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C, ~l. _~...--. _..._.__.__._..._.______ -- _ ____._._.---.T_. _., .....-.__,--~..~^_______. _~...~._R.___.. _.__._.~..~____--._._,-_ a ~, s" ~~"' ~_ ;; v~ ~ # ~ He~- .~ ~ 1, * IAN `+y 1! ~ t ~ y 7Y ~~ \~~ a~ x x ~~. ;~? ~` 1 . ~9,._ r ~1' I ~ i'h ~ ~~ f 1 ,~ ~ , kF ,~ ~, ~ ~ r y t i ~ i~~ c j r,, . ~~ ~ ~~ ~ :' wt ~ N ~' ~ ~ 9 ~ `~ u L Y ' ~ _.~~ ry.. 1, V,' t'~ ~ ` ~4~ t t.. r t J ` ~ ~~ i y a V~~ ~~. ~t w ~' ~~ x ~ Fey T ~ r , k it r~ ~ ~~i ~ ~i ~,~ SF ~F:1 Y ~ ,, ;f , ° ~ a . ~ t\ o~ r , ~ M ~A ' ' ' ~ a~ ~ ~~ ', O ~ a ~ ~ f ~ ~ ~ " ~ ~ ~ ~ a~ ~ ,,,~ o~ ow +r e ~ ~o c 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~ County Code Year File Number PO 60X.280601 ~~ .' fNHERITANCE TAX RETURN 2 1 0 9 0 5 4 7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 211 14 3840 O1 23 2009 Decedent's Last Name Suffix SIGLER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 08 29 1924 Decedent's First Name MI DOROTHY L Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) n 8 Decedent Died Testate ~ ~ Decedent Maintained a Living Trust I=1 (Attach Copy of Will) (Attach Copy of Trust) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) ~ (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A. WEIGLE ESQUIRE 717 532 7388 r.a Firm Name (If Applicable) WEIGLE & ASSOCIATES, P.C. First line of address 126 EAST KING STREET Second line of address City or Post Office State ZIP Code SHIPPENSBURG PA 17257 c~ REGIST~ WILLS E OILY I ~ ~ ~ _ /~ ~+ :7 ; . .~ ,,, ,. _ r7..~ ~ ~ _i . ~ . , __[[ ~ • ., J r... ~ ~,,,,,~ , . ~, .._.., ~-~-,, ... _i. a _py, \. / .J e~.. - .. , .. , `~ ~ ~. DATE FILED fT Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~ .rl `" William E. Sigler 2 -2 y~l~ ADDR `SS , 30 r en Spring Road, Newvil e, PA 1 41 SIG ATURE F PR//~R OTH~ ~ AN~~S TAT E DATE l//JaJ~ Jerry A. Weigle Esquire Z ~-' 2 ~~fQ ADDRESS V ~ '~ - 126 East King Street, Shippensbu , PA 17257 " Side 1 1505607120 1505607120 'e PA ! ~ h ~ rl~a ~ ~~ ~'ax Re~u r~ Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Sigler, Dorothy L. 21-09-0547 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 #2 Name Address1 Address2 City, State, Zip Date Carol J. Robi --- 43 Country View Estates _. _-- _ - Newville, PA 17241 J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents Name: Dorothy L. Sigler 2 11 14 3 8 4 0 RECAPITULATION 1. Real Estate (Schedule A) ...................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................._........................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................._........................ 4. 9,713.98 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property • (Schedule G) ~ Separate Billing Requested ............. 7. 9 , 7 1 3 9 8 g, ........................... .... Total Gross Assets (total Lines 1-7) ............................._. ., g. 1, 1 2 3 5 0 9. ( ) ...................................... Funeral Expenses & Administrative Costs Schedule H 9. 6 , 4 6 8 . 7 6 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................................ 10. 7, 5 9 2 2 6 11. ( ) .............................---................................. Total Deductions total Lines 9& 10 11. 2 , 1 2 1 7 2 12. ......................... Net Value of Estate (Line 8 minus Line 11) .............................._.. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................................. 13. 2 , 1 2 1 . 7 2 14. .............................................. Net Value Subject to Tax (Line 12 minus Line 13 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0. 0 0 15 0 0 0 (a)(1.2) X .00 . 16. Amount of Line 14 taxable 2 , 12 1 . 7 2 16. 9 5 . 4 8 at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 0 0 0 at collateral rate X .15 . 19. .........................................................._................... Tax Due ................................. 19. 9 5 . 4 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^X Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-0547 DECEDENT'S NAME Dorothy L. Sigler STREET ADDRESS Shippensburg Health Care Center 121 Walnut Bottom Road __ _- CITY ;STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 216.30 0.00 Total Credits (A + B + C) (1) 95.48 (2) 216.30 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (3) (4) 120.82 (5) (5A) (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 property transferred :............................................................................ ^ . x b. retain the right to designate who shall use the property transferred or its income :................................ ^ x c. retain a reversionary interest; or ..............................__............................__.............................................. ;_-', d. receive the promise for life of either payments, benefits or care? ........................................................... `U~j x 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?......... [~ n 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................... U U IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statutedoes not exempta transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. 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. 4 f Rev.1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sigler, Dorothy L. 21-09-0547 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. (Ir more space Is neetled, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+ (12-99) ~ ,~ ;., COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Sigler, Dorothy L. 21-09-0547 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. ~ Attorney's Fees Weigle & Associates, P.C. 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 79.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 294.50 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 1,123.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NI~MBER Sigler, Dorothy L. 21-09-0547 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland Law Journal -advertising Letters Testamentary 75.00 2 News Chronicle -advertising Letters Testamentary 129.50 3 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00 4 Register of Wills, Cumberland County -filing Family Settlement Agreement 75.00 H-B7 subtotal 294.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev,1512 EX+ (12-08) SCHEDULE 1 i ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sigler, Dorothy L. 21-09-0547 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburoed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule 1 (Rev. 12-08) RED(-1513 EX+ (11-08) " ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Sigler, Dorothy L. 21-09-0547 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) Do Not List Tnistee(s I ' TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)) 1 Carol J. Robinson Daughter One-Half 1,060.86 43 Country View Estates Newville, PA 17241 2 William E. Sigler Son One-Half 1,060.86 309 Green Spring Road Newville, PA 17241 Total 2,121.72 Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 150 0 cover sheet, as appr opriate, III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTA L OF PART II- ENTER TOTAL NON-TAXARt F nlsTRiRi iT1nNS nti I inii= ~ ~ n~ Rw_~ inn rn~i~o cu~~~r n nn Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 11-08) LAST WILL AND TESTAMENT , I, DOROTHY L. SIGLER, of 795 Mickey Inn Lane, Chambersburg, Franklin County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby -revoking and making void all ~, wills by me at any time heretofore made. FIRST. I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give and bequeath any automobile that I may own at the time of my passing to my granddaughter, LISA J. ROBINSON. THIRD. I give, devise and bequeath all of the rest and residue of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my children, namely CAROL J. ROBINSON and WILLIAM E. SIGLER, on a per stirpes distribution basis. FOURTH. I nominate, constitute and appoint my daughter, CAROL J. ROBINSON, and my son, WILLIAM E. SIGLER, or the survivor, to be the Co-Executors of this my Last Wi11 and Testament. FIFTH. I hereby direct that all federal, state and other death taxes payable because 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 administration of my estate and that such be paid out of the rest and residue of my estate. ~ ~ ,~~ ~r~-~ ( SEAL) r -Z- NARK, \AjEIGL= /-~.[J7 ~c?KINS - ~,TTORNEYS AT L.~.~<<% - i?6 EAST KWG STP.=ET - S%-11~~=:.S~~JKG, PA. 17257 SIXTH. I ~.irect that my personal representatives shall not be ;required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, DOROTHY L. SIGLER, have hereunto set my hand and seal to this my Last Will and Testament, written on two pages, the first page signed for ~h identification only, this day of , 1990. r - ~"~ ~ (SEAL) ,,~ , This instrument was by the Testatrix, DOROTHY L. SIGLER, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. ~, <' , ,:~ ,/~~,,~J,;~ ., ~.r _2_ MARK, VJEiG-= ~.[~]D PERKINS - ATTORi~=~'~ ~.T LAW - 126 EAST KING c-=~_-- - S.-!i?PENSBURG. PA. i 7G~ i COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND I,, DOROTHY L. SIGLER, the Testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed.it as my free and voluntary act for the purposes therein expressed. ~~~ ~, ~~~ Sworn or affirmed to and acknowledged before m by DOR HY L. S GLER, the Testatrix, this Lj day of ~ ~' ~, 199 ~ ~ ~ NOTAR{AL SEAL ,may A. Weiy{s, Notary Public ~ippancbutp, PA Cum{wrland County M!- Commiccwn ExpirQC July 31,1994 ~~ MARK, W~ICLc ~,:`~1:: ~=RKlt~S - ATTORNcYS AT LG.~rV - 1?5 .AST KING STREET - S-:;=='=I"~~UR6, PA. 17257 ii I COMIKONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND r, ~ i We , . ~ - t C~~i~7~ and ; ~Ji~~~ r .~ i i ~~ ~ the witnesses whose names are' signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw DOROTHY L. SIGLER, 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 was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence . `~~~ _.. Sworn or affir d to and s bs r bed befor ~ by ' and ~~~~f;? ; :~, wi~~ss s, t is C.f ;day o i9~ NOTARIAL SEAL :...Jviry A. VYeiiple, Notary Public Shippancburp, PA Cumbotland County ~ Commission Expires July 31, 19~J4 I,~,.~' `''- `r`~-~ ALE AND PEP,KINS - .^,TTO=;;:'~=`/S AT LAW - iZ6 EAST iafv... r,.c E - SHIPPENSBURG, PA. 1 , Z_7 ir_ c~--,--_ ~ ~ M~ ~3~::. 499 Mitchell Road, Millsboro, DE 19966 Mai] Code DE-MB-12 Phone (888)502-4349 Fax (302)934-2955 June 18, 2009 Weigle & Associates, P.~. Attorneys at Law 126 East King Street Shippensburg, Pennsylvania 17257-1397 Re: Estate of Dorothy L. Si ler Social Security: 211-14-3840 Date of Death: January 23, 2009 Dear Sir or Madam: Per your inquiry dated June l 1, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Checking Account 9839253318 Dorothy L Sigler* 7/12/05 Closed 6/17/09 $ 9,413.81 $ 0.17 $ 9,413.98 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Walnut Bottom Office # 717-532-2414. Sincerely, p ~~ •' l,•~W Tracie Hare Adjustment Services t COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 ~ J 1 July 7, 2009 WEIGLE & ASSOCIATES JERRY A WEIGLE ESQUIRE 126 EAST KING STREET SHIPPENSBURG PA 17257 Re: DOROTHY SIGL,ER CIS #: 710129702 SSN: 211-14-3840 Date of Death: 01/23/2009 Dear Attorney Weigle: 9 2009 Please be advised that the Department of Public Welfare maintains a claim in the amount of $3,783.76 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $3,783.76, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $.00, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, ,A ~~ Jennifer Hartman TPL Program Investigator 717-772-6962 717-772-6553 FAX Enclosure t-~-,5 - ~> c~ ~~ ~ ~~ ~ ~~ l~ ~1 ~~