HomeMy WebLinkAbout03-1039PETITION FOR PROBATE and GRANT
Estate of WILLIAM H. NELSON, III No.
also known as To:
OF LETTERS
2,/ -o $ - i o ,r3 cj
Deceased.
Social Security No. 172-36-1612'
The petition of the undersigned respectfully represents that:
petitioner(s), who is/are 18 years of age or older~anndltte executrix
Your
in the last wilt of the above decedent, dated June 2 4
and codicil(s) dated N/A
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
in the
named
,19 98
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 2701 Market Street, Rear, Borouqh of
Camp Hill, Cumberland County, Pennsylvania.
(list street, number and muncipality)
Decendent, then 58 years of age, died December 8 , :[~. 200__3,
at 2701 Market Street, Rear, Camp Hill, Cumberland County, P~nn.qylxr~n~a_ .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: see attached sheet.
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:
5rO00.O0
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
"Sta . Ne '
195 Greensprinqs Road
York. PA 17404
~,_ ~,~.,_.~ ~.~
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 of petitioner(s) and that as Personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the e%tate according to law.
Sworn to or affirmed and subscribed ,- /~/g(,g~/Y~90;,'l ~
._. before me this __16th __ day of [ ~Stac~y L. Nelson __Heiland
/'. ) December r~ 19 2003 J .
Donna M. Otto, 1st Deputy F- ~' Regist-e~Ati~~-6t ,/_.,,~? ,a~, (/{. !(~ ~g.i~L'lO~ ~_
No. 21-2003-1039
Estate of WILLIAM H. NELSON, III
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW December 18th, ~ 2003, in consideration of the petition .on
the reyerse side hereof, satisfactory proof having been presented before, me,
'IT IS DECREED that the instrument(s) dated June. 24; 1998,
described therein be admitted to probate and filed of record as the last will of William H.
Nelson," III, ;
and Letters TeStamentary
are hereby granted to Stacey L. Nelson Hei!a-nd.
Now Known As Stace¥ L. Heiland
FEES
Probate, Letters, Etc .......... $ 25.00
Short Ce~ificates( ~ .......... $15.00
Renun~ation . .(.~) ........... $ 5.00
x-Pages (2) $ 6.00
JCP Fee TOTAL $~
Filed .~V.~.t~..,..~Q0~ ..........
Mailed Letters to Attorney on 12/18/2003
Register of Wills
Donna M. Otto, 1st Deputy
Marlin R. McCaleb, Esq. (06353)
ATTORlqEY ~.uD. Ct.I.D~N~) -
219 East Mazn ~treet, ~.u. Box 230
Mechanicsburg, PA 17055-0230
ADDRESS
(717) 691-7770
PHONE
21-2003-1039
REGISTER OF WILLS OF CU~B~.R~,ANV ~COUNTY
OATH OF SUBSCRIBING WITNESS
LINDA B. NELSON
(~mll) a subscribing witness to the will presented herewith, (ffi~l) being duiy qualified according to
law, depose(s) and say(s) that I was present and saw
William H. Nelson, III,
the testator , sign the same and that I signed as a witness at the
request of testator in h is presence and (i~:fl~t~'~c~x~c~t~:%~tfc~r) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this /'6 ~ day of
Do_c ~_mh~.r ~ 2003
Notary Public
Marlin R. M(X?~eb, No~a~j Public
My Commission Expir~Dec. 14, 2006
2110 Warren Way, Mechanicsburg, PA
(Address)
(Name)
(Address)'
OATH OF NO~-SUBSCRIBING WITNESS
(each) a subscriber hereto, (each) being duly qu~fi?d according to law, depose(s) and say(s) that
familiar with the"sjgnature of
/' ~x codicil '
testat of (one of the subscribing witnesses t~) the will presented herewith and
.... '~ ~ codicil
that _ 5elieves the sign~ure on the will is in the handwriting of
to the best of knowledg/and belief.
/
Sworn to or affirmed and subscrib,f/~ before
me this '-19day of ~/Name)
(Address)
Register
17050
(Name)
(Address)
21-2003-1039
REGISTER OF WILLS OF CUMBER*,AND COUNTY
OATH OF SUBSCRIBING WITNESS
MARLIN R. McCALEB
(~) a subscribing witness to the will presented herewith, (~acta) being duly qualified according to
law, depose(s) and say(s) that I was
present and saw
William H. Nelson, III
the testat or , sign the same and that I . signed as a witness at the
request of testat or in h is presence and (~~lroJ~~) (in the presence of the
other subscribing witness(es)).
Sworn to or affirmed and subscribed before
me this 16th day of Marl~aRm'e)McCaleb
,~~ December ^ 1:9:2r_ 2003 219 East Main St., Mechanicsburg,
OzZL ~ _t~_ _.~//'a~4~; ~.-~-7.ptO4~.,t.fi~ (Address)
Donna M. Otto, 1st De~utv' d' ,z/_--.. ~ ~ ~/~
,- ~ v ttegtsfer
(Name)
PA 17055
(Address)
--,. REGISTER OF WILLS OF COUNTY " OATH OF NON-SUBSCRIBING WITNESS
(each) a subscriber hereto, (eachi be. lng duly qualified according to law, depose(s) and say(s) that
familiar, with the signature of
...... codicil
testat~ of (one of the subscribing witfi~Sses to) the will presented herewith and
codicil
that believes the signature on the will is in the handwriting of
to the best of knowledg~ and belief. ~
Sworn to or affirmed and subscribed before
me this day of
19
Register
(Name)
(Address)
(Name)
(Address)
RENUNCIATION
21-2003-1039
In Re Estate of WILLIAM H. NELSON, III
deceased.
To the Register of Wills of. Cumberland
County, Pennsylvania.
The undersigned Tonya R. Smith of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testamentary
be issued to Stacey L. Nelson Hei]and
WITNESS
my
hand this __12th dayof December 259 2003.
(Signature)
Tonya R. Smith
254 NE Lenox Street
Hillsboro, 6~dres~712 4
(Signature)
(Address)
(Signature)
(Address)
INFORMATION STATEMENT
21-2003-1039
Decedent and Linda B. Nelson were divorced by Decree of
Divorce entered in the Court of Common Pleas of Cumberland
County, Pennsylvania, on August 26, 2003, to No. 03-199.
Stacey L. Nelson, one of the Co-Executrices named in Item
LASTLY of Decedent's Last Will and Testament dated June 24, 1998,
has since married and is now known as Stacey L. Nelson Heiland.
Tonya R. Smith, another Co.Executrix named in Item LASTLY of
Decedent's Last Will and Testament dated June 24, 1998, has
renounced her right to serve as Co-Executrix in favor of Stacey
L. Nelson Heiland.
his 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 tl the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9811504
No.
Local Registrar
i0
Date
,05.144 Rev. t/9! COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
//29-160 (Coroner)
[ ]SOCIAL SECURITY NUMBER [DATE OF DEATH (Mo~, Day,
William H. Nelson III ]'.Male 13.1 72-36-1 612 14 Dece
~. P ~ 2701 Market Street, Rear ]u,~,,~,~ ..... . [
white
rT2/e~USU~ KIND~mNES~HDUSTRY ' I~S~CE~mEVERIN ~C~m .......... I~: b0.
~,Camp Hill, PA 1 7011 I~) Cumberland ~, ~--~ Oam~ u~ ~
William H. Nelson, Jr. I" ~scner W. Hurst
I,~.~ ureensprzngs A~.,xork,PA77404
I. fO--O- te Cre ator
~ Gunshot ~ound to ~ead '
~E ~ ~ ~ry c. ~ '
~DE~H$ IN"'" O H~m ~lDec 8, 2003 I 5'00 ~ I ~ ~ [ SeAr-inflicted gunshot-
b,d. December 10,2003
'MEDICAL EXAMINER/CORONER -
mln~l~ Ii Ithted ................................................. , , P , ua to the olule(i) and []
l"em27)Type°'P'~ichard C. Middlekauff
6375 Basehore Rd, Suite
=- Mechanicsbur~A, 17050
~~.
,. 2:)o_.o_..m./.ow /o/~oo~
LAW OFFICE5
MARLIN R. McCALEB
LAST WILL AND TESTAMENT
-/o$ ?
I, WILLIAM H. NELSON, Iil, of the Township of Hampden, County of
Cumberland and Commonwealth of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this as and for my
Last Will and Testament, hereby revoking and making void all former wills and
codicils by me at any time heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be paid
by my Executrix or Co-Executrices, as the case may be, hereinafter named, as
soon as conveniently may be done after my decease.
SECOND. I give and bequeath my automobiles and remaining personal
effects and such household goods, furniture and furnishings as may be my
individual property and not the property of my wife or owned jointly by me with her,
and other tangible personalty of like nature (not including cash or securities),
together with any existing insurance thereon, unto my wife, LINDA B. NELSON, if
she survives me for a period of thirty (30) days. Provided, however, that if my said
wife shall predecease me or fail to survive me for a period of thirty (30) days, then
! give and bequeath such tangible personalty and insurance thereon in equal
shares unto my children, namely: STACEY L. NELSON and TONYA R. SMITH (or
to the survivor of them if either is not then living), the same to be divided between
them by my Co-Executrices, hereinafter named, with due regard for their personal
preferences in as nearly equal shares as possible.
LAW OFFICES
MARLIN R. McCALEB
THIRD. I give, devise and bequeath all the rest, residue and remainder of my
estate, real, personal and mixed, whatsoever and wheresoever situate, unto my
wife, LINDA B. NELSON, absolutely and in fee simple, if she survives me for thirty
(30) days.
FOURTH. If my wife, LINDA B. NELSON, shall predecease me or fail to
survive me for a period of thirty (30) days, then and in that event I give and
bequeath the sum of One Thousand ($1,000.00) Dollars unto the BLESSED
KATHARINE DREXEL CATHOLIC CHURCH, of Silver Spring Township,
Cumberland County, Pennsylvania, for use in the general fund.
FIFTH. If my wife, LINDA B. NELSON, shall predecease me or fail to survive
me for a period of thirty (30) days, then and in that event I give, devise and
bequeath all the rest, residue and remainder of my estate, real, personal and
mixed, whatsoever and wheresoever situate, in equal shares unto my daughters,
STACEY L. NELSON and TONYA R. SMITH, share and share alike, absolutely
and in fee simple.
Should either of my said daughters predecease me leaving lawful
issue to survive me, then I order and direct that the share provided herein for such
deceased daughter shall be paid over and distributed unto her said lawful issue
per stirpes, said issue to take the ancestor's share by representation and not per capit
LASTLY. I nominate, constitute and appoint my wife, LINDA B.
NELSON, Executrix of this, my Last Will and Testament, but if for any reason she
LAW OFFICES
MARLIN R. McCALEB
shall fail to qualify as such Executrix or cease so to serve, then and in that event I
nominate, constitute and appoint my daughters, STACEY L. NELSON and TONYA
R. SMITH, Co-Executrices, to serve in her place and stead, all to serve without
bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I, WILLIAM H. NELSON, III, have hereunto set my
hand and seal to this, my Last Will and Testament which consists of three (3)
typewritten pages to each of which I have affixed my signature this ~ zZZ' ~
day of ~_.~z.~, .~.. , A.D., One Thousand Nine Hundred Ninety-
Eight (1998).
The preceding instrument, consisting of this and two (2) other typewritten
pages, each identified by the signature of the Testator, was on the date thereof
signed, sealed, published and declared by WILLIAM H. NELSON, III, the Testator
therein named, as and for his Last Will and Testament, in the presence of us, who,
at his request, in his presence, and in the presence of each other, have subscribed
our names as witnesses hereto.
WILLIAM H. NELSON, III
L~W OFFIGES
FRANKEBERGER BUILDING
~lO EAST MAIN STREET
MEGHA/qlGSBURG, PENNSYLVANIA 17055
LAW OFFICES
MARLIN R. McCALEB
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: William H. Nelson, III
Date of Death: December 8, 2003
Will No. 21-03-1039
To the Register:
I certify that notice of beneficial interest and estate
administration required by Rule 5.6(a) of the Orphans' Court
Rules was personally served on the following beneficiaries of
the above-captioned estate on December 30, 2003.
Name
Stacey L. Nelson Heiland
Tonya R. Smith
St. Katherine Drexel
Church
Address
195 Greensprings Road
York, PA 17404
254 NE Lenox Street
Hillsboro, OR 97124
1 Peter Drive
Mechanicsburg, PA 17050
Notice has now been given to all persons entitled thereto under
Rule 5.6(a).
?
Date: December 30, 2003
Marlin R. McCaleb
Attorney I.D. No. 06353
219 East Main Street
P.O. Box 230
~ Mechanicsburg, PA 17055
(717) 691-7770
FAX: (717) 691-7772
Counsel for Personal Representative
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
D
E
C
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I DATE OF DEATH (MM-DD-YEAR) DATE Of BIRTH (MM-DD-YEAR)
12/08/2003 02/19/1945
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
E
D
E
N
T
DECEDENT'S NAME(LAST, FIRST, AND MIDDLE INITIAL)
Nelson III William H.
R 5.
E
C
A 6.
P
I
T
U 7.
L
A
T 8.
I
O 9.
N 10.
C
O
M
OFFICIAL USE ONLY
FILE NUMBER
21-03-1039
COUNTYCODE YEAR NUMBER
CAPB
HpRL
EpIO
caAC
E~TK
co"
TU"
T
I
0
N
SOCIAL SECUR[TY NUMBER
172-36-1612
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return ~ 247! Supplemental Return U
4. Limited Estate . Future Interest Compromise (date of death after 1Z- 1Z-8Z)
6. Decedent Died Testate Decedent Maintained a Living Trust 0
(Attach copy of Will) (Attach copy of Trust)
U 9. Litigation Proceeds Received I 110. Spousal Poverty Credit
(date of death between 1Z-31-91 and 1-1-95)
NAME
Marlin R. McCaleb Esq.
FIRM NAME (If Applicable)
Law Offices-Marlin R. McCaleb
4,979.13
5,898.71
(919.58)
1,000.00
TELEPHONE NUMBER
717/691-7700
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
Mortgages & Notes Receivable (Schedule D) (4)
Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
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)
Net Value of Estate (Line 8 minus Line 11)
(date of death
3. Remainder Return prior to 12:- 13-eL)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
[~ Election to tax under Sec. 9113(A)
1
1.
(Attach Sch O}
COMPLETE MAILING ADDRESS
219 East Main Street
P. O. Box 230
Mechanicsburg, PA 17055
None
None
None
None
4,979.13
None
-0-
(6)
5,327.77
570.94
(11)
(lZ)
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
16. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15)
16. Amount of Line 14taxable atlineal rate (1,919.58) X .0 45 (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)
¢3~IC[AL USE ON~=)Y
(1,919.58)
0.00
0.00
0.00
0.00
0.00
Copyright (c) 2:000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00~/
Decedent's Complete Address:
STREET ADDRESS
2701 Market Street
CITY STATE ZiP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits ( A + B + C )
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 request 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 + SA. This is the BALANCE DUE. (SB)
0.00
0.00
0.00
0.00
0.00
0o00
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING GUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retaintheuseorincomeofthepropertytransferred; .........................
b. retain the right to designate who shall 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 security at his
or her death? .............................................. r-']
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 GUESTIONS 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 thts 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.
SIG~TUREOFPERSONRESPONSIBLEFORFILINGRETURN Stacey L. Nelson Heiland DATE
V~ ~ ~f7 - /~ · ~ ~ 195 Greensnrin~s Road . / /
................................
SIGNATU~OFPREPARE~ERTHANREPR~NTATIVE Law Offices-Marlin R. McCaleb DATE
For dates of death on or a~or ~ul~ 1, 1~04 and before Janua~ 1, 1005, the tax rate imposed on the net value of transfers to or for the use of the
survivin~ spouse is 3% [72 ~.S. ~118 (a) (1.1) (i)].
flor dates of death on or a~er ~anua~ 1, 10~$, the tax rate imposed on the net value of transfers to or ~or the use of the survivin~ spouse
[72 ~.S. ~11~ (a) (1.~) (ii)]. The statute does not exempt a transfer to a survivin~ spouse from tax, and the statuto~ requirements for disclosure of assets
and filin~ a tax return are still applicable even if the survivin~ spouse is the onl~ beneficial.
For dates of death on or a~er July 1, 2000:
lhe tax rate imposed on the net value of transfers from a deceased child twen~-one ~ars of a~o or youn~er at death to or for tho use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 ~.S. ~ ~8 (a) (1.2)].
lhe tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, e~cept as noted in 72 P.S.
[72 ~.S. ~1 l~(a)(l)].
lhe tax rate imposed on the net value of transfers to or ~or the use of the decedent's siblings is 12% [72 ~.S. ¢~ l~(a)(1.3)]. ~ siblin~ is defined, under
Section ~02, as an individual who has at least one parent in common with the decedent, whether b~ blood or adoption.
Copyright (c) ~000 form software only the kackner Group, lnc. Form ~-~00 ~ (~ev. fi-O0)
LAW OFFICES
MARLIN R. McCALEB
LAST WILL AND TESTAMENT
I, WILLIAM H. NELSON, III, of the Township of Hampden, County of
Cumberland and Commonwealth of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this as and for my
Last Will and Testament, hereby revoking and making void all former wills and
codicils by me at any time heretofore made.
FIRST. I order and direct that all my just debts and funeral expenses be paid
by my Executrix or Co-Executrices, as the case may be, hereinafter named, as
soon as conveniently may be done after my decease·
SECOND. I give and bequeath my automobiles and remaining personal
effects and such household goods, furniture and furnishings as may be my
individual property and not the property of my wife or owned jointly by me with her,
and other tangible personalty of like nature (not including cash or securities),
together with any existing insurance thereon, unto my wife, LINDA B. NELSON, if
she survives me for a Period of thirty (30) days. Provided, however, that if my said
wife shall predecease me or fail to survive me for a period of thirty (30) days, then
· ~ give and ~hc'q,_~ea~h. ~, ,ch,. ~n,~ih~,~._,,~.~.~ personalty and insurance -,.., ~..., ,~H"~'",, in equal
shares unto my children, namely: STACEY L. NELSON and TONYA R. SMITH (or
to the survivor of them if either is not then living), the same to be divided between
them by my Co-Executrices, hereinafter named, with due regard for their personal
preferences in as nearly equal shares as possible.
LAW OFFICES
MARLIN R. McCALEB
THIRD. I give, devise and bequeath all the rest, residue and remainder of my
estate, real, personal and mixed, whatsoever and wheresoever situate, unto my
wife, LINDA B. NELSON, absolutely and in fee simple, if she survives me for thirty
(30) days.
FOURTH. If my wife, LINDA B. NELSON, shall predecease me or fail to
survive me for a period of thirty (30) days, then and in that event I give and
bequeath the sum of One Thousand ($1,000.00) Dollars unto the BLESSED
KATHARINE DREXEL CATHOLIC CHURCH, of Silver Spring Township,
Cumberland County, Pennsylvania, for use in the general fund.
FIFTH. If my wife, LINDA B. NELSON, shall predecease me or fail to survive
me for a period of thirty (30) days, then and in that event I give, devise and
bequeath all the rest, residue and remainder of my estate, real, personal and
mixed, whatsoever and wheresoever situate, in equal shares unto my daughters,
STACEY L. NELSON and TONYA R. SMITH, share and share alike, absolutely
and in fee simple.
Should either of my said daughters predecease me leaving lawful
issue to survive me, then I order and direct that the share provided herein for such
deceased daughter shall be paid over and distributed unto her said lawful issue
per stirpes, said issue to take the ancestor's share by representation and not per capi
LASTLY. I nominate, constitute and appoint my wife, LINDA B.
NELSON, Executrix of this, my Last Will and Testament, but if for any reason she
-2-
LAW OFFICES
MARLIN R. McCALEB
shall fail to qualify as such Executrix or cease so to serve, then and in that event I
nominate, constitute and appoint my daughters, STACEY L. NELSON and TONYA
R. SMITH, Co-Executrices, to serve in her place and stead, all to serve without
bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I, WILLIAM H. NELSON, III, have hereunto set my
hand and seal to this, my Last Will and Testament which consists of three (3)
typewritten pages to each of which I have affixed my signature this
day of --.~/-~.,._.~-~'~ ~'-~.~ , A.D., One Thousand Nine Hundred Ninety-
Eight (1998).
The preceding instrument, consisting of this and two (2) other typewritten
pages, each identified by the signature of the Testator, was on the date thereof
signed, sealed, published and declared by WILLIAM H. NELSON, III, the Testator
therein named, as and for his Last Will and Testament, in the presence of us, who,
at his request, in his presence, and in the presence of each other, have subscribed
our names as witnesses hereto.
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
William H. Nelson III
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
SS~/ 172-36-1612 12/08/2003 21-03-1039
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
NUMBER
1
2
3
4
5
6
7
8
9
10
11
12
DESCRIPTION
1988 Dodge Ram 50 Pickup, Long Bed.
B.A.P.S., Inc., Decedent's final paycheck.
Capital One, refund.
Comcast Cablevision, refund.
Country Music Weekly Magazine, refund.
Doubleday Books, refund.
Doubleday Books, refund.
Gate of Heaven Cemetery, cemetery lot and burial rights.
Household goods, contents, furniture and furnishings.
State Farm Insurance, refund of unearned premium.
U. S. Treasury, refund of 2003 federal income tax.
West Shore Tax Bureau, refund of 2003 local income tax.
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
VALUE AT DATE
Of DEATH
1,110 00
726 32
9 98
23 83
12 65
4 95
19.07
1,560.00
1,192.75
53.85
197.45
68.28
$ 4,979.13
Form REV-1508 EX (Rev. 1-97)
Printed by S. heiland
~ kbb.¢om
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Blue Book Private Party Report
Pennsylvania · December 19, 2003
1988 Dodge Ram 50 Pickup Long Bed
Engine: 4-Cyl. 2.6 Liter
Trans: Automatic
Drive: 2 Wheel Drive
Mileage: 85,172
Equipment
Air Conditioning
Power Steering
Power Door Locks
Tilt Wheel
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Cruise Control
AM/FM Stereo
Pickup Shell/Cap
Consumer Rated Condition: Fair
"Fair" condition means that the vehicle probably has some mechanical or
cosmetic defects, but is still in safe running condition. The paint, body
and/or interior need work to be performed by a professional in order to be
sold. The tires need to be replaced. There may be some repairable rust
damage. The value of cars in this category may vary widely. A clean title
history is assumed. Even after significant reconditioning this vehicle may
not qualify for the Blue Book Suggested Retail value.
Private Party Value $1,110
Private Party value represents what you might expect to pay for a used car
when purchasing from a private party. It may also represent the value you
might expect to receive when selling your own used car to another private
party.
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Get a Person to Person Auto Loan
http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb. PA;249602;PA 133& 17404;pic+p;&722;Dod... 12/19/2003
Value Comments / Status (for my
Qnty Description Assessed notes Category personal records)
I
Black & partical
2 TV stands $20.00 board, 10 each Furniture ;Salvation Army
dresser $30.00 not solid wood Furniture Salvation Army
Oak desk and chair $160.00 Furniture Salvation Army
Mens clthing rack $5.00 Furniture Salvation Army
TV tray $5.00 Furniture Salvation Army
Lamp $5.00 15 yr old Furniture Salvation Army
telephone stand $5.00 Furniture Salvation Army
20 yr old - good
Sofa $100.00 condition Furniture Salvation Army
2 Wood bookcases $20.00 10 each Furniture Salvation Army
Upholstered chair $50.00 Furnitor~ Salvation Army
leather gloves $2.50 Clothing Salvation Army
23 Short sleeve Tshirts $23.00 Clothing Salvation Army
7 hats $14.00 Clothing Salvation Army
2 mens jackets $20.00 Clothing Salvation Army
3~ belts $9.00 Clothing Salvation Army
4!vests $12.00 older/well worn Clothing Salvation Army
sweat jacket $5.00 Clothing Salvation Army
shorts $3.00 Clothing Salvation Army
6 pair pants $60.00 Clothing Salvation Army
4 pair jeans $40.00 Clothing Salvation Army
2 short sleeve polos $6.00 Clothing Salvation Army
4 short sleeve shirts $4.00 Clothing Salvation Army
pajamas $3.00 Clothing Salvation Army
5 long sleeve flannel shirts $10.00 Clothing Salvation Army
3 lair wool socks $3.00 Clothing Salvation Army
utility belt $3.00 Clothing Salvation Army
3 bandanas $1.50 Clothing Salvation Army
5 handkerchiefs $1.25 Clothing Salvation Army
4 undershirts $4.00 Clothing Salvation Army
ice grippers/shoe tips $4.00 Clothing Salvation Army
Various hard cover books $5.00 Books Salvation Army
large print bible series $4.00 Books Salvation Army
bible $1.00 Books Salvation Army
3 dictionaries $3.00 Books Salvation Army
puzzle book $1.00 Books Salvation Army
dictionary $1.00 Books Salvation Army
no answering
phone and wires $5.00 machine Electronics Salvation Army
cable wires $2.00 Electronics Salvation Army
2 clip lites $6.00 Electronics Salvation Army
stereo (storage) $15.00 20 yrs old Electronics Salvation Army
6 Disc DC changer $50.00 Electronics Salvation Army
i Value Comments I I Status (for my
Qnty Description Assessed notes Category personal records)
grapefruit knife $0.50 Kitchen Salvation Army
cheese grater $0.50 Kitchen Salvation Army
vegetable brush $0.50 Kitchen Salvation Army
can opener $0.50 Kitchen Salvation Army
pizza stone $4.00 Kitchen Salvation Army
pyrex measuring cup $1.00 Kitchen Salvation Army
doiley $0.50 Linens Salvation Army
2 dish towels $1.00 Linens Salvation Army
2 throw pillows $2.00 Linens Salvation Army
oe boxer blanket $5.00 Linens Salvation Army
4 chair cushions $4.00 Linens Salvation Army
sheet set $2.00 Linens Salvation Army
3X5 rug $2.00 Linens Salvation Army
bed skirt $3.00 Linens Salvation Army
2 curtains $4.00 Linens Salvation Army
bath mat $2.00 Linens Salvation Army
4 washclothes $2.00 Linens Salvation Army
4 towels $4.00 Linens Salvation Army
2 scissors $2.00 Office supplies Salvation Army
magnifying glass $1.00 Office supplies Salvation Army
3 clipboard $1.50 Office supplies Salvation Army
asstd office supplies $5.00 Office supplies Salvation Army
hole punch $0.50 :Office supplies Salvation Army
~rotractor $0.50 Office supplies I Salvation Army
office trays $2.00 Office supplies i Salvation Army
desk organizer $2.00 Office supplies Salvation Army
Notepad $1.00 Misc Salvation Army
dust pan/brush $2.00 Misc Salvation Army
3 candle tart burners $3.00 Misc Salvation Army
2 statues $2.00 Misc Salvation Army
4 beer steins $8.00 Misc Salvation Army
music box $5.00 Misc Salvation Army
4plaques $8.00 Misc Salvation Army
dustpan $1.00 Misc Salvation Army
anvil $1.00 Misc Salvation Army
herbal therapy pack $2.00 Misc Salvation Army
2stuffed animals $1.00 Misc Salvation Army
wallet $1.00 Misc Salvation Army
stop clock $2.00 Misc Salvation Army
cane tips - 2 box $4.00 Misc Salvation Army
shaving bag $3.00 Misc Salvation Army
notre dame mug $1.00 Misc Salvation Army
3trash cans $6.00 Misc Salvation Army
laundry hamper $3.00 Misc Salvation Army
mug $1.00 Mis¢ Salvation Army
rubbermaid containers $3.00 Misc Salvation Army
shoe horn $1.00 Misc Salvation Army
thermometer $1.00 Misc Salvation Army
wood cane $5.00 Misc Salvation Arm),
~ Value Comments I Status (for my
Qnty Description Assessed notes Category personal records)
I
2 speakers $5,00 old small ones Electronics Salvation Army
ear phones $2.00 Electronics Salvation Army
sound machine $5.00 i Electronics Salvation Army
flash light $2.00 Electronics Salvation Army
heating pad $2.00 Electronics Salvation Army
typewriter and accessories $20.00 Electronics !Salvation Army
clock/radio $3.00 Electronics Salvation Army
clock/radio $2.00 Electronics Salvation Army
2 magnifying lights $40.00 Electronics Salvation Army
AC adaptor $1.00 Electronics Salvation Army
clock/radio $2.00 Electronics Salvation Army
Floor lamp $5.00 Electronics Salvation Army
hair clipper $4.00 Electronics Salvation Army
record player $10.00 turntable only Electronics Salvation Army
,toaster $2,00: Kitchen Salvation Army
electric knife $2.00 Kitchen Salvation Army
electric mixer $2,00 Kitchen Salvation Army
canister set $3.00 Kitchen Salvation Army
George Foreman Grill $10.00 Kitchen Salvation Army
griddle $2.00 Kitchen Salvation Army
splatter cover $1.00 Kitchen Salvation Army
casserole set $5.00 Kitchen Salvation Army
4 metal baking pans $4.00 Kitchen Salvation Army
rubbermaid dish drainer $1.00 Kitchen Salvation Army
plastic steamer $1.00 Kitchen Salvation Army
3 tupperware bowls $3.00 Kitchen Salvation Army
steak knife set $4.00 ! Kitchen Salvation Army
hand jar opener $1.00 ~ Kitchen Salvation Army
peeler $1.00 Kitchen Salvation Army
hand can opener $1.00 Kitchen Salvation Army
chip clips $1.00 Kitchen Salvation Army
measuring spoons $2.00 Kitchen Salvation Army
measuring cups $2.00 Kitchen ~Salvation Army
knife sharpener $1.00 Kitchen Salvation Army
spoon set $1.00 Kitchen Salvation Army
2 oven mitts $2.00 Kitchen Salvation Army
asparagus cooker (pot) $2.00 Kitchen Salvation Army
3 tupperware bowls $3.00 Kitchen Salvation Army
measuring cup-glass $1.00 Kitchen Salvation Army
tupperware blue set $2.00 Kitchen Salvation Army
meal divider plate/lid $2.00 Kitchen Salvation Army
corning ware dish set (4 piece) $5.00 Kitchen Salvation Army
6'mugs $6.00 Kitchen Salvation Army
tupperware pitcher $2.00~ Kitchen Salvation Army
2 bowls $2.00 Kitchen Salvation Army
3 tupperware cereal bxes $3.00 Kitchen Salvation Army
butter holder for corn $0.50 Kitchen Salvation Army
Value Comments I Status (for my
Qnty Description iAssessed notes Category personal records)
TOTAL ~ $1,022.75
30 cassetts $15.00 Family kept
21 VHS tapes (home recorded) $10.00 Family kept
25 CDs $50.00 Family kept
.. 4 glasses $2.00 Family kept
cutting board $3.00 I Family kept
pots and pans/cooking utensils $20.00 Family kept
CD holder $10.00 Family kept
2 flashlights $5.00 Family kept
scale $5.00 Family kept
CD player-boombox $5.00 Family kept
small tool set $10.00 Family kept
watch $20.00 Family kept
VCR (15 yrs old) $5.00 Family kept
TOTAL $160.00
20+ yrs old,
broken-
!27 inch TV $0.00 unusable-trash Electronics TRASH
orthopedic-
!special made-
2 3air shoes $0.00 trash Misc TRASH
belts $0.00 torn-trash Misc TRASH
sheet set/comforter $0.00 trash Linens TRASH
removed by
cleaning
company /
twin size bed and frame $0.00 trashed TRASH
TOTAL $0.00
Donating to
Cell phone $10.00 women's shelter
TOTAL PERSONAL ASSETS FROM HOME: ' $1,192.75
ADDITIONAL ASSETS:
Dodge Truck - 1988 - Ram (per www. kbb.com) $1,110.00
Bank Accounts (Marlin getting final figure from bank) $820.00
Cemetary Plot $1,175.00
TOTAL ESTIMATED ASSETS: $4,297.75
Gate of HeaVen Cemetery
1313 South York Street
Mechanicsburg, Pa. 17055
1-717-697-0206
Stacey L. Nelson Heiland
195 GreenSprings Rd.
York, Pa. 17404
Dear Stacey, 01/05/04
Enclosed is the "Authorization To Cancel Burial Rights" form. Please
sign the form at the bottom X. Return the form to Gate of Heaven Cemetery.
When I have received your signed form and that ofLinda B. Nelson, I will
proceed with the cancellation of the graves, burial vaults, grave marker and
granite base. The refund for the items listed above will be as follows,
2 - graves $1000.00
1 - 44x14 bronze 770.00 (70% of $1100.00)
1 - granite base 300.00
2 - burial vaults1050.00
Total Refund $3120.00
The refund will be in two checks, one
to Linda B. Nelson and one to the Estate of William H. Nelson III. If you
have any questions please call me.
Tom Brla~~
I!
REV-1510 EX + (1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RES[DENT DECEDENT
ESTATE OF
William H. Nelson III SS# 172-36-1612 12/08/2003
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
FILE NUMBER
21-03-1039
DESCRIPTION OF PROPERTY % OF
I-TEM INCLUDETHE NAMEOFTHETRANSFEREE, 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 Members 1st Federal Credit 55.46 55.46 0.00
Union, Regular Savings
Acct. #188846-00, in names
of Decedent and Stacey L.
I~eiland, made joint
03/15/2003. Principal
balance as of D.O.D.:
$55.45; interest accrued to
D.O.D.: $ 0.01.
2 Members 1st Federal Credit 162.00 162.00 0.00
-Union, Checking Acct.
f/18846-11, in names of
Decedent and Stacey L.
Heiland, made joint
03/15/2003. Principal
balance as of D.O.D.
TOTAL (Also enter on line 7, Recapitulation) $ 0.00
(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)
MEMBERS
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
188846 -00
11/05/1999
$55.45
$.Ol
$55.46
Stacey L. Heiland
03/15/2003
188846 -11
11/05/1999
$162.00
$.oo
$162.00
Stacey L. Heiland
03/15/2003
rv~'MBERS 1sT FEDERAL CREDIT UNION
Denise A. Wolfe ~.'
Insurance Supervisor
January 26, 2004
Estate of: WILLIAM H. NELSON, III
Date of Death: 12/09/2003
Social Security Number: 172-36-1612
5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www. memberslst.org
REV- 1511 EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
William H. Nelson III SS# 172-36-1612 12/08/2003 21-03-1039
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
Bo
1
2
3
FUNERAL EXPENSES:
Musselman Funeral Home,
funeral expense.
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 Law Offices-Marlin R. McCaleb
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State Zip
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, advertising Letters.
EnviroGroup, - bio-medical clean-up of Decedent's apartment.
Firestone Tire & Service Center, inspection of and repairs
truck.
Register of Wills, - filing
Reserve for filing Account,
The
Patriot-News,
Inventory and Appraisement.
Releases, etc.
advertising Letters.
to
1,544.10
2,550.00
96.00
75.00
275.60
404.77
23.00
250.00
109.30
TOTAL (Also enter on line 9, Recapitulation) $ 5,327.77
(If more space is needed, insert additional sheets of the same size)
Copyright(c) 1996 form software only CPSystems, lnc. Form REV-1511 EX (Rev. 1-97)
REV-151Z EX * (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
William H. Nelson III
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
SS# 172-36-1612 12/08/2003
FILENUMBER
21-03-1039
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
AT&T Wireless, account payable.
Blair Credit Services, account payable.
Comcast Cable, account payable.
Pinnacle Health Medical Center, account payable.
State Farm Insurance, account payable.
West Shore Tax Bureau, account payable.
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
30.38
33.15
43.45
76.00
42.96
345.00
570.94
Copyr ght (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
William H. Nelson III SS# 172-36-1612 12/08/2003 21-03-1039
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
2
II.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(~(1.Z)]
Stacey L. Nelson Heiland
195 Greensprings Road
York, PA 17404
Tonya R. Smith
254 NE Lenox Street
Hillsboro, OR 97124
Daughter
Daughter
One-Half (1/2)
One-Half (1/2)
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ i, 000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
B. CHARITABLEAND GOVERNMENTALDISTRIBUTIONS
Saint Katharine Drexel Church, charitable bequest per Item
FOURTH of Will.
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1,000.00
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estateof William H. Nelson III
also known as
, Deceased
No. 21-03-1039
Date of Death 12/08/2003
Social Security No. 172~36-1612
Stacey L. Nelson Heiland,
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
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that 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/~Ve verify that the statements made in this Inventory are true and correct. I/VVe understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: Marlin R. McCaleb Esq.
I.D. No.: 06353
Address: 219 East Main Street
Telephone:
Mechanicsbur~, PA 17055
717/691-7700
Personal Representative
Signature: ~ 67~/~/~~
'Stac~ L. Nelson Heiland
Signature:
Address: 195 Greensprin~s Road
York, PA 17404
Telephone: 717/433-1643
Dated:
(See continuation page(s)
(Attach additional sheets if necessary)
Description
attached)
Value
Total: 20,196.59
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association % ~'~'. '
Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (199Z) ~'L'~
Doubleday Books, refund.
Doubleday Books, refund.
Gate of Heaven Cemetery,
cemetery lot and burial
rights.
Household goods, contents,
furniture and furnishings.
State Farm Insurance, - refund
of unearned premium.
U. S. Treasury, refund of
2003 federal income tax.
Unum Life Insurance Co. of
America, proceeds of group
life insurance.
West Shore Tax Bureau,
refund of 2003 local income
tax.
4.95
19.07
1,560.00
1,192.75
53.85
197.45
15,000.00
68.28
19,979.13
TOTAL RECEIPTS OF PRINCIPAL ...............
20,196.59
-2-
FAMILY SETTLEMENT AGREEMENT,
RECEIPT AArD RELEASE
WHEREAS, WILLIAM H. NELSON, III, late of the Borough of
Camp Hill, Cumberland County, Pennsylvania, died on December 8,
2003, and Letters Testamentary issued by the Register of Wills
of Cumberland County, Pennsylvania, to STACE¥ L. NELSON
HEILAND; and
WHEREAS, STACEY L. NELSON HEILAND and TONYA R. SMIT~ are
daughters, heirs and next of kin of the said decedent and the
only persons interested in his Estate; and
NOW KNOW ALL MEN BY THESE PRESENTS, that we, STACEY L.
NELSON HEILAND and TONYA R. SMITH, being the beneficiaries
sharing in the distribution ef the Estate of said decedent, do
hereby declare and say that we have examined the Account and
Statement of Proposed Distribution efa STACEY L. NELSON
HEILAND, Executrix, as aforesa±d, for the period ending August
10, 2004, and find the same to be accurate and according te
law, and we, STACEY L. NELSON HEILAND and TONYA R. SMITH,
beneficiaries as aforesaid, do hereby acknowledge that we, this
day have, had and received ef and from STACEY L. NELSON
HEI ~L~ND, the Executrix under the Last Will and Testament of
WILL-IAM H. NELSON, III, the cash er property set opposite our
nam~ in the above stated Statement of Proposed Distribution,
in 811 satisfaction, payment and discharge of all claims we,
or ~ of us, have or may have against each other er against
the Estate of WILLIAM H. NELSON, III, Deceased, and all
interest accrued thereon.
NOW,
TONYA R.
presents,
THEREFORE, we, the same STACEY L. NELSON HEILAND and
SMITH, beneficiaries as aforesaid, do by these
remise, release, quit claim and forever discharge
each other and the said STACEY L. NELSON HEILAND, Executrix,
her heirs, executors and administrators, of and from our
distributive shares of the Estate as set forth in the Statement
of Proposed Distribution aforesaid, and of and from all
actions, suits, payments, accounts, reckonings, claims and
demands whatsoever, for or by reason thereof, or by contract,
or under the intestate law of the Commonwealth of Pennsylvania,
or by reason of any other act, matter, cause or thing
whatsoever, from the beginning of the world to the day and date
of these presents, except for any obligations arising under
this Family Settlement Agreement, Receipt and Release or under
the StaEement of Proposed Distribution.
AND desiring to avoid the delay and expense of the
settlement of said Estate by filing the foregoing Account of
said administration in ~he Office of the Register of Wills of
said County and by having the balance in the hands of the Co-
Executors, as shown by said Account, distributed by the Court
of Common Pleas of Cumberland County - Orphans' Court Division,
we do hereby agree that the within Family Settlement Agreement,
Receipt and Release concerning the matter of settlement may be
recorded with the same effect upon us as if the same had been
reported upon by said Court, and a decree of distribution made
on such report by the said Court of Common Pleas - Orphans'
Court Division.
AND in consideration of the aforesaid settlement being
made without the aid of such Court of Common Pleas Orphans'
Court Division, that we, STACEY L. NELSON HEILAND and TONYA R.
SMITH, beneficiaries as aforesaid, do hereby agree that if any
debts or demands other than those included in the aforesaid
Account of the said STACEY L. NELSON HEILAND, the Executrix
under the Last Will and Testament of WILLIAM H. NELSON, III,
Deceased, as hereinbefore set forth, shall be hereafter
recovered against the Estate of said decedent and be legally
payable out of the same, that we will return to the said
Administrator such amount thereof as may be necessary to pay
such debts or demands.
The signature page or pages may be executed by the parties
hereto in several counterparts (one by each signatory hereto),
each of which is an original and all of which taken together
shall be deemed and considered as part of the original document
herein.
IN WITNESS WHEREOF,
seals this~-// day of
we have hereunto set our hands and
Stag~ L. Nelson Heiland
Tonya R. Smith
(SEAL)
-3
STATE OF PENNSYLVANIA)
: SS
on this, the //~ day of /~.~' :004,
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared STACEY L. NELSON
HEILAND, known te me (er satis{actorily proven} te be the
person whose name is subscribed te the within instrument and
acknowledged that she executed the same for the purposes
therein contained.
seal.
(SEAL}
IN WITNESS WHEREOF,
I hereunto set my hand and official
Notary Public
My commission expires:
Notarial Seal
Madin R ~aleb, Notary Public
Mechan~sbur9 Bor0, Cumberland County
My Commission Expires Dec 14, 2006
STATE OF
COUNTY OF
On this,
PENNSYLVANIA
SS
CUMBERLAND
the /y~ day of
2004,
before me, a Notary Public in and for said State and County,
the undersigned officer, personally appeared TONYA R. SMITH,
known to me (or satisfactorily proven) to be the person whose
name is subscribed to the within instrument and acknowledged
that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
Notary Public
My commission expires:
Notadat Seal
Marlin R McCaleb, Nota6~ Public
Mechanicsburg Boro, Cumberland County
My Commission Expires Dec. 14, 2006
Member ~'ennsy~wnia Assooat~o~ Of Notades
( SEAL
BUREAU OF TNDIVIDUAL TAXES
/NHERTTANCE TAX DTYTSTON
DEPT. 'E80601
HARRISBURG, PA 17128-0601
CONHONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF ZNHER/TANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1547 EX AFP (01-03)
MARLIN R NCCALEB ESQ
N R NCCALEB LAW OFCS
PO BOX 250
HECHANICSBURG PA 17055
DATE OF DEATH
08-02-200q
NELSON
12-08-Z003
21 03-1039
CUHBERLAND
101
WILLIAM H
FZLE_,NUHIIER
ACN
: ~_:~ ~'.. Amoun~ Remi'l:~ed
HAKE CHECK PAYABLE AND REHZT PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG TH'rS LINE ~ RETAIN LOWER PORT'rON FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF NELSON III WILLIAM H F*rLE NO. 21 03-1039 ACN 101 DATE 08-02-200q
TAX RETURN WAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE 'rNTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~e (Schedule A) (1)
2. S~ocks end Bonds (Schedule B) (2)
$. Closely Held S~ock/Par~nersh/p In~eres~ (Schedule C) ($)
q. Mortgages/No,es Rece/vabla (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (5)
6. Jo/n~ly Owned Proper~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. To,al AssaYs
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9)
10. Debts/Mortgage L/ab/Ii,/es/Liens (Schedule I) (10)
11. To,al Deduc~/ons
12. Ne~ Value of Tax Re~urn
00
O0
O0
O0
~,~ 979,13
O0
O0
(8)
5,327.77
570.9q
NOTE: To /nsura proper
cred/~ ~o your account,
subm/~ ~he upper por~/on
13.
1¢.
NOTE:
ASSESSMENT OF TAX:
15. Amoun~ of L/ne 1~ a~ Spousal ra~a
16. Amoun~ of L/ns lq ~:axable a~ L/naal/Class A ra~a
17. Amoun~ of L/ne lq a~: Sibl/ng ra~a
18. Amoun~ of L/ne lq ~axable a~ Collateral/Class B ra~a
19. Pr/nc/pal Tax Due
TAX CREDTTS:
PAYMENT RECEIPT DISCOUNT (+}
DATE NUMBER INTEREST/PEN PAID (-)
of ~his for. w/~h your
~ax payment.
q,979.13
(11) 5 .aga.71
(12) 919.58-
Char/~able/governman~:al Bequests; Non-elac~:ad 9113 Trusts (Schedule J) (13) . O0
No~ Value of Es~a~:e Subjec~ ~co Tax (lq) 919.58-
If an assesseent 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.
(15) .00 x O0 = .00
(16) .00 X Of~5 = .00
(17) .00 x 12 = .00
(~a) .00 x 15 : .00
(19)= . O0
IF PAID AFTER DATE INDZCATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
AMOUNT PAID
TOTAL TAX CREDIT
SALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
( ZF TOTAL DUE ZS LESS THAN $1) NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Zj 198Z -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collatara1) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Comeonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laeful Class 8 (collatara1) rate an any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Actj Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit aith your payment to the Register of Nills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office
of the Register of Hills, any of the Z$ Revenue District Offices, or by calling the special Z4-hour
ansaering service for forms ordering: 1-800-56Z-ZOSO~ services for taxpayers aith special hearing and / or
speaking needs: 1-800-447-30Z0 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as sheen on this Notice must object eithin sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals~ Dept. Z810Z1~ Harrisburg, PA 17ITS-lOT1) OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601) Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (ST) discount of
the tax paid is alloeed.
The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996~ the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to tho date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
~ 20X .000548 ~'~'~'~-1991 lIT .000301
1983 16Z .000438 199Z 97. . O00247
1984 lIT .000301 1993-1994 72 .O00lgz
1985 132 .000356 1995-1998 92 .000247
1986 lOX .000274 1999 7Z . O0019Z
1987 lex .000274 ZOO0 72 .O0019Z
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID
Interest Daily
Year Rate Factor
~ 9Z .000247
200Z 6Z .000164
ZOO3 5Z .000137
2004 4Z .000110
X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
~EV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601 FILE NUMBER
DECEDENTS NAME WILLIAM H. NELSON, III 2103-1039
ACN
REVIEWED BY CHARLES WRIGHT 101
ITEM EXPLANATION OF CHANGES
SCHEDULE NO.
J The estate is insolvent and there isn't money for the charity.
ROW Page 1
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~L/~ ~f/,~
Date of Death: /~-~-~
Will No. O$-- / 37
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:
State whether administration of 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.
( MAH: rmf/AM3 )
Signature
Name (Please type
, or_~ prl, nt )
Address
Tel. No.
Capacity:
__Personal Representative
~ Counsel for personal
representative