HomeMy WebLinkAbout02-0228Estate of
also known as
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
No. ~/- 0.2. o~-Z~
Jack D. Reben
, Deceased Social Security No. 179-12- 5715
Jan M. Wtle,_Ej__~sutre
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
(COMPLETE 'A' or 'B' BELOW:)
~'] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or_named in the last Will of
the Decedent, dated~and codicil(s) dated None
Helen K. Reben died on 02~_q~2001
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
~'~ B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Residence
E Name Relationship.__.___
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cu.mberland County, Pennsylvania with his/her last family
or principal residence at 100 Mt. Allen Drive, M
(lis"-'~ street, number, and mumclp ity)
Decedent, then 80 years of age, died 02/22 ,~.O02,at Messiah Vtlla_.~ Mechanctsburg, PA
~ (Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property
(If not domiciled in PA) personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
550,000.00
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
for.__~.m t..~o the undersigned: ~nted name and residence
nature ~ Jan M. Wiley, Esquire
vb.% ~ One S. Baltimore St. , Dillsburg, PA 17019
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 ,o~ Pefifiqner(s) and that, as personal representative(s) of
the Decedent, Petitioner(s) will well and truly administer the es~tate according to law.
Sworn to or affirmed and subscribed /..~ . ~ ._ ~
/an M. Wiley, Esquire ~
before me this 4 t h:lay of
~ARCH 2002 l~x
(
M~RY e L~/igIg:ortt~eRegisi;~' ~ 7
No. _~ I - i~).,O -_,~,.~ _'~'
Estate of Jack D. Reben
Social Security No: 179-12-5715 Date of Death: 02/22/02
AND NOW, MARCH 4, 2002
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~] Testamentary E~] Of Administration
DeCeased
, ~ irt ~Ons deratie__~ :['!:
(c.t.a.; d,b.n.c.ta.; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Jan M. Wiley, Esquire
Short Certificate(s) ..... $
Renunciation ........ $
Affidavits ( ) ....
Extra Pages ( ) .... $
Codicil ........... $
JCP Fee .......... $
Inventory .......... $
Other ...........
in the above estate and that the instrument(s) dated 04/16/86
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $ 375.00
Attorney: David J. Lehox, Es~ire
6.00
I.D. No: 29078
The Wiley Group
Address: One S. Baltimore St.
5.00
Dtllsburg, PA 17019
Telephone: 717/432 - 9666
FILED 3-4-02
ATTORNEY [~CKED UP ON 3-4-02
TOTAL ......... $ 4'J6.00
Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Jais is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
I,ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 8030740
No.
SHOULD READ AS FO[LOWS:
Local Registrar
FEB 2 6 2002
Date
COMMONWE~(LTH OF PENNSYLVANIA · DEPARTMENT
OF HEALTH ,. VITAL RECORDS
CERTIFICATE OF DEATH
eben
__ Mole 179
80 j
' 8-26-21 ,. Pax~ng, PA '~,~
Meehaniesb ~
l~anee Na~on~
~'*~ 12
Messiah ViSage
John S. Reben
Dorothi ord
Ob'~(Sooe, dVJ__
124
-- 12 -- 5715 2-22-02
WZdowed
17112
804
~~-oz -zz s
~ttst i.Ll ~trt~ ~est~cm~rrt
OF
JACK D. REBEN
BE IT RENI~`~1BERED, that I, JACK D. REBEN, of R.D. 3, Dillsbur~;,
Carroll Township, York County, Pennsylvania, being of sound mind, memory
and understanding, do make, publish and declare this as and for my Last
Will and Testament, hereby revoking and making null and void any and all
Wills and Testaments and writings in the nature thereof by me at any
time heretofore made.
ITEP~I l: I direct that all my just debts and funeral expenses be
paid as soon after my demise as may be convenient.
ITEM 2: All the rest, residue and remainder of my estate, of
whatsoever nature and wheresoever situate, whether it be real, personal
or mixed, including property over which I have a mower of appointment, I
give, devise and bequeath unto my wife, HELEN K. REBEN, absolutely,
provided she survives me for a period of thirty (30) days.
ITEM 3: I give, devise and bequeath the contents of my china
closet in the dining room to my niece, JUDITH WILLOW, providing she
survives me.
ITEM 4: Should my wife, HELEN K. REBEN, predecease me, fail to
survive me for a period of thirty (30) days, or should we die simultaneously,
I then give, devise and bequeath ray estate as follows:
A. I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to The Humane Society of Harrisburg - West Shore Shelter, Mechanics-
burg, Pennsylvania.
B. I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to the International Fund for Animal Welfare of Yarmouth Port, Mass.
C. I give and beaueath the sum of Five Thousand ($5,000.00)
Dollars to the Braille Bible Division, National Association for the
Blind of Oakland Park, Florida.
WITNESS:
_..Q µ, Li~P~
~1~~-
CiJ (sEAL>
J 'K D. REBEN
D. All the rest, residue and remainder of my estate I give
equally unto the following charities:
(1) Shriner's Hospital for Crippled Children;
(2) Shrine Burn Center; and
(3) Radio Bible Class of Grand Rapids, MI.
ITEM 5: I direct my Executrix to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature-and kind, to which my
Estate or the transfer of any property passing hereunder or otherwise
passing by reason of my demise, may be subject and to charge such taxes
against my residuary estate, it being my intention that none of the
aforesaid taxes, either federal or state, on any property required to be
included in my gross estate, under the provisions of any state or federal
law now in force or hereafter enacted, shall be prorated among the
persons interested in my estate to whom such property is or may be
transferred or to whom any benefit accrues.
ITEM 6: I appoint my wife, HELEN K. REBEN, as Executrix of this
my T,ast Will and Testament. Should my wife, HELEN K. REBEN, predecease
me, fail to qualify, cease act or renounce probate, I then appoint JAN
M. WILEY, ESQUIRE as alternate Executor of this my Last Will and Testament.
Should JAN M. WILEY, ESQUIRE predecease me, fail to qualify, cease to
act or renounce probate, I then appoint COMMONZ~IEALTH NATIONAL BANK of
Harrisburg, Pennsylvania, as second alternate Executor of this ~lY Last
Will and Testament.
ITEM 7: I direct that my Executrix, guardian or their successors
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN //WITNESS WHEREOF, T have hereunto set my hand and seal this
_____~cP~__ day of __ _ , 1986.
WITNESS:
ni (sEAL)
JA ~ D . REBEN
COMMONWEAL'I`H OF PENNSYLVANIA
SS
COUNTY OF YORK
We, JACK D. REBEN , JAN M. WILEY, ESQUTRE ,
and GLENDA M. WETHINGTON , the Testator and the
witnesses respectively, whose names are signed to the attached or fore-
going instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument
as his Last Will and Testament and that he had signed willingly (or
willingly directed another to sign for him), and that he executed it, as his
free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the Testator, signed
this Last Will and Testament as witness and that to the best of their
l~owledge the Testator was at that time eighteen (18) ,years of age or
older, of sound mind and under no constraint or undue influence.
Sworn to and subscribed to before me
this ~~ - " day of ,
1986.
NOT Y PUBLIC
My Commission Expires:
GLERiDA p, rA~ET8INGTON, MOTARI' PUQIIC
DILLSBUR6 60ROUGi1, 1'OkX COUPiTY
MY CO~FNISSiON EXPIRES DtC. 1i, lggg
Wsmber, P®nnsyMnia Association of A1nta~izs
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Jack D. Reben
Date of Death: 02/22/02
Estate Number: 21-02-0228
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
April 8, 2002:
Name
The Humane Society of Harrisburg
The International Fund For Animal Welfare
Shriners Hospital for Crippled Children
Shrine Burn Center
Radio Bible Class of Grand Rapids, MI
Address
Sinclair & Eppley Rd., Mechanicsburg, PA 17055
411 Main St., Yarmouth Port, MA 02675
3551 N. Broad St., Philadelphia, PA 19140
51 Blossom Street, Boston, MA 02114
3000 Kraft Ave., SE, Grand Rapids, MI 49512
Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except: Braille Bible
Division, National Association for the Blind of Oakland Park Florida. (Unable to locate - No
listing in the entire state of Florida.)
Date: 04/08/02
Name: David J. Lenox, Esquire
Address: One S. Baltimore St.
Dillsburg, PA 17019
Telephone: (717) 432-9666
Capacity: Counsel for personal Rep.
CERTIFICATION OF NOTICE UNDER RULE 5,6 (~)
UPDATED 05/15/02
Name of Decedent: Jack D. Reben
Date of Death: 02/22/02
Estate Number: 21-02-0228
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
April 8, 2002:
Nam~
The Humane Society of Harrisburg
The International Fund For Animal Welfare
Shriners Hospital for Crippled Children
Shrine Burn Center
Radio Bible Class of Grand Rapids, MI
Address
Sinclair & Eppley Rd., Mechanicsburg, PA 17055
411 Main St., Yarmouth Port, MA 02675
3551 N. Broad St., Philadelphia, PA 19140
51 Blossom Street, Boston, MA 02114
3000 Kraft Ave., SE, Grand Rapids, MI 49512
Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except: Braille Bible
Division, National Association for the Blind of Oakland Park Florida. (Unable to locate - No
listing in the entire state of Florida.) WE ItAVE NOW LOCATED TItE BRAILLE BIBLE
FOUNDATION, AND HAVE FORWARDED TItE A BENEFICIAL INTEREST IN TItE
ESTATE OF JACK D. REBEN ON 5/16/02. TItEIR ADDRESS IS PO BOX 948307,
MAITLAND, FL 32794-8307.
Date: 05/16/02
Signature v
Name: David J. Lenox, Esquire
Address: One S. Baltimore St.
Dillsburg, PA 17019
Telephone: (717) 432-9666
Capacity: Counsel for personal Rep.
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of Reben, Jack D. No. 21 - 02 - 00228
also known as Date of Death 2/22/2002
, Deceased Social Security No. 179-12-5715
Jan M. Wiley, Esquire
The 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 located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We vedfy 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.
Attorney: David J Lenox, Esq.
I.D. No.: 29078
Address:
1 S. Baltimore Street
Dillsburg, Pa 17019
Telephone: 717/432-9666
Personal Property
Savings Bond Redemption:
PNC Bank, N.A. (Money Market Account):
PNC Bank, N.A. (Checking Account):
Fulton Bank (Certificates of Deposit):
Waypoint Bank (Certificates of Deposit):
Continental Casualty Company:
Ohio National Financial Services:
Eureka Lodge:
Verizon (refund):
Continental Casualty Company:
Signature:
Address: 1 S. Baltimore St.
Dillsburg, PA 17019
Telephone: 717-432-9666
Dated:
81,007.20
446,344.50
7,239.21
40,000.00
5,051.00
3,105.00
723.26
45.00
12.73
2,700.00
(Attach additional sheets if necessary) Total Personal Property and Real Estate $586,227.90
Estate of
also known as
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
continued
Reben, Jack D. No. 21 - 02 - 00228
, Deceased
Date of Death 2/22/2002
Social Security No. 179-12-5715
Total Personal Property
$586,227.90
2
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 1712S-0~101
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
/'7-
~iE .UM,E.
21 02 00228
COUNTY CODE YEAR NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~ Reben, Jack D. 179-12-5715
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST SE FILED IN DUPUCATE WITH 'I'NE
o 02/22/2002 08/26/1921
"' REGISTER OF WILLS
~3
'IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z
O
[] 1. OdginalRetum [] 2. SupplementaIReturn
] 3. Remainder Return (date of death prior to 12-13-82)
[]
[]
[]
12-3%91 and 1-1-95)
~AME
David J Lenox, Esq.
4. Limited Estate [] 4a. Future Interest Compromise (date of death after
12-12-82) [] 5. Pederal Estate Tax Return Required
6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
of Will) copy of Trust) --
9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (data of death between [] 1 1. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
FIRM NAME (If applicable)
The Wiley Group
TELEPHONE NUMBER
717/432-9666
1 S. Baltimore Street
Dillsburg, PA 17019
9.
14.
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
None
81,007.20
None
None
505,220.70
None
None
51,505.05
5,962.23
Net Value of Estate (Line 8 minus Line 11)
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)
OFFICIAL USE ONLY
(8)
586,227.90
57,467.28
528,760.62
528,760.62
0.00
(11)
(12)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
x .00 (15)
16.Amount of Line 14 taxable at lineal rate
x .045 (16)
17. Amount of Line 14 taxable at sibling rate x ,12 (17)
18. Amount of Line 14 taxable at collateral rate x .15 (18)
19. Tax Due (19)
20. []
Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decede~'s Complete Address:
tSTREET ADDRESS
~ITY Mechanicsburg
STATE PA zip 17055
Messiah Village
100 Mt. Allen Drive
Tax Payments and Credits:
1, Tax Due (Page 1 Line 19)
2. Credits/Payments
^, Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.0 0
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page I 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. (5) 0.0 0
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.0 0
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 trensferred; .................................................................................. ~ ~
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.
under penalties of perjury, I declare that I have exan;ii-.~d this return, including acco,~,panying schedules and statements, and to the beat of my knowledge and belief, it is true, correct and complete. DecJaretion 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
Jan ~KWiley, Esquire ~/~
~iGNATURE OF PREPAI~ER OTHER TH~ REPRESENTATIVE
David J Lenox, Esq.
ADDRESS
ADDRESS
1 S. Baltimore St.
Dillsburg, PA 17019
ADDRESS
1 S. Baltimore Street
Dillsburg, Pa 17019
DATE
DATE
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 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
OF
JACK D. REBEN
~1 - ~32-22~
BE IT ~ERED, that I, JACK D. ~EN, of R.D. 3,. Dillsburg,
Carroll Township, York County,. Pennsylvania, being of sound mind,, memory
and understanding, do make, publish and declare this as and for my Last
Will and Testament, hereby revoking and making null and void any and all
Wills and Testaments and writings in the nature thereof by me at any
time heretofore made.
I5~ 1: I direct that all my just debts and funeral expenses be
paid as soon after my demise as may be convenient.
ITEM 2: Ail the rest, residue and ~emainder of my estate, of
whatsoever nature and wheresoever situate, whether it be real, perSonal
or mixed, including property over which I have a power of .appointment, I
give, devise and bequeath unto my wife, PU~.T.~N K. REBEN, absolutely,
~Q~.~she m~es me for a period of thirty (30) days.
ITEM '3: I give, devise and bequeath the contents of nlV china
closet in the dining room to my niece, JUDi~ WTTIOW, providing she
survives n~.
ITEM 4: Should my wife, ~ K. REBEN, predecease me, fail to
survive me for a period of thirty (30) days, or should we die simultaneously,
i then give, devise and bequeath n7~ estate as follows:
A. I give and bequeath the §urn of Five Thousand ($5,000.00)
Dollars to The Humane Society of HarTisb~rg - West Shore Shelter, Mechanics-
burg, Pennsylvania.
B. I give and bequeath the sum of 'Five Thousand ($5,000.00)
Dollars to the International Fund for ~nimal Welfare of Yarmouth Port, Mass.
C. I give and bequeath the sum of Five Thousand ($5,000.00)
Dollars to the Braille Bible Division, National.Association for the
Blind of Oakland Park, Florida.
WITNESS:
D. All the rest, residue and remainder of nv estate I give
equally unto the following charities:
(~) Shriner's Hospital for Crippled Children;
~(2) Shrine Burn Center; and
(3) Radio Bible Class of Grand Rapids, MI.
ITEM 5: I direct nv Executrix to pay ail inheritance, estate,
succession and legacy taxes of whatsoever nature- and kind, to which my
Estate or the transfer of any property passing hereunder or otherwise
passing by reason of nv demise, m~ay be subject and to charge such taxes
against my residuary estate, it being mY intention that none of the
aforesaid taxes, either federal or state, on any property required to be
included in my gross estate, under the provisions of any state or federal
law now in force or hereafter enacted, shall be prorated among the
persons interested in nv estate to whom such property is or may be
transferred or to whom any benefit accrues.
ITEM 6: I appoint nv wife, HELF. N K. REBEN, as Executrix of this
nv Last Will and Testament. Should nly wife, ~.k~N K. REBEN, predecease
me, fail to ~ualify, cease act or renounce probate, I then appoint JAN'
M. WILEY, ESQUIRE as alternate Executor of this nV Last Will and Testament.
Should JAN M. WILEY, ESQUIRE predecease me, fail to qualify, cease to
act or renounce probate, I then appoint CO~0NWEALTH NATIONAL BANK of
He~risburg, Pennsylvania, as second alternate Executor o~ this nv Last
Will and Testament.
~ 7: I direct that nv Executrix, guardian or their successors
shall not be required to give bond for the faithful performance of their
duties in any Jurisdiction.
IN WITNESS WHEREOF, I have hereunto set nV hand and seal this
WITNESS: /
CO~ONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
: SS
:
We, -JACK D. REBEN , JAN M. WILEY: ESQU]IRE
and GLENDA M. WE~TON , the Testator and the
witnesses respectively, whose-names are signed to the attached or fore-
going instrument., being first dUly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrun~nt
as his Last Will and. Testament and that he bad signed willingly (or
willingly directed another to sign for him), and that 'he executed it, as his
free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the Testator,. signed
this Last Will and Testament as witness and that to the best of their
knowledge the Testator was at that time eighteen (18) years of age or
older, of sound mind .and under no constraint or undue influence.
Sworn to and subscribed to before me
this 0f
1986.
/- NOTARY PUBLIC '~
My CDn~ission Expires:
DILLSBu~G ~ROUG~ ?0~ COU~JTF
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Reben, Jack D. FILE NUMBER
21 - 02 - 00228
All property jointly-owned with right of survivomhip must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 Savings Bond Redemption: 81,007.20
TOTAL (Also enter on line 2, Recapitulation)
81,007.20
~O:~O00OL, Oi: ~3~8~BB~Ol~' OOO:~
000~
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Reben, Jack D. !FILE NUMBER
21 - 02 - 00228
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivomhlp must be disclosed on schedule F.
ITEM
NUMBER
I
DESCRIPTION VALUE AT DATE Of
DEATH
PNC Bank, N.A. (Money Market Account):
PNC Bank, N.A. (Checking Account):
Fulton Bank (Certificates of Deposit):
Waypoint Bank (Certificates of Deposit):
Continental Casualty Company:
Ohio National Financial Services:
Eureka Lodge:
Verizon (refund):
Continental Casualty Company:
TOTAL (Also enter on Line 5, Recapitulation)
446,344.50
7,239.21
40,000.00
5,051.00
3,105.00
723.26
45.00
12.73
2,700.00
505,220.70
~ No. 181000662
ashier's Check
Sou~hcentral PA M~RCH O~ 8002
D~to
"'/"8 &OOOEB ii.' ~:O ::1, t,:~ I, ii? 38~.'
PNC Bank, National Association
S ~qq~O?~/".'
Cashier's Check
PN CBAN(
PHC Bank, National Assodnflon '
$outhcentral PA
Date
60-1273/318
No. 181000661
MARCH 04 P002
· ?.ay. tot,he ESTATE OF ,,lACK. D ********************* ~ [ $$$$$$$?,839,81~
U foot
..... ~ PNC B~ National ~sodafion
5 ~hqqqO? ~ ~.'
53
OOq. O00 Oq~ q,'
COMMONWEALTH OFPENNSYLVAN~
INHER~ANCETAXRETURN
RESIDENT DECEDENT
~H
ESTATE OF FILE NUMBER
Reben, Jack D.
21 - 02 - 00228
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Jan M. Wiley, Esquire
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 1 S. Baltimore St.
City Dillsburg State PA Zip 17019
Year(s) Commission paid
Attorney's Fees David J. Lenox, Esqu~e
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:
State ~ Zip
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
PNC Bank (refund of social security):
Cumberland Law Journal (advertise)
Total of Continuation Schedule(e)
TOTAL (Also enter on line 9, Recapitulation)
21,500.00
21,500.00
416.00
878.00
75.00
7,136.05
51,505.05
ScheduleH
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Reben, Jack D. FILE NUMBER
21 02-00228
3 The Sentinel: 103.55
PNC Bank (safe deposit box key):
Filing Fee:
Dorothy Stanford (Power-of-Attorney Fee):
Rev. Charles Teagues (service & ministry services)
12.50
20.00
6,000.00
1,000.00
Page 2 of Schedule H
COMMONWEAL'FH OF PENNSYLVAI'~IA
INHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Reben, Jack D.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
21 - 02 - 00228
Include unreimbumed medical expenses.
ITEM
NUMBER
DESCRIPTION
Messiah Village:
Verizon:
Holy Sprit Hospital:
West Shore EMS:
Pharmerica:
PA Neuro Assoc., Ltd:
Quantum Imaging & Therapy:
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
5,017.06
12.73
812.00
34.80
29.36
49.45
6.83
5,962.23
REV-IL13 EX+ (g-o0) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Reben, Jack D.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 - 02 - 00228
NUMBER
II.
1
2
3
4
5
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO
DECEDENT
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
The Humane Society of Harrisburg
And the International Foundation for Animal Welfare ($5,000.00 Each):
Radio Bible Class of
3000 Kraft Ave., SE Grand Rapids, MI 49512
Braille Bible Foundation
PO Box 948307, Maitland, FL 32794-8307:
Shriners Hospital for Crippled Children
3551. Broad St., Philadelphia, PA 19140:
Shrine Burn Center
51 Blossom St., Boston, MA 02114:
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
AMOUNT OR SHARE
OF ESTATE
10,000.00
171,253.54
5,000.00
171,253.54
171,253.54
528,760.62
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~'~(~J<' b,
Date of Death:
Will No. ~/-0~-~O~~ 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 o'f the estate is complete:
Yes ~ No__
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes__ No
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
d.. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: //-~/-~ ~
(MAH:rmf/AM3)
Name (Please type o~ print)
i m rc 6
~dd~ess~ll~~ ~ 1'701~
Tel. No.
Capacity:
Personal Representative
~--~°unsel for personal
representative
BUREAU OF ZNDZVZDUAL TAXES
/NHERTTAHCE TAX D/VISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COHMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSHENT OF TAX
REV-15~I? EX AFP (01-03)
DAVID J LENOX E~Q
THE WILEY GROUP
I S BALTIMORE ST
DILLSBURG
PA 17019
DATE 01-20-2005
ESTATE OF REBEN
DATE OF DEATH 02-22-2002
FILE NUMBER 21 02-0228
COUNTY CUMBERLAND
ACN 101
Amount Remitted
JACK D
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF REBEN JACK D FILE NO. 21 02-0228 ACN 101 DATE 01-20-2003
TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Roe1 Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
~. Hortgegms/Notos Receivable (Sch®dule D) (q)
E. Cash/Bank Doposits/Hisc. Personal Property (Schedule E) ($)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expmnses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Dmbts/Hortgagm Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Velum of Tax Roturn
81~007.20
.00
505~220.70
.00
.00 NOTE: To insure proper
crmdit to your account,
submit the upper portion
.00 of this form with your
tax payment,
.00
(8)
51,505.05
15.
NOTE:
ASSESSMENT OF TAX:
1E. Amount of Line lq at Spousal rats
16. Amount of Line lq taxable at Lineal/Class A rate
17. Amount of Line lq at Sibling rate
18. Amount of Line lq taxable at Collateral/Class B rata
19. Principal Tax Due
TAX CREDITS.'
PAYNENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-
5~962.25
(11)
(12)
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Nat Velum of Estate Sub~ect to Tax
If an assessment was lssued previously, 11nes 14, 15 and/or 16, 17,
reflect figures that include the total of ALL returns assessed to date.
586,227.90
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
57.467.28
528,760.62
528,760.62
.00
18 and 19 will
(16) .00 X O0 = .00
(:].6) .00 X 0~5= .00
(27) .00 X 12 = .00
(18) .00 x 15 = .00
(19)= . O0
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED.
IF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)