HomeMy WebLinkAbout04-0541PETITION FOR PROBATE and GRANT OF LETTERS
Estate of "~'. fi ,.~ _% 'O ~ ~_ 'x }r~, %. i2--
also known as
, Deceased.
Social Security No. &
No..~1-~/-] ~ ~/t
To:
Register of Wills for the .
County o tQ-~xs~,~\ c~&
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 ! ~ 7-.~ v ~._ % C-'7
and codicil(s) dated
in the
named
,19~5ca
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~,,~r41r, I~:i'~cr~ ,~,.~ County, Pennsylvania, with
h ~ last f~mily or principal residence at 7~ ~ ~ c ~ ~ ~ ~
(list street, number and muncipality)
Decendent, then G ~w y~ars of age, died 3 ~ ~ ~ ~ ~ C , ~
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 fo~robate; was not the victim of a killing and was never adjudicated
incompetent: ~o Cyme [~ x , ,~5
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:
theron.
WHEREFORE, petitioner(s) respectfully .re_._quest~) the pro_bate of the. ~last will and codicil(s)
presented herewith and the grant of letters ~ ~ -~ ', ~ -~-~C ~ ', ~ · -., c~
(testamentary; admini~tion c.t~a.; administration d.b.n.c.t.a.)
C._
C
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 3
COUNTY OF O-_-~,~,x~e.~c,~o.cx~ jv 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 represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affi,/4~e~ and subscribed
befo[exme this "'5'"? ' day of
'.~.r-~.~ Regis,~
Estate Of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~ ~
the reverse side h~reof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated \~ ~ {~e~ - ~<~q
described therein be admitted to.p_probate and filed of record as the last will of
and Letters ~~m~c:~?~'cx ~<x-c'~- * "~
are hereby granted to ~c~, L_ ~,/o.~x 'N-X,,o, a~o
q c~Oo~ ~lO ., in consideration of the petition on
FEES
Probate, Letters, Etc .......... $~_~
Short Certificates( ) $
~n d~%. ,.._~~ $
$ io.c3~
TOTAL ~ $
Filed . .~. ?.?.: ?.. ~ ..................
Register of Wi~'~
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
I05 805 REV 9/86
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 ~ling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9825538
No.
LO Oc/- 54 /
Local Registrar
- /'bate'
TYPE/PRINT
PERMANENT
BLACK INK
i
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
(~29-188
NAME O~ DEC~DENT (F~I, M~e. Last) SEX I ~OCM~. SECURITY NUMAR IO~E OF ~H (~. Day
" Mary D Verha~e z FemaleI" 372 32 4224],. January 16, 2004
s 67 v.. v. 11. 1936 Ocheydon. Iowa ~ ~ ~ ~ ~ ~ m,~
~ Cumberland ~pper ~llen ~ 725 Edgewood Lane I~ ~,~.~c~.
· ~. - I~~°~' I~o.
., Faralegal .~. Law ~=. ~ ~ ~ ~ E,~ ~
,~. ~,a 12 4°~s*~ ,,. Married Ward L VerHage
725 Edgew~d Lane ~c[ ,,,.re,t, P~nn~ylva~ia ~ ~,,.~ ~,.~,~ Upper Allen Twp
~ Mechanicsburfl, Ponn~l~ania ~7055~ ~*~.~ Cumberland ~* ~.~'~
John C. Holt
HER'S ~ME (F~.. U~. ~ ~) Veda Miller
~.. Ward L. VerHage ~. 725 Edflew~d Lane Mechanicsburq Pa 170~5
~t.. ...... ~.----/ . ~ a~. Jan 19, 2004 [a~. Conolite Cremato~ [a~., Schaefferstown, Pa 17088
~a ~ % ' I ~ .~ 22b. FD-O14318-L ~. M~m Funeral Home, Inc. 37 Easl Main Street Mechanicsburq. Pa. 17055
I
" .... ~' I~' 5'00 A . ]~ January' 16, 2004 ~. m ~ ~o~
Probable
Infarction
,~)~ .. ~yocara~a~
~~ ~. Occlusive Coronary Artery Disease
~o~.t~-v~,~.,~,~,em..~,.~~.l.~.~...~ .......................... ~ ~*.._,.. January
'MEDICALEX~INE~COR~ER rJI~2~TY~Pr~ ~lchael L. Norris. Coroner
,:
LAST WILL AND TESTAMENT
OF
MARY D. VER HAGE
i -
I, MARY D. VER HAGE, now of 725 Edgewood Lane, Mechanicsburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby make, publish and declare this
to be my Last Will and Testament, hereby revoking all other Wills
and Codicils previously made by me.
ITEM I: I direct that payment of all my just debts,
expenses of my last illness, cremation expenses, and the costs of
administering my estate from my estate as soon after my death as
conveniently may be done.
ITEM II: I give, devise and bequeath all of the rest,
residue and remainder of my estate, of every nature and wherever
situate, together with all insurance policies thereon, unto my
spouse, WARD L. VER HAGE, providing my said spouse shall survive me
by ninety (90) calendar days.
ITEM III: Should my said spouse predecease me or die on
or before the ninetieth (90th) day following my death, I give,
devise and bequeath all of the rest, residue and remainder of my
estate of every nature and wherever situate, together with all
insurance policies thereon, as follows:
A. A share in the amount of seven and one-half percent (7.5%)
to each of my then living grandchildren (i.e., the children of my
two children).
B. My two children shall have the right to take whatever
personal articles, jewelry, firearms, automobiles, or household
articles with their respective share to be charged at the appraised
value used on the inheritance tax return; in the event there is any
dispute as to both wanting the same article they are to resolve the
dispute by the toss of a coin.
C. All the rest, residue and remainder to my two children,
Eric H. Ver Hage and Kendra E. Koser, absolutely, share and share
alike; in the event any of my children predeceases me or dies
within ninety (90) days of my death, then his or her share to go
equally to his or her children then living, per stirpes and not per
capita, otherwise to the survivor of my said two children.
ITEM IV: The share of any beneficiary under thirty (30)
years of age shall go to ERIC H. VER HAGE and KENDRA E. KOSER or
the survivor of them in trust, for the following purposes:
1. The income and the corpus of the Trust to go for the care,
maintenance, education, occupational training and to enhance any
personal skills or interest in the musical field or any other field
and the welfare of said beneficiaries to the extent other income is
insufficient. My said Trustee shall give the highest regard and
credibility to the adult person with whom said person resides and
upon request or demand of such adult person for payment or
reimbursement for present or future expenses that involve the said
items for the good and welfare of my beneficiaries, said Trustee is
authorized to pay such requests or demands for present and future
expenses without any further investigation or order of court and
without any further liability or responsibility for the application
of such monies paid.
2. Whenever said beneficiary attains the age of thirty (30)
years, then the Trust shall pay over to said beneficiary all the
rest, residue and remainder to the said beneficiary. If the
beneficiary dies before attaining age thirty (30), the Trust shall
terminate and such share shall be distributed to his or her
personal representative.
ITEM V: I direct that any and all taxes that may be
assessed in consequence of my death, including all inheritance,
estate and transfer taxes imposed upon my estate passing under my
Will or otherwise, shall be paid out of the principal of my
residuary estate as a part of the expense of the administration of
my estate.
ITEM VI: I authorize and empower my personal
representative to compromise, adjust, release and discharge in such
manner as my personal representative may deem proper, all debts and
claims owed by or to me or my Estate; to sell, lease or exchange at
public or private sale or in such manner, at such prices, and upon
such terms of credit or otherwise, as my personal representative
may deem proper, all or any part of my property, real or personal;
to exec ute, acknowledge and deliver instruments of conveyance,
including deeds in fee simple; to borrow money for the purpose of
paying estate, inheritance or other taxes which are required to be
paid and to secure any such loans by pledge or mortgage of all or
any part of my property and to execute the necessary instruments to
carry out such powers; to distribute my estate in kind or partly in
money or partly in kind, and to determine the fair value at which
any property so distributed in kind shall be received by the
distributees; to conduct any business in which I have an interest
at the time of my death, for such period as my personal
representative may deem proper, power to borrow money and pledge
assets of the business and the power to do all other acts tha~ I,
in my lifetime, could have done, to delegate such power to any
partner, manager or employee without liability for any loss
occurring therein and to organize a corporation to carry on said
business as capital to such corporation and accept stock in the
corporation in lieu thereof and hold such stock for the uses of
this my Will, and to vote said stock or sell the same as to my
personal representative may seem best; to retain all stocks,
assets, bonds and investments owned by me without being confined to
what is known as legal investments; to execute any options to
purchase, to apply for stocks, bonds or other investments, to
purchase or otherwise acquire real estate and to execute the same
powers thereover as hereinbefore provided, to retain indefinitely
any part of my assets, real or personal, which is or may become
unproductive or to make sale thereof; to pay carrying charges and
expenses of the property out of other principal or income of my
estate; to invest and reinvest in all forms of property without
restriction to investments authorized for Pennsylvania fiduciaries,
as my personal representative deems proper, without regard to the
principle of diversification or risk; to exercise any law-given
option to treat administrative expenses either as income tax or as
estate deductions, without regard to whether the expenses were paid
from principal or income. The powers herein conferred shall be to
my named personal representative and all successors thereto and
shall be in addition and not in limitation of other powers
conferred on said fiduciary.
Any and all payment or payments of any sum or sums, whether in
cash or in kind and whether for principal or income payable to any
beneficiary shall be made upon the sole receipt of the respective
beneficiary to whom the payment is made and free from anticipation,
alienation, assignment, attachment, and pledge and free from
control by the creditors of any such beneficiary.
ITEM VII: All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obligation
of the beneficiaries and any of them and shall not be subject to
any execution or attachment, levy or sequestration or other claims
of the creditors of said beneficiaries or any of them.
ITEM VIII: I nominate, constitute and appoint my
spouse, WARD L. VER HAGE as the sole Executor of this my Last Will
and Testament, to serve without bond. In the event of the
renunciation, death, resignation, refusal or inability to act for
any reason whatsoever of the said WARD L. VER HAGE, I nominate,
constitute and appoint ERIC H. VER HAGE and KENDRA E. KOSER as the
Executors of this my Last Will and Testament, to serve without
bond.
IN WITNESS WHEREOF, I, MARY D. VER HAGE, have, to this my Last
Will and Testament, set my hand this /~g~ day of
(SEA ,)
MARY D. eVER HAGE ~
Signed, sealed, published and declared by MARY D. VER HAGE,
the above named Testatrix on the /~- day of
/~/~eF , 19.~ , as for her Last Will and Testament,
in the presence of us, who, in her presence, and in the presence
of each other, have, at her request, subscribed our names as
witnesses hereto.
Name
residing at
residing at M,~h~;~bur~.Pa. 17055
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF : SS
COUN~ OF C~B£RLAX9
WE, the undersigned, the Testatrix and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn and qualified according to law, do hereby
declare to the undersigned authority that we were present and saw
the Testatrix sign and execute the instrument as her 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 hearing of the Testatrix, signed
the Will as witnesses and that to the best of their knowledge, the
Testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence, and I, the
said Testatrix, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament, that I signed it
willingly, and that I signed it as my free and voluntary act for
the purposes therein expressed.
ix ~ARY D. VER HA~E
witness
Sworn to and subscribed before
me this /~ day of /~c~ ,
19 ~ .
Notary Public i Not.~re:l $~a~
My Commission Expires :i Matin [-{i~son. No~a~ Pt.~blic
Hamoden Twp., CumberlanrJ County
My Commission Expires July 27, 2000
7
Name of Decedent:
Date
of
Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. ,.A, oO ct - o K ¥ [ Adm/n. No. ~ ]- o ~4- OK~ {
To the Regismr:
I certify that notice of (beneficial intere~0 es~te adminiub,~tion 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 ~ °t - O "/ - c~ ~ :
Name Address
Notice has now been given to ail persons entitled thereto under Rule 5.6(a) except.
Date:
Capacity:
). -
Signature
Address
Telephone ('l ~ -2 ~(.. A ~ ~ CO
. Personal Representative
__.Counsel roi' personal representative
EV. 1500 EX (6-00) ~
OOMMONWEALIH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
ILl
z
LU
z
0
O.
o
[---'~ 1. Original Return
r-'-~ 4. Limited Estate
[~6. Decedent Died Testate (Attach copy of Will)
~]9. Litigation Proceeds Received
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE Of DEATH (MM-DD-YEAR) -~ DATE OF'BIRTH (MM-DD-YEAR)
(if APPLICABLE) SURVIVING SPOUSE'S nAME (laST, fiRSt, aND MIDDLE INit l)
)
EZZ] 2. Supplemental Return
[~4a. Compromise (date of death after 12-12-82)
Futura
Interest
~7. a Living (A~ch ~py of Trust)
Decedent
Maintained
Trust
~t Spousal Pove~ (date of death ~n 12-31-91 and 1-1-95)
0.
Credit
NAME
FiR~ NA~E (If~pl~e)
TELEPHONE NUMBER
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
[--]3. Remainder Return (date of death prior te 12-13-82)
[~5. Federal Estate Tax Return Required
(~ 8. Total Number of Safe Deposit Boxes
r'--~ 11. Election to tax under Sec. 9113(A) (Attach Sch O)
COMPLETE MAILING ADDRESS
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)
I-]separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (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.
Charitable and Govemmental 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)
(8)
(11)
(12)
(13)
(14)
15.
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) ~ J ~ j ~ '~ ~
x .0_ (15) C.,2
16. Amount of Line 14 taxable at lineal rate x .0 __ (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)
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
REV-1503 EX + ('- 97) ~ ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
All property jointly-owned with right of sun~ivorship must be disclosed on Schedule F.
FILE NUMBER
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
TOTAL (Also enter on line 2, Recapitulation $
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM I,CLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REN. ESTATE.
NUMBER VALUE OF ASSET INTEREST I,F A~UCAa. E)
'-7'- ·
TOTAL (Also enter on line 7, R~pitulation) $ ~ I ~, ~ G ~, )G
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: ~-) ~ .~ ,")
1.
5.
6.
7.
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 Fees
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
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
MARY Do VER HAGE
I, MARY D. VER HAGE, now of 725 Edgewood Lane, Mechanicsburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby make, publish and declare this
to be my Last Will and Testament, hereby revoking all other Wills
and Codicils previously made by me.
ITEM I: I direct that payment of all my just debts,
expenses of my last illness, cremation expenses, and the costs of
administering my estate from my estate as soon after my death as
conveniently may be done.
ITEM II: I give, devise and bequeath all of the rest,
residue and remainder of my estate, of every nature and wherever
situate, together with all insurance policies thereon, unto my
spouse, WARD L. VER HAGE, providing my said spouse shall survive me
by ninety (90) calendar days.
ITEM III: Should my said spouse predecease me or die on
or before the ninetieth (90th) day following my death, I give,
devise and bequeath all of the rest, residue and remainder of my
estate of every nature and wherever situate, together with all
insurance policies thereon, as follows:
A. A share in the amount of seven and one-half percent (7.5%)
to each of my then living grandchildren (i.e., the children of my
two children).
B. My two children shall have the right to take whatever
personal articles, jewelry, firearms, automobiles, or household
articles with their respective share to be charged at the appraised
value used on the inheritance tax return; in the event there is any
dispute as to both wanting the same article they are to resolve the
dispute by the toss of a coin.
C. All the rest, residue and remainder to my two children,
Eric H. Ver Hage and Kendra E. Koser, absolutely, share and share
alike; in the event any of my children predeceases me or dies
within ninety (90) days of my death, then his or her share to go
equally to his or her children then living, per stirpes and not per
capita, otherwise to the survivor of my said two children.
ITEM IV: The share of any beneficiary under thirty (30)
years of age shall go to ERIC H. VER HAGE and KENDRA E. KOSER or
the survivor of them in trust, for the following purposes:
!. The income and the corpus of the Trust to go for the care,
maintenance, education, occupational training and to enhance any
personal skills or interest in the musical field or any other field
and the welfare of said beneficiaries to the extent other income is
insufficient. My said Trustee shall give the highest regard and
credibility to the adult person with whom said person resides and
upon request or demand of such adult person for payment or
reimbursement for present or future expenses that involve the said
items for the good and welfare of my beneficiaries, said Trustee is
authorized to pay such requests or demands for present and future
expenses without any. further investigation or order of court and
without any further liability or responsibility for the application
of such monies paid.
2. Whenever said beneficiary attains the age of thirty (30)
years, then the Trust shall pay over to said beneficiary all the
rest, residue and remainder to the said beneficiary. If the
beneficiary_ dies before attaining age thirty (30), the Trust shall
terminate and such share shall be distributed to his or her
personal representative.
iTEM V: I direct that any and all taxes that may be
assessed in consequence of my death, including all inheritance,
estate and transfer taxes imposed upon my estate passing under my
Will or otherwise, shall be paid out of the principal of my
residuary estate as a part of the expense of the administration of
my estate.
ITEM VI: I authorize and empower my personal
representative to compromise, adjust, release and discharge in such
manner as my personal representative may deem proper, all debts and
claims owed by or to me or my Estate; to sell, lease or exchange at
public or private sale or in such manner, at such prices, and upon
such terms of credit or otherwise, as my personal representative
may deem proper, all or any part of my property, real or personal;
to exec ute, acknowledge and deliver instruments of conveyance,
including deeds in fee simple; to borrow money for the purpose of
paying estate, inheritance or other taxes which are required to be
paid and to secure any such loans by pledge or mortgage of all or
any part of my property and to execute the necessary instruments to
carry out such powers; to distribute my estate in kind or partly in
money or partly in kind, and to determine the fair value at which
any property so distributed in kind shall be received by the
distributees; to conduct any business in which I have an interest
at the time of my death, for such period as my personal
representative may deem proper, power to borrow money and pledge
assets of the business and the power to do all other acts that I,
in my lifetime, could have done, to delegate such power to any
partner, manager or employee without liability for any loss
occurring therein and to organize a corporation to carry on said
business as capital to such corporation and accept stock in the
corporation in lieu thereof and hold such stock for the uses of
this my Will, and to vote said stock or sell the same as to my
personal representative may seem best; to retain all stocks,
assets~ bonds and investments owned by me without being confined to
what is known as legal investments; to execute any options to
purchase, to apply for stocks, bonds or other investments, to
purchase or otherwise acquire real estate and to execute the same
powers thereover as hereinbefore provided, to retain indefinitely
any part of my assets, real or personal, which is or may become
unproductive or to make sale thereof; to pay carrying charges and
expenses of the property out of other principal or income of my
estate; to invest and reinvest in all forms of property without
restriction to investments authorized for Pennsylvania fiduciaries,
as my personal representative deems proper, without regard to the
principle of diversification or risk; to exercise any law-given
option to treat administrative expenses either as income tax or as
estate deductions, without regard to whether the expenses were paid
from principal or income. The powers herein conferred shall be to
my named personal representative and all successors thereto and
shall be in addition and not in limitation of other powers
conferred on said fiduciary.
Any and all payment or payments of any sum or sums, whether in
cash or in kind and whether for principal or income payable to any
beneficiary shall be made upon the sole receipt of the respective
beneficiary to whom the payment is made and free from anticipation,
alienation, assignment, attachment, and pledge and free from
control by the creditors of any such beneficiary.
ITEM VII: All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obligation
of the beneficiaries and any of them and shall not be subject to
any execution or attachment, levy or sequestration or other claims
of the creditors of said beneficiaries or any of them.
ITEM VIII: I nominate, constitute and appoint my
spouse, WARD L. VER HAGE as the sole Executor of this my Last Will
and Testament, to serve without bond. In the event of the
renunciation, death, resignation, refusal or inability to act for
any reason whatsoever of the said WARD L. VER HAGE, I nominate,
constitute and appoint ERIC H. VER HAGE and KENDRA E. KOSER as the
Executors of this my Last Will and Testament, to serve without
bond.
IN WITNESS WHEREOF, i, MARY D. VER HAGE, have, to this my Last
Will and Testament, set my hand this /~/~ day of
MARY D. VER HAGE
Signed, sealed, published and declared by MARY D. VER HAGE,
the above named Testatrix on the /~- day of
~~f , 19~' , as for her Last Will and Testament,
in the presence of us, Who, in her presence, and in the presence
of each other, have, at her request, subscribed our names as
witnesses hereto.
-
Name
residing at
residing at
M,.nh~-~icsbur~. Pa. 17055
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF
WE, the undersigned, the Testatrix and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn and qualified according to law, do hereby
declare to the undersigned authority that we were present and saw
the Testatrix sign and execute the instrument as her 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 ~resence and hearing of the Testatrix, signed
the Will as witnesses and that to the best of their knowledge, the
Testatrix was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence, and I, the
said Testatrix, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament, that I signed it
willingly, and that I signed it as my free and voluntary act for
the purposes therein expressed.
witness
Sworn to and subscribed before
me this /~. day of /~F~£ ,
19 ~ .
Notary Public / I Notarial
MV Commission Expires :~ Ma,~in Ripson, No,~a~ Public
' - I Flare.eh Twp., Cumbe¢lan~J County
L y Commis~on Expires July 27, 2000
Decedent's Complete Address:
ISTREETADDRESS
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C )
3. IntarestJPenalty 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 request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX BUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
(1) ~
(2) c~
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 dght to designate who shal~use the property transferred or its income; ............................................ [] []
¢. 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 secudty 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 examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tree, correct and complete.
Deda, aiJo,~ of preparer other than the personal representetive is ~ on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
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 RS. §9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 RS. §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 RS. §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 RS. §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.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEI1ENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSI1ENT OF TAX
*'
REV-1547 EX AFP (03-05)
WARD L VER HAGE
725 EDGE WOOD LN
MECHANICSBURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-28-2005
VERHACE
01-16-2004
21 04-0541
CUMBERLAND
101
Allount Rellitted
MARY
D
PA 17055
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Il!V-~~"Yf.WJ.m~'U!1.WtJfYI!t.W.Ir~WA!'fJCM!!.m.lMlmMMf~.~t!lV,(AtY.arr.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF VERHACE MARY D FILE NO. 21 04-0541 ACN 101 DATE 03-28-2005
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. stocks and Bonds (Schedule B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. ~rtgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/l1isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
U)
(2)
(3)
(4)
(5)
(6)
(7)
.00
5.085.34
.00
.00
.00
.00
118.662.10
(S)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
123.747.44
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/l1isc. Expenses (Schedule H)
10. Debts/l1ortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
UO)
3.811.70
.00
Ul)
(12)
(3)
(4)
3.811 70
119.936.04
.00
119.936.04
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ~
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Anount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (IS)
19. Principal Tax Due
TAX CR D S:
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
119.936.04 X 00 =
.00 X ~5 =
.00 X 1t=S=
.00 X 15 'f")
(19) fT2
J""'<:1:
C.::',}
l'~ ,"";
~:~.~
.00
.0.0
.0.0
.00
.OQ
...,.',.)
DATE
NUI1BER
+
INTEREST/PEN PAID (-)
AI10UNT PAID
C-,.)
U"'I
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYI1ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU I1AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS.~ ~~
Cumberland County - Register Of Wills
One CQurthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/16/2005
VER RAGE WARD L
725 EDGEWOOD LANE
MECHANICSBURG, PA 17055
RE: Estate of VER RAGE MARY D
File Number: 2004-00541
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. I, for decedents dying on or after
July I, 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:
1/16/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~ ~.f A /J
. -4.. . I #!. 1~J
);:. V&i''''c;~_l ~:.z_~
GLENDA FARNER STRl\SRLI,;uGH
REGISTER OF WILLS .~
cc: File
Counsel
Judge
ct
~
~
----
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~
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,..~ ""'" ~,\
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~ _ ~ _.'l.....,~~ _..!l...t.--:rr.r~llil _ _.II! tf""1_____:l_ _-......ii ,._._-....2 J('"'\_....,..,~-!:!--
Jl'\..\t:::Z;Jl.<SiI(.(i;;Jl'tU'!l. 'If'" J!..JI.!J.::;; ((jjJ!.. '01Uj.Jll1.illUl<CJL".lli:1UIRU ~.AJI<I..:lli.!i.<l.J
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~~{\,~ ~ \Jft~ )~ --{\ G- E:.
Date of Death: o ) - )~- 0'-\
Estate No.: -.:2 Cl 0 Lj - vcsY \
.
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 00 No 0
2. If the answer is No, state when the personal represeni.ativc rea50:L.ably believes tb..t
the administration will be complete:
3. If the answer to No. I. is Yes, state the following'
a. Did the personal representative file a fmal account with the Cocit?
Yes 0 No 00
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state fu"1 account informally to the parties in
interest? Y es ~ 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: ) ~ - ;).. ') - C.S;-
'-'J c- J f -d-. 'J.,~ ~
Signature
~H
w (:J ~ l. \J I; ''L \~~ c,~
Name
'") ~ S ~G-E L~.s,<:1':I L.~"-ic,
Address ""'- 1<: c. \'<\ (.\ "'-~ c. <, ;\, '" '- '\ ~ ...
n" ';.- "-1\ ,(..
('-l '-' '\ I ~ (, - ~"'.i, 10
Telephone No.
Capa.citj: ~ PersGlial P~epresentati.\le
o Counsel fc~r personal representative
~~