments by the Executor. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as he deems it wise, and even though such property is not the kind of property an Executor would purchase as an invest- ment; and even though to retain sound diversification principles. such property might violate 4. To cause any security or other property which may constitute a portion of a trust or of my estate to be issued, held or registered in his own name, or in the name of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of a trust or of my estate, and to take any action with reference to such securities which, in the opinion of the Executor is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to him as owner of any securities constituting a portion of a trust or of my estate resulting from any reorganization, consolidation, readjustment, sale, conversion or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of a trust or of my estate, including such compensations to Executor which shall be in accordance with established fees throughout the period of administration of a trust or of my estate. 7. To determine what is "income" and what is "principal" hereunder, and his decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Executor may determine. 8. To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by him, at public or private sale, or otherwise. 9. To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value. 10. To distribute in cash or in kind. 11. To borrow money from any person, firm or corpor- ation, including any corporation acting as an Executor hereunder, for the purpose of protecting and preserving or improving my estate or trust hereunder~ to execute promissory notes or other obligations for amounts so borrowed. 12. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers and other agents and employees and to pay them reasonable compensation out of my estate or any funds held hereunder to which said compensation is attributable. 13. To do all other acts in his judgment necessary or desirable for the proper and advantageous management, invest- ment and distribution of a trust or of my estate. SEVENTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor pay, or provide for payment of all such taxes at such time, or times, and in such manner as my Executor deems best. IN WITNESS WHEREOF, I, MARJORIE R. HESS, the Testatrix to this, my Last Will and Testament, typewritten on five sheets of paper which I have identified at the bottom of each ~age by my hereunto set my hand and sea! the ~ day of signature, ///BY , 19 9[0 . / MARJOBIE R. ~ The preceding instrument consisting of this and five other typewritten pages, each identified by the signature of the Testatrix, MARJORIE R. HESS, was on this day and date thereof signed, published and declared by MARJORIE R. HESS, the Testatrix therein named, as and for her Last Will,in the presence of us who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses. 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, MARJORIE E. HESS, 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. M RJOR R. ESS Sworn of affirmed to and acknowledged before me, by MARJORIE R. HESS, the Testatrix the /& w~ day of FD~ , 19 qo (SEAL) Notary Public JNOTARIAL SEAL SUSAN M. DERK, NOTARY PUBLIC HARRISBURG, DAUPHIN COUNTY _.MY,,C;OMMI$SiON EXPIRES SEPT, 21, 11~12 5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN and ~. , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix 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 eighteen or more years of age, of sound mind and under no constraint or undue influence. r Sworn of affirmed (SEAL) to and subscribed to before me by and ~u.~A~ ~1. Co~,~ do~ , and , witnesses, this ~/G~ day of Notary Public CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: MARJORIE R. HESS Date of Death: February 9, 2002 Will No.: 2002-00220 Admin. No.: 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 Name Address Michael Hess 3508 Margo Road, Camp Hill, PA 17011 Pamela Hess 5269 E. Trindle Roac Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: '¢'///¢/'~ ~ Signature Name Edmund G. Myers, Esq. Johnson, Duffle, Stewart & Weidner Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Capacity: Personal Representative X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD O01145 EDMUND G MYERS ESQUIRE 301 MARKET STREET P O BOX 109 LEMOYNE, PA 17043 fold ESTATE INFORMATION: SSN: 160-16-5347 FILE NUMBER: 21 02-0220 DECEDENT NAME: HESS MARJORIE R DATE OF PAYMENT: 05/03/2002 POSTMARK DATE: 05/02/2002 COUNTY: CUMBERLAND DATE OF DEATH: 02/09/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,500.00 TOTAL AMOUNT PAID: $5,500.00 REMARKS: EDMUNDG MYERS ESQUIRE SEAL CHECK# 92 INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of MAPOORIE R. HESS No. 21-02-00220 Also known as Date of Death: FEBRUARY 9, 2002 Social Security No. 160-16-5347 ,Deceased I, MICHAEL HESS Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation place opposite each item of said Inventory represent its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. ~ Personal Representative: Name of Attorney: EDMUND ~. MYERS /S/ ~ ~'~ ~' X~C HICHAEL I-i~ESS, EXECUTOR i No.: 20558 Address: 3508 MARGO ROAD Address: Johnson, Duffle, Stewart & Weidner 30i Market Street, P.O. Box i09 Lemoyne, PA 17043 Telephone: (717) 761-4540 NEW CUMBERLAND, PA 17070 Telephone: 717/774-3336 Dated: / / Description 1. Allfirst Bank - Checking Account No. 00426-6888-3 Date of death balance, plus interest 2. Allfirst Bank - Certificate of Deposit No. 8-700-814-1070967 Date of death balance, plus interest 3. Mellon Bank- Checking Account No. 112-462-0806 Date of death balance Value $ 12,098.50 28,407.98 2,235.51 TOTAL: $42,741.99 RE[/- 1500 EX + (6-00/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN OFFICIAL USE ONLY /7- FILE NUMBER 21-02-00220 COUNTYCODE YEAR NUMBER cAPB HpRL EpIO cRAC KoTK ES Co. RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Hess Marjorie R. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 02/09/2002 I 12/18/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 160-16-5347 THIS RETURN UUST BE FILED IN DUPUCATE WITH THE REGISTER OF W' I $ SOCIAL SECURITY NUMBER 1. Original Return 2. Supplemental Return 4. Limited Estate 4a. Future lnterest Compromise (date of death after 12-12-82) 6. Decedent Died Testate __ 7. Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) [~9. Litigation Proceeds Received [----] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) (d.ate of death 3. Remainder Return prlorto 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ~--~ 11. Election to tax under Sec. 9113(A) (Attach Sch O) NAME Edmund G. Myers FIRM NAME (If AppliCable) Johnson, Duffle, TELEPHONE NUMBER 717./761-4540 Stewart & Weidner COMPLETE MAILING ADDRESS P. 0. Box 109 301 Market Street Lemoyne, PA 17043-0109 R E C A P I T U L A T I O N C O M T I 0 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) J-~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (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. 14. No~e ! None None None 42,741.99 None 103,838.88 5,016.67 1,319.53 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) [~-~,' F FICIAL'U S E:0 N LY (8) 146,580.87 (11) 6,336.20 (12) 140,244.67 (13) (14) 140,244.67 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 140,244.67 X .0 0 (15) 0.00 X .0 45 (16) 6,311.01 X .12 (17) 0.00 X .15 (18) 0.00 19. Tax Due (19) 6,311.01 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS Claremont Nursin8 Home 375 Claremont Drive CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 5,500.00 289.47 STATE PA (1) Total Credits ( A + B + C ) (2) ZIP 17013 6,311.01 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to re~luest a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... 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? ................................ ~-~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 5,789.47 0.00 0.00 521.54 0.00 521.54 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Michael Hess DATE ~G~NA~~ ~A EP~RES~EN{~TAT'I 3508 Mar oRoad ~//~/~ ............ '_g_ ..................................... Camp Hill, PA 17011 -- A NR VE Johnson, Duffle, Stewart & Weidner DATE P. O. Box 109 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)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse'is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) ZOO0 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV- 1508 EX ~- (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie R. Hess SS~/ 160-16-5347 02/09/2002 21-02-00220 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 00426-6888-3 Date of death 12,098.50 2 3 Allfirst Bank - Checking Account No. balance, plus interest Allfirst Certificate of Deposit No. death balance, plus interest 8-700-814-1070967 - Date of Mellon Bank - Checking Acct. No. 112-462-0806 balance - Date of death 28,407.98 2,235.51 TOTAL (Also enter on line 5, Recapitulation) $ 42,741.99 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form RI:V- 1508 EX (Rev. 1-97) REV-~5~0 EX+(~-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Har.~orie R. Hess SS~/ 160-16-.5347 02/09/2002 21-02-00220 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDETHE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER NUMBER ATTACH A COPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (iF APPLICABLE) 1 Rvocable Trust Mellon Bank, Trustee Beneficiary: Michael Hess, Son 103,838.88 100.00% 103,838.88 TOTAL (Also enter on line 7, Recapitulation) $ 103,838.88 (if more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) REV-~Stl EX +0-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Marjorie R. Hess SS~/ 160-16-5347 02/09/2002 FILE NUMBER 21-02-00220 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 1 2 3 FUNERAL EXPENSES: Cremation Society of Pennsylvania - Funeral Rolling Green Cemetery West Shore Baptist Church - Funeral Meal Expenses 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: Attorney's Fees Johnson, Duffie, Stewart & Weidner Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal Register of Wills - The Patriot-News Co. State Zip - Legal Advertisement File Inventory & Inheritance Tax Return Legal Advertisement 1,265.00 193.00 250.00 3,000.00 106.00 75.00 25.00 102.67 TOTAL (Also enter on line 9, Recapitulation) $ 5,016.67 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV- 151;' EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marjorie R. Hess SS~/ SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS 160-16-5347 02/09/2002 FILE NUMBER 21-02-00220 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION Associated Cardiologists - account balance Country Meadows - Final charges Internal Revenue Service - Tax due on decedent's West Shore Emergency Medical SErvice 2001 tax return decedent's account balance AMOUNT 21.74 632.50 594.34 70.95 TOTAL (Also enter on line 10, Recapitulation) $ 1,319.53 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Marjorie R. Hess SS~ 160-16-5347 02/09/2002 21-02-00220 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.?)] Michael Hess 3508 Margo Road Camp Hill, PA 17011 S on Residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) z ~c ~o~ ~0 t-rj 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 001300 EDMUND G MYERS ESQUIRE 301 MARKET STREET P O BOX 109 LEMOYNE, PA 17043 ........ fold ESTATE INFORMATION: SSN: 160-16-5347 FILE NUMBER: 2102-0220 DECEDENT NAME: HESS MARJORIE R DATE OF PAYMENT: 06/17/2002 POSTMARK DATE: 06/1 4/2002 COUNTY: CUMBERLAND DATE OF DEATH: 02/09/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $521.54 REMARKS' TOTAL AMOUNT PAID: MICHAEL HESS C/O EDMUND G MYERS ESQUIRE $521.54 SEAL CHECK# 0095 INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF TNDZVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. :~806nl HARRISBURG.. PA I7128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX EDNUND G HYERS JOHNSON ETAL PO BOX 109 LEHOYNE CUT ALONG THIS LZNE REV-Z547 EX AFP (01-02) DATE 08-05-2002 ESTATE OF HESS DATE OF DEATH 02-09-2002 FILE NUNBER 21 O2-OZZO COUNTY CUHBERLAND ACN 101 Amount REV-15¢i7 EX AFP (01-02) NARJORZE R HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~ RETAIN LOWER PORTZON FOR YOUR RECORDS ~ NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR ESTATE OF HESS DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX HARJORZE R FILE NO. 21 02-0220 ACN 101 DATE 08-05-200? TAX RETURN gAS: (X) ACCEPTED AS FZLED RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Sohedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. CZoseZy Held Stock/Partnership Interest (Schedule C) (3) ~. Nortgages/Notes Receivable (ScheduZe D) (~) 5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5) 6. Jointly Owned Propar*y (Schedule F) (6) 7. Transfers (Schedule G) (7). 8. Total Assets APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expanses/Adm. Costs/NLsc. Expenses (Schedule H) (9) 10. Debts/Nortgage Liabilities/Liens (Schedule Z) (10) 11. Total Deductions 12. Net Value of Tax Return 42~741.99 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper por~ion .00 of this form with your tax payment. 103,838.88 (a) 146,580.87 5,016.67 1~$19.53 (11) 6.336.2n 140,244.67 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATZON OF ADDITIONAL INTEREST. CD001145 CDO01$O0 INTEREST/PEN PAID (-) 289.47 .00 ANOUNT PAZD 5,500.00 521.54 TOTAL TAX CREDZT I 6,311.01 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. / .00 TOTAL DUE ~ . O0 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR ZNSTRUCTZONS.) 6,511.01 TAX CREDITS: ~ PAYNFNT / RECEIPT _ DATE NUHBER 05-OZ-ZO02 06-14-2002 (12) 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 14. Not Value of Estate Subject to Tax (14) 140,244.67 NOTE: Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 16. Aeount of Line 14 at Spousal rate (15) .00 X O0 = .00 16. Amount of Line lfi taxable at Lineal/Class A rata (16).. 140,244.67 X 045 = 6,$11.01 17. Amount of Line lq at Sibling rate (17). .00 X 12 = .00 18. Amount of Line lfi taxable Bt Collateral/Class B rata (18) .00 X 15 = O0 19. Principal Tax DUB ' (19)= PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.'12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARJORIE R. HESS Date of Death: February 9, 2002 Will No.: 2002-00220 Admin No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No If the answer is No, state when the personal representative reasonably believes that the administration will be complete: If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the Court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is:. C. Did the personal representative state an account informally to the parties in interest? Yes No X The Executor was the sole beneficiary. D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature Edmund G. Myers, Esq. Johnson, Duffle, Stewart & Weidner 301 Market Street, P.O. Box 109 Lemoyne, PA 17043-0109 Address (717) 761-4540 Telephone No. Capacity: Personal Representative X Counsel for Personal Representative